Oxymorphone Addiction: Causes, Effects and Treatment

Oxymorphone, a powerful opioid analgesic, is prescribed for severe pain management. However, its high potency and addictive nature have contributed to a rise in misuse and addiction. According to Babalonis, S., Comer, S.D.,  Jones, J.D. et al. 2021 in an article titled “Relative potency of intravenous oxymorphone compared to other opioid agonists in humans.” published by Psychopharmacology, Oxymorphone has been found to be significantly more potent than other opioids in several key measures, including the intensity of drug liking and the severity of respiratory depression (p <0.05). Specifically, for abuse-related subjective outcomes, oxymorphone is 2.3 to 2.8 times more potent than hydromorphone and an astonishing 12.5 to 14 times more potent than oxycodone.

The causes of Oxymorphone addiction start with using oxymorphone for legitimate medical reasons but can quickly develop a tolerance, leading to increased dosages and dependency. Psychological factors, such as stress and a history of substance abuse, also play a significant role. Additionally, social and economic factors, including lack of access to healthcare and support systems, can exacerbate the risk of addiction​.

The effects of oxymorphone addiction include severe health issues, like respiratory depression, liver damage, and increased risk of infectious diseases due to needle sharing. Psychologically, addiction causes cognitive impairments, anxiety, depression, and drastic changes in behavior. Socially, it leads to strained relationships, unemployment, and legal issues. 

Treatment for oxymorphone addiction involves a comprehensive approach that includes medical, psychological, and social interventions. Medically, detoxification and the use of medications are standard practices to manage withdrawal symptoms and reduce cravings. Psychological support, through counseling and therapy, is standard for addressing the underlying causes of addiction and developing coping mechanisms. Social support systems, including support groups and rehabilitation programs, provide an essential network for individuals recovering from addiction. 

What is Oxymorphone?

Oxymorphone is a powerful semi-synthetic opioid medication prescribed for the relief of severe pain. Oxymorphone, was first developed in 1914 and introduced to the market in 1959. It is derived from thebaine, an alkaloid of the poppy plant. Over the years, it has been recognized for its effectiveness in pain relief but also for its high potential for abuse and addiction. 

Oxymorphone is primarily prescribed for the relief of moderate to severe pain in patients who require continuous, around-the-clock opioid treatment for an extended period. It is also used in cases where other pain treatments are inadequate. The medication is available in both immediate-release and extended-release formulations to manage different pain needs.

What is Oxymorphone Addiction?

Oxymorphone addiction is a type of substance use disorder characterized by the compulsive use of oxymorphone, a powerful opioid analgesic, despite harmful consequences. This condition involves both a physical and psychological dependence on the drug, leading to increased tolerance, withdrawal symptoms, and a persistent desire to obtain and use oxymorphone. Factors contributing to oxymorphone addiction include prolonged medical use, psychological stress, a history of substance abuse, and socio-economic challenges such as limited access to healthcare and support systems.

What are the Signs of Oxymorphone Addiction?

The signs of Oxymorphone addiction include needing higher doses to achieve the same effects, experiencing withdrawal symptoms like muscle pain and nausea, and encountering physical health issues such as respiratory depression and chronic constipation. Behavioral indicators include drug-seeking behavior, neglecting responsibilities, and social changes like withdrawal from family and friends. Psychological changes may involve increased anxiety and mood swings, while financial and legal problems can also arise.

According to the National Institute on Drug Abuse (NIDA) in an article titled “Opioid Facts and Statistics.”, misuse of prescription opioids is a major public health issue. In 2020, about 10.1 million people in the United States misused prescription opioids, including oxymorphone, highlighting the widespread issue of opioid misuse and the potential for addiction.

What are the Physical Symptoms of Oxymorphone Addiction?

The physical symptoms of Oxymorphone addiction include:

• Tolerance: Needing higher doses of oxymorphone to achieve the same pain-relieving effects and reduced effectiveness of the drug over time.
• Withdrawal Symptoms: Experiencing symptoms such as muscle pain, sweating, nausea, vomiting, anxiety, and agitation when not using oxymorphone.
• Physical Health Issues:
  • Respiratory depression or difficulty breathing.
  • Chronic constipation and gastrointestinal problems.
  • Drowsiness, dizziness, and impaired coordination.
  • Noticeable weight loss or gain.

What are the Behavioral Indicators of Opana Misuse?

