Drugs and Medicines II CHEMISTRY 100 ATENEO DE ZAMBOANGA UNIVERSITY Ms. M.A.

Deles

Drugs and Medicines C. Illegal Drugs Marijuana Metamphetamine

MDMA Cocaine Opium and opium derivatives Morphine Heroin LSD Prescription drugs

ILLEGAL DRUGS MARIJUANA

Marijuana is the most commonly abused illicit drug in the United States. A dry, shredded green/brown mix of flowers, stems, seeds, and leaves of the plant Cannabis sativa, it usually is smoked as a cigarette (joint, nail), or in a pipe (bong). It also is smoked in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, often in combination with another drug. It might also be mixed in food or brewed as a tea. As a more concentrated, resinous form it is called hashish and, as a sticky black liquid, hash oil. Marijuana smoke has a pungent and distinctive, usually sweet-and-sour odor.(1) The main active chemical in marijuana is THC (delta-9-tetrahydrocannabinol). The membranes of certain nerve cells in the brain contain protein receptors that bind to THC. Once securely in place, THC kicks off a series of cellular reactions that ultimately lead to the high that users experience when they smoke marijuana. (2) Street names: Grass, pot, weed, bud, Mary Jane, dope, indo, hydro(3) SHORT-TERM EFFECTSWhen marijuana is smoked, its effects begin immediately after the drug enters the brain and last from 1 to 3 hours. If marijuana is consumed in food or drink, the short-term effects begin more slowly, usually in 1/2 to 1 hour, and last longer, for as long as 4 hours. Smoking marijuana deposits several times more THC into the blood than does eating or drinking the drug.(4) Within a few minutes after inhaling marijuana smoke, an individuals heart begins beating more rapidly, the bronchial passages relax and become enlarged, and blood vessels in the eyes expand, making the eyes look red. The heart rate, normally 70 to 80 beats per minute, may increase by 20 to 50 beats per minute or, in some cases, even double. This effect can be greater if other drugs are taken with marijuana.(5)

As THC enters the brain, it causes a user to feel euphoric or highby acting in the brains reward system, areas of the brain that respond to stimuli such as food and drink as well as most drugs of abuse. THC activates the reward system in the same way that nearly all drugs of abuse do, by stimulating brain cells to release the chemical dopamine.(6) A marijuana user may experience pleasant sensations, colors and sounds may seem more intense, and time appears to pass very slowly. The users mouth feels dry, and he or she may suddenly become very hungry and thirsty. His or her hands may tremble and grow cold. The euphoria passes after awhile, and then the user may feel sleepy or depressed. Occasionally, marijuana use produces anxiety, fear, distrust, or panic.(7) LONG-TERM EFFECTSSomeone who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers do, such as daily cough and phlegm production, more frequent acute chest illnesses, a heightened risk of lung infections, and a greater tendency toward obstructed airways. Cancer of the respiratory tract and lungs may also be promoted by marijuana smoke. Marijuana has the potential to promote cancer of the lungs and other parts of the respiratory tract because marijuana smoke contains 50 percent to 70 percent more carcinogenic hydrocarbons than does tobacco smoke.(8) Marijuana's damage to short-term memory seems to occur because THC alters the way in which information is processed by the hippocampus, a brain area responsible for memory formation. In one study, researchers compared marijuana smoking and nonsmoking 12thgraders' scores on standardized tests of verbal and mathematical skills. Although all of the students had scored equally well in 4th grade, those who were heavy marijuana smokers, i.e., those who used marijuana seven or more times per week, scored significantly lower in 12th grade than nonsmokers. Another study of 129 college students found that among heavy users of marijuana critical skills related to attention, memory, and learning were significantly impaired, even after they had not used the drug for at least 24 hours. (9)

