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Oxymorphone is an opioid analgesic. It’s marketed in the U.S. under the trade name “Opana.” 

It’s available as a tablet and comes in two forms:1, 2, 3, 4 

  1. An immediate-release formulation for moderate to severe pain
  2. An extended-release (ER), or long-acting, formulation for around-the-clock pain

Drug manufacturer Endo Pharmaceuticals removed Opana ER from the U.S. market in 2017. This was after the Food and Drug Administration (FDA) requested the drug’s removal due to its high abuse rates. 

However, generic versions of oxymorphone extended-release tablets may still be available by prescription.5, 6

Opana works by binding to opioid receptors and increasing pain threshold. It’s three times more potent than oral morphine.1, 3, 4

Opana is a potent and effective opioid analgesic. It’s a Schedule II drug, meaning it carries a high risk for dependence and is considered dangerous when misused. 

The drug is reserved for people who don’t tolerate or receive adequate pain control from alternative non-opioid analgesics or opioid combination products. 

Like other prescription opioids, Opana may be intentionally misused or abused for its euphoric effect. 

How is Opana Used?

Opana pills must be taken on an empty stomach 1 hour before or 2 hours after a meal. They’re usually taken every 4 to 6 hours. 

Here are a few guidelines for using Opana safely:7, 8, 9

  • Take it as prescribed by your doctor. Don’t increase dosage or use it for extended periods. 
  • Don’t stop taking it suddenly. Doing so may cause withdrawal symptoms. Ask your doctor about the safest way to stop.  
  • Tell your doctor if you’re experiencing withdrawal symptoms or unusual cravings.
  • Don’t crush, chew, or dissolve it. Swallow it whole to avoid potential overdose.
  • Never share it with other people, including those with a history of drug abuse or addiction. 
  • Avoid drinking alcohol with Opana and don’t take medications that may interact with it.
  • Dispose of leftover Opana to prevent other people from ingesting or intentionally misusing it. 
  • Skip any missed dose if it’s almost time for the next one. Don’t take 2 doses to make up for a missed dose.

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Side Effects of Opana

People taking Opana may experience these common side effects:1, 3, 7, 8, 9

  • Nausea
  • Vomiting
  • Dry mouth
  • Sedation
  • Unusual sleepiness
  • Insomnia
  • Dizziness
  • Headache
  • Increased sweating
  • Fatigue
  • Decreased appetite
  • Constipation
  • Diarrhea
  • Abdominal pain

Opana may also cause less common adverse reactions, including:1, 3, 7, 8, 9

  • Respiratory depression
  • Allergic reactions
  • Euphoria
  • Dysphoria
  • Agitation
  • Hallucination
  • Slow or fast heart rate
  • Palpitations
  • Low blood pressure
  • Miosis (contraction of pupils)
  • Central nervous system (CNS) depression
  • Low oxygen in tissues
  • Ileus (non-mechanical bowel obstruction)
  • Hot flashes
  • Urinary retention

Opana Abuse

Like other Schedule II opioid analgesics, Opana also has a high potential for addiction, abuse, and misuse. 

Illicit Opana use occurs when it’s taken without a prescription to experience euphoria. A person may use the drug by:1 

  • Chewing the pill to enhance drug release
  • Crushing the tablet and snorting the powder
  • Dissolving the drug in water and injecting the solution

Drug tolerance may occur even if someone takes Opana without any intention to misuse it.  

People who misuse Opana may do certain things to get the same level of pain relief, like:  

  • Taking Opana at a higher dosage or frequency
  • Taking Opana for a longer time than prescribed

Improper use of Opana is dangerous, as it carries a high risk of overdose, dependence, and addiction. Once someone is dependent, dangerous withdrawal symptoms can develop if they stop taking the drug abruptly.  