The behavioral symptoms of Opana/Oxymorphone addiction include:

• Drug-Seeking Behavior:
  • Frequently visiting different doctors or emergency rooms to obtain prescriptions (doctor shopping).
  • Persistently requesting early refills or higher doses of oxymorphone.
  • Using oxymorphone in larger amounts or over a longer period than intended.
• Neglecting Responsibilities:
  • Failing to meet obligations at work, school, or home due to drug use.
  • Decreased performance in professional or academic settings.
  • Neglecting personal hygiene and appearance.
• Social Changes:
  • Withdrawal from family and friends, leading to social isolation.
  • Changes in social circles, spending more time with other individuals who misuse drugs.
  • Engaging in secretive or suspicious behaviors.
• Psychological and Emotional Changes:
  • Increased anxiety, depression, or mood swings.
  • Irritability or agitation when unable to use the drug.
  • Loss of interest in previously enjoyed activities and hobbies.
• Financial and Legal Problems:
  • Spending excessive amounts of money on obtaining oxymorphone.
  • Stealing or borrowing money to purchase the drug.
  • Legal issues arising from drug possession, theft, or other drug-related activities.

What are the Causes of Oxymorphone Addiction?

The causes of Oxymorphone addiction include a complex interplay of medical, psychological, and social factors. Medically, individuals who are prescribed oxymorphone for chronic pain management may develop tolerance, necessitating higher doses to achieve the same pain relief, which can lead to physical dependence and addiction. Prescription misuse, such as taking larger doses or using the medication more frequently than prescribed, further exacerbates this risk.

• Medical Factors:
  • Chronic Pain Management: Patients with chronic pain conditions who use oxymorphone over extended periods may develop tolerance, requiring higher doses to achieve the same level of pain relief. This can lead to physical dependence and addiction.
  • Prescription Misuse: Misuse of the prescribed medication, such as taking larger doses or using it more frequently than directed by a healthcare provider, can quickly lead to addiction.
• Psychological Factors:
  • Mental Health Disorders: Individuals with mental health issues such as anxiety, depression, or a history of substance abuse are at a higher risk of developing an addiction to oxymorphone as they may use it to self-medicate.
  • Stress and Trauma: High levels of stress or a history of trauma can increase the likelihood of substance abuse as individuals seek relief from their emotional pain.
• Social and Environmental Factors:
  • Accessibility: Easy access to prescription opioids, whether through legitimate prescriptions or illicit sources, increases the risk of abuse.
  • Peer Influence: Social circles that engage in drug use can significantly influence an individual’s likelihood of trying and becoming addicted to substances like oxymorphone.
  • Economic Hardship: Economic instability and lack of access to healthcare and support services can drive individuals to misuse opioids as a coping mechanism.

With Oxymorphone becoming more available to the public the risk of addiction is much higher. According to an article titled “Oxymorphone” published by the Drug Enforcement Administration, a study by the IQVIA National Prescription Audit™ found that the number of oxymorphone prescriptions dispensed saw a significant rise from 268,536 in 2007 to approximately 1.2 million in 2012. This number shows how these numbers have significantly increased.

What are the Effects of Oxymorphone Addiction?

The effects of Oxymorphone addiction include physical effects such as respiratory depression, gastrointestinal issues, drowsiness, and tolerance and dependence; mental effects like cognitive impairment, mental health disorders, and anhedonia; and behavioral effects including drug-seeking behavior, social isolation, risky behaviors, and financial difficulties.

According to the 2022 National Survey on Drug Use and Health (NSDUH) published by Substance Abuse and Mental Health Services Administration (SAMHSA), the misuse of prescription opioids, including oxymorphone, has significantly impacted public health. In 2021, SAMHSA reported that nearly 9.2 million people aged 12 and older misused opioids in the past year, highlighting the widespread issue of opioid misuse in the United States.

Physical Effects of Oxymorphone Addiction:

• Respiratory Depression: A significant risk of life-threatening breathing problems, leading to a high risk of overdose and death.
• Gastrointestinal Issues: Chronic constipation, nausea, and vomiting are common side effects.
• Drowsiness: Extreme sleepiness and lethargy, impairing daily functioning.
• Tolerance and Dependence: Increasingly higher doses are needed to achieve the same effect, leading to physical dependence and withdrawal symptoms such as muscle pain, sweating, and agitation​.

Mental Effects of Oxymorphone Abuse:

• Cognitive Impairment: Altered brain chemistry affecting decision-making, memory, and concentration.
• Mental Health Disorders: Heightened anxiety, depression, and severe mood swings.
• Anhedonia: Difficulty experiencing pleasure from activities that were once enjoyable.

Behavioral Effects of Oxymorphone Misuse:

• Drug-Seeking Behavior: Prioritizing drug acquisition and use over personal and professional responsibilities.
• Social Isolation: Deterioration of personal and professional relationships due to addictive behaviors.
• Risky Behaviors: Engaging in dangerous activities, such as driving under the influence or sharing needles, increasing the risk of accidents and infectious diseases.
• Financial Difficulties: High costs associated with maintaining addiction, potentially leading to criminal activities to procure the drug​

What Treatment Options Are Available for Oxymorphone Addiction?

