Oxys, Roxys, blues. 20s, 40s, 80s. Generically it’s known as oxycodone. Connoisseurs order it by name. OxyContin. It’s the most prescribed pain pill on the planet. It’s also the drug most responsible for launching the opioid epidemic.   Oxycodone’s first clinical use was in 1917, but it wasn’t introduced into the US market until May 1939. In early 1928, Merck introduced an oxycodone analogue of the morphine-based “twilight sleep,” with ephedrine added to reduce circulatory and respiratory effects. The result provided pain relief with cocaine-like side effects. And the drug instantly became known as the "Miracle Drug of the 1930s" all across Continental Europe.

In 2013, the United States became the world’s largest consumer of oxycodone per capita. Furthermore, illicit prescription opioid use is now more common in the US than heroin, cocaine, and methamphetamine combined.

Opioid Epidemic

Oxycodone can be administered intramuscularly (injection directly into the muscle), intravenously (injection into the bloodstream), and subcutaneously (injection under the skin). But most users take the drug orally. In tablet form, OxyContin can remain effective for up to 12 hours. Abusers of the drug however either crush the pill into powder and then snort it; chew it; or dissolve the tablets in water and then inject the
solution. These methods are used to beat the drug’s time-release mechanism. And they cause its active ingredient to take effect almost immediately. Since dosages are calibrated for timed release, these methods also significantly increase the risk of overdose. OxyContin users sometimes mix the crushed or liquefied drug with cocaine. That’s a form of speedballing.

Short Term Effects of OxyContin

When taken as prescribed, OxyContin can bring about the following desirable feelings:

  • Euphoria
  • Extreme Relaxation
  • Reduced anxiety
  • Pain relief
  • Sedation

Long Term Effects of OxyContin

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OxyContin’s positive, pain-reducing effects can also come with a number of unwanted side effects, including:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Dry Mouth
  • Constipation
  • Dizziness
  • Stomach Pain

OxyContin’s positive, pain-reducing effects can also come with a number of unwanted side effects, including:

  • Drowsiness
  • Flushing
  • Sweating
  • Weakness
  • Headache
  • Mood Swings

These side effects generally worsen as the dosage increases. Yet aside from discomfort, they are relatively benign. There are other, much more serious side effects however. And they may require immediate medical help. These side effects include:

  • Irregular heart rate and/or rhythm
  • Chest pain
  • Hives, itching, or rash

These side effects generally worsen as the dosage increases. Yet aside from discomfort, they are relatively benign. There are other, much more serious side effects however. And they may require immediate medical help. These side effects include:

  • Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • Hoarseness
  • Difficulty breathing or swallowing
  • Seizures
  • Extreme drowsiness
  • Postural hypotension
  • Lightheadedness

OxyContin’s most dangerous side effects concern the respiratory functions. A markedly slowed respiratory rate can quickly turn life-threatening, especially in overdose situations. When OxyContin is combined with alcohol, the respiratory risk becomes even higher. As does the risk of overdose.