METHAMPHETAMINE
Today, methamphetamine is second only to alcohol and marijuana as the drug used most frequently in many Western and Midwestern states. Seizures of dangerous laboratory materials have increased dramaticallyin some states, fivefold. In response, many special task forces and local and Federal initiatives have been developed to target methamphetamine production and use. Legislation and negotiation with earlier source areas for precursor substances have also reduced the availability of the raw materials needed to make the drug.(1) Methamphetamine is a highly addictive drug with potent central nervous system stimulant properties. In the 1960s, methamphetamine pharmaceutical products were widely available and extensively diverted and abused. The 1971 placement of methamphetamine into Schedule II of the Controlled Substance Act (CSA) and the removal of methamphetamine injectable formulations from the United States market, combined with a better appreciation for its high abuse potential, led to a drastic reduction in the abuse of this drug. However, a resurgence of methamphetamine abuse occurred in the 1980s and it is currently considered a major drug of abuse. The widespread availability of methamphetamine today is largely fueled by illicit production in large and small clandestine laboratories throughout the United States

and illegal production and importation from Mexico. In some areas of the country (especially on the West Coast), methamphetamine abuse has outpaced both heroin and cocaine. (2) The drug has limited medical uses for the treatment of narcolepsy, attention deficit disorders, and obesity.(3) STREET NAMES: Speed, Meth, Ice, Crystal, Chalk, Crank, Tweak, Uppers, Black Beauties, Glass, Bikers Coffee, Methlies Quick, Poor Man's Cocaine, Chicken Feed, Shabu, Crystal Meth, Stove Top, Trash, Go-Fast, Yaba, and Yellow Bam, Shabu

SHORT-TERM EFFECTSAs a powerful stimulant, methamphetamine, even in small doses, can increase wakefulness and physical activity and decrease appetite. A brief, intense sensation, or rush, is reported by those who smoke or inject methamphetamine. Oral ingestion or snorting produces a long-lasting high instead of a rush, which reportedly can continue for as long as half a day. Both the rush and the high are believed to result from the release of very high levels of the neurotransmitter dopamine into areas of the brain that regulate feelings of pleasure.(4) Methamphetamine has toxic effects. In animals, a single high dose of the drug has been shown to damage nerve terminals in the dopamine-containing regions of the brain. The large release of dopamine produced by methamphetamine is thought to contribute to the drugs toxic effects on nerve terminals in the brain. High doses can elevate body temperature to dangerous, sometimes lethal, levels, as well as cause convulsions.(5) LONG-TERM EFFECTSLong-term methamphetamine abuse results in many damaging effects, including addiction. Addiction is a chronic, relapsing disease, characterized by compulsive drug-seeking and drug use which is accompanied by functional and molecular changes in the brain. In addition to being addicted to methamphetamine, chronic methamphetamine abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin, which is called formication). The paranoia can result in homicidal as well as suicidal thoughts.(6) With chronic use, tolerance for methamphetamine can develop. In an effort to intensify the desired effects, users may take higher doses of the drug, take it more frequently, or change their method of drug intake. In some cases, abusers forego food and sleep while indulging in a form of binging known as a run, injecting as much as a gram of the drug every 2 to 3 hours over several days until the user runs out of the drug or is too disorganized to continue. Chronic abuse can lead to psychotic behavior, characterized by intense paranoia, visual and auditory hallucinations, and out-of-control rages that can be coupled with extremely violent behavior.(7) Although there are no physical manifestations of a withdrawal syndrome when methamphetamine use is stopped, there are several symptoms that occur when a chronic user stops taking the drug. These include depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the drug.(8)

In scientific studies examining the consequences of long-term methamphetamine exposure in animals, concern has arisen over its toxic effects on the brain. Researchers have reported that as much as 50 percent of the dopamine-producing cells in the brain can be damaged after prolonged exposure to relatively low levels of methamphetamine. Researchers also have found that serotonin-containing nerve cells may be damaged even more extensively. Whether this toxicity is related to the psychosis seen in some long-term methamphetamine abusers is still an open question.(9)