Available treatment options for Oxymorphone addiction include detoxification under medical supervision, medication-assisted treatment (MAT), and both inpatient and outpatient rehab programs. Behavioral therapies such as Cognitive-Behavioral Therapy (CBT), Contingency Management (CM), Motivational Interviewing (MI), and Dialectical Behavior Therapy (DBT) are also effective. For more detailed information, please refer to the table/list provided.

• Detoxification Process: Detoxification is a critical first step in the treatment of oxymorphone addiction. This process focuses on removing the drug from the individual’s system while managing withdrawal symptoms. Medical supervision is essential to ensure safety and to alleviate severe withdrawal symptoms, which can include anxiety, nausea, muscle pain, and agitation. The duration of detoxification varies based on the severity of the addiction and the individual’s overall health.
  • Medical supervision during detoxification is crucial for patient safety.
  • Medications may be administered to help manage withdrawal symptoms, making the detox process more manageable.
• Medication-Assisted Treatment (MAT): Medication-assisted treatment (MAT) is an effective approach that combines medications with counseling and behavioral therapies to treat oxymorphone addiction. Research indicates that MAT significantly reduces opioid use, decreases the risk of opioid-related overdose deaths, and enhances social functioning and retention in treatment programs.
• Medications Used for Oxymorphone Addiction
  • Methadone: A long-acting opioid that helps reduce cravings and withdrawal symptoms.
  • Buprenorphine: A partial opioid agonist that suppresses withdrawal symptoms and reduces cravings.
  • Naltrexone: An opioid antagonist that blocks the euphoric effects of opioids, aiding in relapse prevention. According to SAMHSA, individuals receiving MAT for opioid addiction are 50% less likely to die from an opioid-related overdose compared to those not receiving MAT.
• Inpatient and Outpatient Rehab Programs: The choice between inpatient and outpatient rehabilitation programs is influenced by the severity of the addiction. An initial consultation with a healthcare professional is essential to determine the most appropriate treatment option.
  • Inpatient Rehab Programs
    • Provide 24/7 care, offering constant medical and emotional support.
    • Feature a structured environment that allows individuals to focus entirely on recovery.
    • Are particularly beneficial for those with severe addiction, co-occurring mental health disorders, or previous outpatient treatment failures.
  • Outpatient Rehab Programs
    • Offer flexible care, enabling individuals to maintain daily responsibilities while receiving treatment.
    • Are less structured, allowing patients to balance work, school, and family commitments.
    • Are suitable for those with less severe addictions or individuals who have completed an inpatient program.
• Behavioral Therapy for Oxymorphone Addiction: Behavioral therapy plays a vital role in treating oxymorphone addiction by addressing the psychological and behavioral aspects of substance use disorders. This therapy helps individuals understand and modify their drug-use behaviors, develop healthier coping mechanisms, and improve their overall mental health.
  • Types of Behavioral Therapy
    • Cognitive-behavioral therapy (CBT): Focuses on recognizing and changing negative thought patterns and behaviors related to drug use. It equips patients with skills to cope with triggers and manage stress, ultimately preventing relapse.
    • Contingency Management (CM): Utilizes positive reinforcement to encourage sobriety and adherence to treatment. Patients receive rewards for meeting treatment goals, such as maintaining drug-free urine tests, which significantly increases abstinence rates.
    • Motivational Interviewing (MI): A client-centered approach that enhances motivation to change. Therapists help patients explore ambivalence about quitting drug use, fostering a commitment to treatment.
    • Dialectical Behavior Therapy (DBT): Combines cognitive-behavioral techniques with mindfulness practices to help patients manage emotions and reduce self-destructive behaviors, particularly effective for those with co-occurring mental health disorders.

According to Carroll et al. (2006), in their study published in the American Journal of Psychiatry, behavioral therapy is highly effective in treating substance use disorders, including oxymorphone addiction, with patients undergoing cognitive-behavioral therapy experiencing a 52% reduction in drug use. This underscores the effectiveness of behavioral interventions in addiction treatment.

Can Oxymorphone Use Lead to Overdose?

Yes, oxymorphone use can lead to overdose, particularly when the drug is misused or taken in higher doses than prescribed. Overdoses occur due to the drug’s potent effects on the central nervous system, which leads to severe respiratory depression and other life-threatening symptoms. Oxymorphone have been linked to a significant number of opioid-related overdose deaths. According to an article called “Drug Overdose Deaths.” from the Centers for Disease Control and Prevention (CDC), opioids were involved in nearly 75% of all drug overdose deaths in 2020, with synthetic opioids like oxymorphone playing a critical role.

What are Symptoms of Oxymorphone Overdose?