Because OxyContin comes in an extended-release format, if taken in pill form, the medication will not begin to wear off for 12-24 hours after the last dose. If the time-release aspect is bypassed, however, withdrawal can start within 4-8 hours after the last dose. Later symptoms typically start 24 hours after the early symptoms. The first full day of OxyContin withdrawal may manifest as severe flu.
But the second day shows more typical withdrawal symptoms. As with other opioid medications, the most acute withdrawal symptoms usually begin to clear up after three days. But for some people, withdrawal can continue for two weeks or more. Some individuals who suffer from severe addictions can experience psychological withdrawal symptoms for months after ending OxyContin use.
A range of treatments are effective in treating OxyContin addiction, including dual-diagnosis medications and behavioral therapy. It’s crucial though to match the best treatment approach with the particular needs of each individual patient. Behavioral therapies for OxyContin addiction include cognitive-behavioral therapy and contingency management. Cognitive-behavioral therapy helps modify the patient’s drug-use expectations and behaviors. It also helps effectively manage triggers and stress. Contingency management provides motivational incentives for staying drug-free. These behavioral treatment approaches are especially effective when used along with a solid 12 Step regimen.
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  • 1995: OxyContin is approved by the FDA. The controlled-release formulation of oxycodone is the first to allow dosing every 12 hours instead of every 4 to 6 hours. At the time of approval, the FDA believed the controlled-release formulation of OxyContin would result in less abuse potential, since the drug would be absorbed slowly and there would not be an immediate “rush” or high that would promote abuse. The FDA based its judgment in part on the prior marketing history of a similar Purdue Pharma product, MS Contin, a controlled-release formulation of morphine that had been used in the medical community since 1987 without significant reports of abuse and misuse.
  • 1999: The number of people who admit to using OxyContin for non-medical purposes reaches 400,000
  • 2001: An ongoing, inter-agency collaboration forms to develop public education regarding prescription drug abuse. The involved agencies include the FDA, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Center for Substance Abuse Treatment (CSAT) and the National Institute on Drug Abuse (NIDA).
  • 2002: The number of people who admit to using OxyContin for non-medical purposes reaches 1.9 million.
  • 2003: The number of people who admit to using OxyContin for non-medical reaches 2.8 million.
  • 2003: The FDA issues a Warning Letter to OxyContin’s manufacturer, Purdue Pharma, for misleading advertisements. Among many other details, the warning specified that the ads omitted and minimized the serious safety risks associated with OxyContin and promoted it for uses beyond those which had been proven safe and effective. Specifically, the letter pointed out that the advertisements failed to clearly present information from the product label’s Boxed Warning regarding the potentially fatal risks and the danger of abuse.
  • 2004: West Virginia sues Purdue Pharma for reimbursement of “excessive prescription costs” paid by the state and charges the company with deceptive marketing. The case never goes to trial. Instead Purdue agrees to settle by paying the state $10 million for programs to discourage drug abuse, and all evidence remains under seal and confidential.
  • 2007: Purdue Pharma pleads guilty to misleading the public about Oxycontin’s risk of addiction and agrees to pay $600 million in one of the largest pharmaceutical settlements in U.S. history. The company’s president (Michael Friedman), top lawyer (Howard R. Udell) and former chief medical officer (Paul D. Goldenheim) all also plead guilty as individuals to misbranding charges, a criminal violation and agreed to respectively pay $19 million, $8 million and $7.5 million in fines. In addition, the three top executives were charged with a felony and sentenced to 400 hours of community service in drug treatment programs.
  • 2007: Kentucky sues Purdue because of widespread Oxycontin abuse in Appalachia. Eight years later, Kentucky settles with Purdue for $24 million.
  • 2012: The New England Journal of Medicine publishes a study finding that “76 percent of those seeking help for heroin addiction began by abusing pharmaceutical narcotics, primarily OxyContin.” It also draws a direct line between Purdue’s marketing of OxyContin and the subsequent heroin epidemic in the U.S.
  • 2019: Thirty six states are actively suing Purdue for deceptive marketing practices involving OxyContin and seeking reimbursement for opioid crisis-related costs of policing, housing, health care, rehabilitation, criminal justice, parks and recreation, as well as to the loss of life and/or compromised quality of life in their respective communities. Massachusetts Attorney General Maura Healey also singles out eight members of the Sackler Family itself, as well as nine Purdue board members or executives.
To say OxyContin abuse has impacted every segment of American society is kind of like saying the earth is a big round orb. True enough of course. But it doesn’t come close to describing the enormity of the truth. Then again, with as many as 255 million opioid prescriptions written over the course of a single year, it’d be pretty much impossible to adequately describe the enormity of OxyContin’s impact. Especially when you take into account that at its peak an astonishing 81.3 prescriptions were written for every 100 man, woman and child in the country. Purdue didn’t target just any medical professionals though. They targeted those with the highest propensity for writing opioid prescriptions. Physicians with ties to blue collar unions were valued. So were those who treated athletes. If injury risks were high, the need for pain analgesics would be highest. And by following Purdue’s prescribing guidelines, in-pocket medical professionals could make the need even higher. Payoffs and kickbacks became the rule rather than the exception. And profit became the primary objective, regardless of who suffered loss.

A unique strain of outlaw culture consequently developed around OxyContin. Distributors did the work of traffickers. Pain management clinics took the place of trap houses. Physicians played the role of pushers. And Purdue Pharma became a bona fide cartel. The 126-year-old pharmaceutical giant could now be crowned for what it had been all along -- actual drug kingpins.


Like all crime bosses, legal issues inevitably ensued. West Virginia took the company to court. Purdue paid the state ten million dollars to keep it all hush-hush. Kentucky sued too. Cost Purdue $24 million. But it took Kentucky eight years to collect. Then the Feds came gunning. Hit Purdue with $600 million in fines. Purdue didn’t mind. By that time OxyContin had generated over $30 billion in revenue. OxyContin doesn’t have much of a place in the arts either. See, unlike more “natural” opiates, OxyContin was never really actively glamorized by the creative class. Consequently there’s no reputable fiction about OxyContin use and abuse, let alone anything worthy written under the effects of the prescription painkiller. There is however a slew of smart coverage concerning OxyContin, as well as the opioid crisis itself. And it all tends to come from the sober side of the street. A few of the very best of those books are Beth Macy’s Dopesick: Dealers, Doctors, and the Drug Company that Addicted America; Robert L. DuPont’s Chemical Slavery: Understanding Addiction and Stopping the Drug Epidemic; Sam Quinones’ Dreamland: The True
Tale of America’s Opiate Epidemic and Barry Meier’s Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic. But just because creatives haven’t embraced OxyContin, doesn’t mean OxyContin hasn’t embraced creatives, albeit in a very roundabout way. The embracing comes about via the Sackler Family, owners of Purdue Pharma, whose fortunes are inextricably tied to OxyContin. The sums are as considerable as the institutions are formidable. American Museum of Natural History’s Sackler Educational Laboratory, the Dia Art Foundation’s Sackler Institute, the Guggenheim Museum’s Sackler Center for Arts Education and the Metropolitan Museum of Art’s Sackler Wing are among the many prestigious institutions who’ve benefited from the Sackler Family largesse. And the funding has created a crisis of conscience throughout the art community. In fact, many institutions are debating whether or not to return Sackler Family endowments. That may be difficult when the Sackler name adorns the very walls, but it illustrates how seriously the art community is considering the issue.

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