MDMA (ECSTASY)
MDMA (3,4-methylenedioxymethamphetamine) is a synthetic, psychoactive drug chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. MDMA is an illegal drug that acts as both a stimulant and psychedelic, producing an energizing effect, as well as distortions in time and perception and enhanced enjoyment from tactile experiences.(1) Adolescents and young adults use it to promote euphoria, feelings of closeness, empathy, sexuality and to reduce inhibitions. It is considered a "party drug" and obtained at "rave" or "techno" parties. However, its abuse has expanded, to include other settings outside of the rave scenes, such as a college campus.(2) Although MDMA is known universally among users as ecstasy, researchers have determined that many ecstasy tablets contain not only MDMA but also a number of other drugs or drug combinations that can be harmful as well. Adulterants found in MDMA tablets purchased on the street include methamphetamine, caffeine, the over-the-counter cough suppressant dextromethorphan, the diet drug ephedrine, and cocaine. Also, as with many other drugs of abuse, MDMA is rarely used alone. It is not uncommon for users to mix MDMA with other substances, such as alcohol and marijuana.(3) Street names:MDMA, Ecstasy, XTC, E, X, Beans, Adams, Hug Drug, Disco Biscuit, Go

Short term effects

In high doses, MDMA can interfere with the bodys ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), resulting in liver, kidney, and cardiovascular system failure, and death. (5) Because MDMA can interfere with its own metabolism (breakdown within the body), potentially harmful levels can be reached by repeated drug use within short intervals. (6) Users of MDMA face many of the same risks as users of other stimulants such as cocaine and amphetamines. These include increases in heart rate and blood pressure, a special risk for people with circulatory problems or heart disease, and other symptoms such as muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating.(7)

Almost 60 percent of people who use MDMA report withdrawal symptoms, including fatigue, loss of appetite, depressed feelings, and trouble concentrating. (8)

Long term effects

Research in animals links MDMA exposure to long-term damage to neurons that are involved in mood, thinking, and judgment. A study in nonhuman primates showed that exposure to MDMA for only 4 days caused damage to serotonin nerve terminals that was evident 6 to 7 years later. While similar neurotoxicity has not been definitively shown in humans, the wealth of animal research indicating MDMAs damaging properties suggests that MDMA is not a safe drug for human consumption.(9)

COCAINE
Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years.(1) Pure cocaine was first extracted from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and Bolivia, in the mid-19th century. In the early 1900s, it became the main stimulant drug used in most of the tonics/elixirs that were developed to treat a wide variety of illnesses.(2) Cocaine abuse has a long history and is rooted into the drug culture in the U.S. It is an intense euphoric drug with strong addictive potential. With the increase in purity, the advent of the free-base form of the cocaine ("crack"), and its easy availability on the street, cocaine continues to burden both the law enforcement and health care systems in America.(3) The powdered, hydrochloride salt form of cocaine can be snorted or dissolved in water and injected. Crack is cocaine that has not been neutralized by an acid to make the hydrochloride salt. This form of cocaine comes in a rock crystal that can be heated and its vapors smoked. The term crack refers to the crackling sound heard when it is heated. (4) Blow, nose candy, snowball, tornado, wicky stick, Perico (Spanish)

(5)

SHORT-TERM EFFECTSCocaines effects appear almost immediately after a single dose, and disappear within a few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them perform simple physical and intellectual tasks more quickly, while others experience the opposite effect.(6) The duration of cocaines immediate euphoric effects depends upon the route of administration. The faster the absorption, the more intense the high. Also, the faster the absorption, the shorter the duration of action. The high from snorting is relatively slow in onset, and may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. (7)

The short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts (several hundred milligrams or more) intensify the users high, but may also lead to bizarre, erratic, and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.(8) LONG-TERM EFFECTSCocaine is a powerfully addictive drug. Thus, an individual may have difficulty predicting or controlling the extent to which he or she will continue to want or use the drug. Cocaines stimulant and addictive effects are thought to be primarily a result of its ability to inhibit the reabsorption of dopamine by nerve cells. Dopamine is released as part of the brains reward system, and is either directly or indirectly involved in the addictive properties of every major drug of abuse.(9) An appreciable tolerance to cocaines high may develop, with many addicts reporting that they seek but fail to achieve as much pleasure as they did from their first experience. Some users will frequently increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive (sensitization) to cocaines anesthetic and convulsant effects, without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.(10) Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia. This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.(11) OPIUM there were no legal restrictions on the importation or use of opium until the early 1900s. In the United States, the unrestricted availability of opium, the influx of opium-smoking immigrants from East Asia, and the invention of the hypodermic needle contributed to the more severe variety of compulsive drug abuse seen at the turn of the 20th century. In those days, medicines often contained opium without any warning label. Today, there are state, federal, and international laws governing the production and distribution of narcotic substances. Although opium is used in the form of paragoric to treat diarrhea, most opium imported into the United States is broken down into its alkaloid constituents. These alkaloids are divided into two distinct chemical classes, phenanthrenes and isoquinolines. The principal phenanthrenes are morphine, codeine, and thebaine, while the isoquinolines have no significant central nervous system effects and are not regulated under the CSA.