Symptoms of Oxymorphone overdose include:

• Respiratory Depression: Slow or shallow breathing, or complete cessation of breathing.
• Extreme Drowsiness: Profound sedation or inability to wake up.
• Pinpoint Pupils: Constriction of the pupils, which may not respond to changes in light.
• Cyanosis: Bluish tint to lips or fingertips due to lack of oxygen.
• Muscle Weakness: Flaccid muscles, limp body.
• Cold and Clammy Skin: Skin feels unusually cool and sweaty.
• Bradycardia: Slow heart rate.
• Hypotension: Low blood pressure, which can lead to shock.
• Unconsciousness or Coma: Lack of responsiveness to stimuli.

According to an article titled “We Level Up CA” published by Zinnia Health in 2024, the risk of overdose with Blues is extremely high. The Drug Enforcement Administration (DEA) reports that as many as 6 in 10 oxymorphone pills sold on the street contain a lethal dose of fentanyl. This has led to a significant number of overdose deaths, as even a tiny amount of fentanyl is fatal.

What Are the Emergency Response Strategies for An Oxymorphone Overdose?

Emergency response strategies for an oxymorphone overdose include immediate medical intervention, and CPR which is critical for the patient’s survival. Here are all the recommended emergency response strategies:

1. Call 911: Immediately call for emergency medical assistance. Provide the dispatcher with all relevant information, including the person’s symptoms and any known use of oxymorphone.
2. Administer Naloxone: If available, administer naloxone (Narcan®), an opioid antagonist that can reverse the effects of an overdose. Naloxone can be given as an injection or nasal spray. It’s essential to follow the instructions carefully and administer it as soon as possible.
3. Perform CPR: If the individual is not breathing or has no pulse, begin cardiopulmonary resuscitation (CPR). Follow the instructions given by the 911 operator until medical personnel arrive.
4. Monitor and Support: Stay with the individual until help arrives. Monitor their breathing and pulse, and be prepared to administer additional doses of naloxone if necessary, as its effects may wear off before the oxymorphone is entirely out of the system.
5. Provide Information: Inform medical personnel about the type and amount of drug taken, the time of ingestion, and any other relevant medical history or information.

How Can I Prevent Oxymorphone Addiction?

Preventing oxymorphone addiction involves using the medication strictly as prescribed, discussing alternative pain management strategies with a healthcare provider, and being aware of the signs of addiction. Regular monitoring by a healthcare provider can help detect early signs of misuse.

Can Oxymorphone Misuse Cause Hormonal Imbalances?

Yes, long-term use of oxymorphone leads to hormonal imbalances, such as opioid-induced hypogonadism. This condition results in decreased levels of sex hormones, causing symptoms like fatigue, depression, reduced libido, and menstrual irregularities​.

Is There a Risk of Developing Hyperalgesia with Prolonged Oxymorphone Use?

Yes, chronic oxymorphone use will lead to opioid-induced hyperalgesia (OIH), where patients become more sensitive to pain. OIH is caused by changes in the central nervous system due to prolonged opioid exposure. It often requires reducing or discontinuing the opioid and transitioning to alternative pain management strategies​.

What are other names for Oxymorphone?

Oxymorphone is known by various names. Common brand names for Oxymorphone include Opana and Numorphan. It is also referred to by its chemical name, 14-hydroxydihydrocodeinone.

What Are the Street Names for Oxymorphone?

The street names for oxymorphone, like many opioids, vary by region and among different user communities. These drugs are also known to be laced with fentanyl, making them extremely dangerous and potentially fatal. Some common street names for oxymorphone include:

• Blues
• Mrs. O
• O Bomb
• Octagons
• Oranges
• Pink Lady
• Stop Signs

“Blues,” often counterfeit oxymorphone pills laced with fentanyl, have a high addiction potential. Fentanyl is 50 to 100 times more potent than morphine, making these pills extremely addictive and dangerous. According to the National Institute on Drug Abuse (NIDA), fentanyl’s high potency significantly increases the risk of addiction and overdose.

How Does Oxymorphone Addiction Impact Mental Health?

Oxymorphone addiction significantly impacts mental health, exacerbating conditions like anxiety, depression, and mood swings. According to the American Psychological Association, chronic misuse can alter brain chemistry, leading to severe cognitive impairments and emotional instability. These mental health issues often require comprehensive treatment plans to address both addiction and psychological well-being.

In cases of Oxymorphone addiction, it is common to see co-occurring disorders. Dual diagnosis treatment is crucial as it addresses both the addiction and any underlying mental health conditions. This approach helps provide a holistic treatment, ensuring that all aspects of the individual’s health are managed effectively. For those with complex addiction issues, understanding the impact of substances like Methadone addiction can also be beneficial.