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Risks of Opana Abuse

Opana abuse carries several risks, including: 

  • A potentially fatal overdose
  • Clinically significant drug interactions
  • An opioid use disorder (OUD)
  • Adverse drug side effects 
  • Pain and dangerous withdrawal symptoms

Overdose

Opana abuse can result in a potentially fatal overdose. The risk is higher if the drug is: 

  • Taken with alcohol or other interacting drugs
  • Chewed, crushed, or injected

Symptoms of Opana overdose are the same as any opioid overdose. They include:1, 7, 8

  • Respiratory depression
  • Unusual sleepiness, leading to unconsciousness or coma
  • Decreased responsiveness
  • Muscle weakness
  • Cold and clammy skin
  • Pale or bluish lips, fingernails, or skin
  • Miosis (contraction of pupils)
  • Low blood pressure
  • Irregular heartbeat
  • Cardiac arrest
  • Death

If you or someone you know is experiencing an Opana overdose, call 911 and seek medical help immediately.

In emergency cases, medical professionals will administer a rescue medication like naloxone or nalmefene to reverse respiratory depression.

They may also supply oxygen and other supportive measures in case of circulatory shock or build-up of fluids in the lungs. 

Cardiac arrest and irregular heartbeat require advanced life support techniques.1, 7, 8

Drug Interactions

Certain substances shouldn’t be combined with Opana. Co-ingestion can increase the risk of adverse reactions to Opana.

These substances include:7, 8, 9

  • Alcohol: Mixing alcohol and Opana may increase blood levels of Opana. This interaction can lead to a potentially fatal overdose.
  • Other types of prescription opioids: Examples include pentazocine, nalbuphine, and butorphanol. Co-ingestion may decrease Opana’s analgesic effect and/or cause withdrawal symptoms.
  • Central nervous system (CNS) depressant drugs: Co-ingestion may cause respiratory depression, low blood pressure, sedation, coma, or death.
  • Cimetidine: This is a drug for reducing stomach acid. Co-ingestion may cause respiratory depression.
  • Anticholinergics: These are drugs used to treat different conditions like asthma and Parkinson’s disease. Co-ingestion may lead to urinary retention and severe constipation.

Addiction

Opana is highly sought-after for its euphoric effect. People with a substance use disorder (SUD) may use Opana by snorting, orally ingesting, or injecting the drug.1

Opana addiction carries several risks, including: 

Switching to More Potent Opioids

People who use prescription opioids sometimes switch to heroin or illicit fentanyl. These opioids are more potent, cheaper, and easier to obtain than Opana.10

Transmission of Bloodborne Diseases

In 2015, Opana ER abuse by injection was at the center of HIV outbreaks in Indiana. 

Opana injection has also been associated with hepatitis C and a rare blood disorder that mimics thrombotic thrombocytopenic purpura. 

These health crises and the opioid epidemic eventually led to Opana ER’s removal from the U.S. market.5, 6

Withdrawal

People may develop withdrawal symptoms if they abruptly stop or reduce their Opana intake. They may continue drug use to avoid uncomfortable symptoms, which include:1, 7, 8, 9

  • Severe drowsiness
  • Restlessness
  • Mood changes
  • Teary eyes
  • Runny nose
  • Sweating
  • Chills
  • Hypertension
  • Irregular heart rate
  • Abdominal pain
  • Muscle and bone pain
  • Nausea
  • Vomiting
  • Diarrhea

Babies may experience neonatal opioid withdrawal syndrome if their mothers use Opana during pregnancy. These babies usually require medical treatment for several weeks.11

Signs of Opana Addiction 

These 3 conditions characterize Opana addiction:12, 13

  • Loss of control
  • Excessive cravings
  • Drug use despite negative consequences

Specific signs that may indicate Opana addiction include:

  • Frequently “losing” prescriptions
  • Returning to the doctor for early refills
  • Seeing different doctors to get more medication
  • Buying the drug from friends or strangers
  • Lying or exaggerating an injury to get a prescription
  • Stealing from family or friends to get drugs
  • Crushing, chewing, or dissolving the drug
  • Repeatedly requesting a dosage increase
  • Dismissing non-opioid treatments
  • An inability to stop taking the drug after multiple unsuccessful attempts
  • Increased pain due to drug tolerance
  • Prioritizing drug use above family, friends, work, or school
  • Experiencing financial difficulties caused by drug use
  • Displaying symptoms like breathing problems, drowsiness, and changes in sleeping habits

Someone who has a substance use disorder may not display these signs immediately. 