The Opium poppy (papaver somniferum) is the key ingredient for all

narcotics. Opium is the substance that is directly extracted from the Opium poppy. Opium grows in Southeast Asia, Southwest Asia, and in the Western Hemisphere (Mexico, Guatemala, and Colombia). Opium is converted into Heroin in laboratories in the countries where it is cultivated, and then consumed locally or shipped to consumer countries. It takes approximately ten kilograms of Opium to make one kilogram of Heroin. About 200,000 acres of opium poppies have been planted in Afghanistan - opium is the raw material of heroin - and the country's late-summer harvest will produce three-fourths of the world's heroin. That will mean further billions for growers, smugglers, corrupt officials and Afghan warlords. Source: Philadelphia Inquirer, May 10, 2004 http://www.streetdrugs.org/opium.htm
HEROIN Heroin is an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates. Heroin is processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It is typically sold as a white or brownish powder or as the black sticky substance known on the streets as black tar heroin. Although purer heroin is becoming more common, most street heroin is cut with other drugs or with substances such as sugar, starch, powdered milk, or quinine. Street heroin can also be cut with strychnine, fentanyl or other poisons. Because heroin abusers do not know the actual strength of the drug or its true contents, they are at risk of overdose or death. Heroin also poses special problems because of the transmission of HIV and other diseases that can occur from sharing needles or other injection equipment.(1) First synthesized from morphine in 1874, heroin was not extensively used in medicine until the early 1900s. Commercial production of the new pain remedy was first started in 1898. It initially received widespread acceptance from the medical profession, and physicians remained unaware of its addiction potential for years. The first comprehensive control of heroin occurred with the Harrison Narcotic Act of 1914. Today, heroin is an illicit substance having no medical utility in the United States.(2) Heroin can be injected, smoked, or sniffed/snorted. Injection is the most efficient way to administer low-purity heroin. The availability of high-purity heroin, however, and the fear of infection by sharing needles has made snorting and smoking the drug more common. National Institute on Drug Abuse (NIDA) researchers have confirmed that all forms of heroin administration are addictive.(3) street names: Smack, thunder, hell dust, big H, nose drops(5) SHORT-TERM EFFECTSIntravenous users typically experience the rush within 7 to 8 seconds after injection, while intramuscular injection produces a slower onset of this euphoric feeling, taking 5 to 8 minutes. When heroin is sniffed or smoked, the peak effects of the drug are usually felt within 10 to 15 minutes. In addition to the initial feeling of euphoria, the short-

term effects of heroin include a warm flushing of the skin, dry mouth, and heavy extremities.(6) Heroin laced with fentanyl and other poisons have been known to cause death within hours. LONG-TERM EFFECTSChronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, cellulites, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heroin's depressing effects on respiration. In addition to the effects of the drug itself, street heroin may have additives that do not really dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.(7) One of the most significant effects of heroin use is addiction. With regular heroin use, tolerance to the drug develops. Once this happens, the abuser must use more heroin to achieve the same intensity or effect that they are seeking. As higher doses of the drug are used over time, physical dependence and addiction to the drug develop.(8) Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (cold turkey), kicking movements (kicking the habit), and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered less dangerous than alcohol or barbiturate withdrawal.(9)

Morphine
Morphine is the principal constituent of opium and can range in concentration from 4 to 21 percent. Commercial opium is standardized to contain 10-percent morphine. In the United States, a small percentage of the morphine obtained from opium is used directly (about 15 tons): the remaining is converted to codeine and other derivatives (about 120 tons). Morphine is one of the most effective drugs known for the relief of severe pain and remains the standard against which new analgesics are measured. Like most narcotics, the use of morphine has increased significantly in recent years. Since 1990, there has been about a 3-fold increase in morphine products in the United States. Morphine is marketed under generic and brand name products including "MS-Contin," Oramorph SR," MSIR," Roxanol," Kadian," and RMS." Morphine is used parenterally (by injection) for preoperative sedation, as a supplement to anesthesia, and for analgesia. It is the drug of choice for relieving pain of myocardial infarction and for its cardiovascular effects in the treatment of acute pulmonary edema. Traditionally; morphine was almost exclusively used by injection. Today, morphine is marketed in a variety of forms, including oral solutions, immediate and sustained-release tablets and capsules, suppositories, and injectable preparations. In addition, the availability of high-concentration morphine preparations (i.e., 20mg/ml oral solutions, 25-mg/ml injectable solutions, and 200-mg sustained-release tablets) partially reflects the use of this substance for chronic pain management in opiate-tolerant patients.

LSD Chemist Albert Hofmann, working at the Sandoz Corporation pharmaceutical laboratory in Switzerland, first synthesized LSD in 1938. He was conducting research on possible medical applications of various lysergic acid compounds derived from ergot, a fungus that develops on rye grass. Searching for compounds with therapeutic value, Hofmann created more than two dozen ergot-derived synthetic molecules.(1) LSD is sold on the street in tablets, capsules, and occasionally in liquid form. It is an odorless and colorless substance with a slightly bitter taste that is usually ingested orally. It is often added to absorbent paper, such as blotter paper, and divided into small decorated squares, with each square representing one dose.(2) STREET TERMSAcid, blotter acid, window pane, dots, mellow yellow SHORT-TERM EFFECTSThe short-term effects of LSD are unpredictable. They depend on the amount of the drug taken; the user's personality, mood, and expectations; and the surroundings in which the drug is used. Usually, the user feels the first effects of the drug within 30 to 90 minutes of ingestion. These experiences last for extended periods of time and typically begin to clear after about 12 hours. The physical effects include dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth, and tremors. Sensations may seem to "cross over" for the user, giving the feeling of hearing colors and seeing sounds. If taken in a large enough dose, the drug produces delusions and visual hallucinations.(5) LONG-TERM EFFECTSLSD users often have flashbacks, during which certain aspects of their LSD experience recur even though they have stopped taking the drug. In addition, LSD users may develop long-lasting psychoses, such as schizophrenia or severe depression. LSD is not considered an addictive drug - that is, it does not produce compulsive drug-seeking behavior as cocaine, heroin, and methamphetamine do. However, LSD users may develop tolerance to the drug, meaning that they must consume progressively larger doses of the drug in order to continue to experience the hallucinogenic effects that they seek. (6)

HYDROCODONE
Hydrocodone is an antitussive (cough suppressant) and analgesic agent for the treatment of moderate to moderately severe pain. Studies indicate that hydrocodone is as effective, or more effective, than codeine for cough suppression and nearly equipotent to morphine for pain relief. Hydrocodone is the most frequently prescribed opiate in the United States with nearly 130 million prescriptions for hydrocodone-containing products dispensed in 2006. There are several hundred brand name and generic hydrocodone products marketed. All are combination products and the most frequently prescribed combination is hydrocodone and acetaminophen (Vicodin, Lortab, Lorcet).