Only healthcare professionals can diagnose Opana addiction precisely. They will use criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for diagnosing a substance use disorder.

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Treatment for Opana Addiction 

Treatment approaches for Opana addiction are similar to those of other opioid treatments. They include:

Medication-Assisted Treatment (MAT)

Medications used for opioid treatment include:14

  • Methadone: An opioid agonist that activates opioid receptors but doesn’t produce euphoria
  • Buprenorphine: A partial opioid agonist that can reduce or remove withdrawal symptoms
  • Naltrexone: A synthetic opioid antagonist that blocks the euphoric effect of any opioid 
  • Lofexidine: A non-opioid prescription medicine that can reduce withdrawal symptoms

Detoxing in a medically assisted detox center is the safest way to treat an Opana SUD. Home-detox (without professional help) is dangerous and unlikely to be successful. It can also lead to death.

Behavioral Treatments

Behavioral treatments are designed to:

  • Change people’s attitudes and behaviors concerning drug use
  • Help people develop healthy life skills
  • Help people stay the course in taking their medications or following other treatment plans

Behavioral treatments can occur in an outpatient or inpatient setting.  

In an outpatient setting, the person regularly visits a counselor. Counseling can be done individually, as a group, or both. 

Outpatient programs typically offer:15 

  • Cognitive behavioral therapy (CBT): Helps people recognize, avoid, and cope with situations in which they are most likely to use drugs
  • Multidimensional family therapy: Designed for teenagers with substance use disorders and their families
  • Motivational interviewing: Maximizes people's readiness to change their behavior and enter treatment
  • Contingency management (motivational incentives): People receive vouchers they can exchange for things that encourage healthy living, like a gym membership

Inpatient or residential treatment is better for people with more severe substance use disorders. Examples include:15

  • Therapeutic communities: Highly structured programs where people stay in residence for 6 to 12 months
  • Shorter-term residential treatment: Focuses on detoxification, initial counseling, and preparation for community-based treatment
  • Recovery housing: Designed to help people transition to an independent life
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Resources

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  1. OXYMORPHONE.” Drug Enforcement Administration. Mar. 2019. 
  2. Babalonis, Shanna et al. “Pharmacodynamic effects of oral oxymorphone: abuse liability, analgesic profile and direct physiologic effects in humans.” Addiction biology vol. 21,1 : 146-58. 
  3. Smith, Howard. “Clinical pharmacology of oxymorphone.” Pain Medicine vol. 10,1 : S3-S10.
  4. Sloan, Paul. “Review of oral oxymorphone in the management of pain.Therapeutics and clinical risk management vol. 4,4 : 777-87. 
  5. Wolf, Lauren. “FDA takes aim at opioid epidemic.” C&EN. American Chemical Society. 14 Jun. 2017. 
  6. Dreisbach, Tom. “Dangers Of Opana Opioid Painkiller Outweigh Benefits, FDA Panel Says.NPR. 16 Mar.2017.
  7. Opana ER (oxymorphone hydrochloride) tablets label.” Endo Pharmaceuticals. Jul. 2012. 
  8. Oxymorphone.” MedlinePlus, National Library of Medicine. 15 Feb. 2021
  9. Thornton, Philip. “Opana.” Drugs.com. 11 Apr. 2021.
  10. Opioid addiction.” MedlinePlus, National Library of Medicine. 18 Aug. 2020.
  11. About Opioid Use During Pregnancy.” Centers for Disease Control and Prevention. 20 Jul. 2021.
  12. Savage, Seddon R et al. “Challenges in using opioids to treat pain in persons with substance use disorders.” Addiction science & clinical practice vol. 4,2 : 4-25. 
  13. Signs of Opioid Abuse.” Johns Hopkins Medicine. 
  14. What are prescription opioids?” National Institute on Drug Abuse. Jun. 2021.
  15. Treatment Approaches for Drug Addiction.” National Institute on Drug Abuse. Jan. 2019.

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