Hydrocodone diversion and abuse has been escalating in recent years. In 2006, hydrocodone was the most frequently encountered opioid pharmaceutical in drug evidence submitted to the National Forensic Laboratory Information System (NFLIS) with 25,136 exhibits; the System to Retrieve Investigational Drug Evidence (STRIDE) analyzed 654 exhibits in 2006. In the 2005 Drug Abuse Warning Network (DAWN) combination products were associated with more emergency room visits than any other pharmaceutical opioid with an estimated 51,225 emergency room visits. Poison control data, medical examiners reports, and treatment center data all indicate that the abuse of hydrocodone is associated with significant public health risks, including a substantial number of deaths. CONTROL STATUSWhen the CSA was enacted in 1971, hydrocodone as a substance by itself was placed in schedule II while products, containing hydrocodone in specified amounts and in combination with other active ingredients, were placed in schedule III and V. At that time, hydrocodone was primarily utilized as a cough suppressant with limited prescriptions. Today, hydrocodone products are increasingly utilized for pain management and are the most frequently dispensed opioid pharmaceuticals in the United States. STREET NAMESVikes, Hydro, Norco SHORT-TERM EFFECTSHydrocodone in an analgesic and antitussive agent structurally similar to codeine but with effects more similar to morphine. Hydrocodone is abused for its opioid effects. Widespread diversion via bogus call-in prescriptions, altered prescriptions, theft and illicit purchases from Internet sources are made easier by the present controls placed on hydrocodone products. Hydrocodone pills are the most frequently encountered dosage form in illicit traffic. Hydrocodone is generally abused orally, often in combination with alcohol. LONG-TERM EFFECTSAs with most opiates, abuse of hydrocodone is associated with tolerance, dependence, and addiction. The co-formulation with acetaminophen carries an additional risk of liver toxicity when high, acute doses are consumed. Data suggests that some individuals who abuse very high doses of acetaminophen-containing hydrocodone products may be spared this liver toxicity if they have been chronically taking these products and have escalated their dose slowly over a long period of time. OXYCONTIN OxyContin is a prescription painkiller used for moderate to high pain relief associated with injuries, bursitis, dislocations, fractures, neuralgia, arthritis, lower back pain, and pain associated with cancer.(1) OxyContin contains oxycodone, the medication's active ingredient, in a timed-release tablet. Oxycodone products have been illicitly abused for the past 30 years.(2) Oxycodone is a Schedule II narcotic analgesic and is widely used in clinical medicine. It is marketed either alone as controlled release (OxyContin) and immediate release formulations (OxyIR, OxyFast), or in combination with other nonnarcotic analgesics such as aspirin (Percodan) or acetaminophen (Percocet). The introduction in 1996 of OxyContin, commonly known on the street as OC, OX, Oxy, Oxycotton, Hillbilly heroin, and kicker, led to a marked escalation of its abuse as reported by drug abuse treatment centers, law enforcement personnel, and health care professionals. Although the diversion and abuse of OxyContin appeared initially in the eastern US, it has now spread to the western US

including Alaska and Hawaii. Oxycodone-related adverse health effects increased markedly in recent years. In 2004, Food and Drug Administration (FDA) approved for marketing generic forms of controlled release oxycodone products.(3) Street names: Kicker, OC, Oxy, OX, Blue, Oxycotton, Hillybilly Heroin SHORT-TERM EFFECTSPharmacological effects include analgesia, sedation, euphoria, feelings of relaxation, respiratory depression, constipation, papillary constriction, and cough suppression. A 10 mg dose of orally-administered oxycodone is equivalent to a 10 mg dose of subcutaneously administered morphine as an analgesic in a normal population. Oxycodones behavioral effects can last up to 5 hours. The drug is most often administered orally. The controlled-release product, OxyContin, has a longer duration of action (8-12 hours).(5) The most serious risk associated with opioids, including OxyContin, is respiratory depression. Common opioid side effects are constipation, nausea, sedation, dizziness, vomiting, headache, dry mouth, sweating, and weakness. Taking a large single dose of an opioid could cause severe respiratory depression that can lead to death.(6) LONG-TERM EFFECTSAs with most opiates, oxycodone abuse may lead to dependence and tolerance. Acute overdose of oxycodone can produce severe respiratory depression, skeletal muscle flaccidity, cold and clammy skin, reduction in blood pressure and heart rate, coma, respiratory arrest, and death.(7) Chronic use of opioids can result in tolerance for the drugs, which means that users must take higher doses to achieve the same initial effects. Long-term use also can lead to physical dependence and addiction -- the body adapts to the presence of the drug, and withdrawal symptoms occur if use is reduced or stopped. Properly managed medical use of pain relievers is safe and rarely causes clinical addiction, defined as compulsive, often uncontrollable use of drugs. Taken exactly as prescribed, opioids can be used to manage pain effectively. (8)

http://www.usdoj.gov/dea/concern/concern.htm