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How much stronger is oxymorphone than oxycodone?

Oxycodone is a semi-synthetic opioid.

Semi-synthetic means that its molecule resembles naturally occurring opioids. Oxycodone is one of many opioids that derives from thebaine.

Thebaine, or paramorphine, is found in the opium poppy. In the lab, scientists can use thebaine to synthesize a variety of opioids and opioid blockers. For example, hydrocodone (Vicodin) and hydromorphone (Dilaudid) come from thebaine.

Drugs used to treat addiction also come from thebaine, including buprenorphine, naltrexone, and naloxone. Thebaine has been the source of medicines that treat pain, lead to addiction, and drugs that treat addiction.

Another opioid that comes from thebaine is oxymorphone. So, in a pharmaceutical lab, scientists can make both oxycodone and oxymorphone from thebaine.

You are likely already familiar with oxycodone.

Oxycodone is the active ingredient in the pain drug, Oxycontin, used to treat moderate to severe pain. After over twenty years on the market, the makers of Oxycontin, Purdue¬†Pharma, are under fire for fueling the opioid epidemic. People believe that they spread misinformation about the drug’s addictive potential.

Oxymorphone, another opioid analgesic, is not as well known, yet it has also been in the news with some negative press. Opana ER is one of the top opioid medications that contain oxymorphone. A few years ago, the FDA recommended that Endo Pharmaceuticals, maker of Opana ER, take their drug off of the market. This unprecedented action was due to a dramatic increase in the abuse of the drug. 

When Opana ER first hit the market, in 2006, Endo promoted it as a superior long-acting opioid. It was to compete with Oxycontin for use in chronic pain management. Their marketing claim was that Opana ER had a steadier release mechanism for better around-the-clock pain control.

Endo also claimed that Oxycontin, their competitor, released much of its medication shortly after the patient consumed it. They stated that Oxycontin released about 40% of its oxycodone upfront. Only 60% of the drug remained for 24-hour the time-release mechanism to deliver.

How much stronger is oxymorphone than oxycodone?

The prescription opioids, oxycodone, and oxymorphone are closely related. When you take oxycodone, your body metabolizes the drug into several metabolites. One of these metabolites is oxymorphone.

Opioid equivalence charts compare the relative strength of various opioids to morphine, the gold standard. Oxycodone is 1.5 times the strength of morphine, and oxymorphone is three times the strength of morphine. As you can see, oxymorphone is twice the strength of oxycodone.

Does it matter that oxymorphone is stronger?

Yes and no. When it comes to routine medical care, the relative potency of one opioid compared to another is not a big deal. Doctors have to know the strengths of pain medications and how to prescribe them.

Opana ER, the product that contains oxymorphone, was available in a top potency of 40mg. Oxycontin, on the other hand, topped out at 80mg. An Opana ER 40mg was equal to Oxycontin 80mg in strength.

One doesn’t have to worry about one being more potent than the other. Doctors know how they compare and prescribe accordingly for pain relief.

Does it matter on the streets which opioid is stronger?

It does matter because drug users must be aware of what they are taking. If an opioid abuser crushes up an Oxycontin to shoot up or snort, they might use a whole 80mg tablet and come close to their tolerance level. Any more might lead to an overdose.

If the same drug user used 80mg of oxymorphone, it might cause an overdose. Of course, a two-to-one potency difference is nothing like the difference between heroin and fentanyl. Fentanyl is about 20 times stronger than heroin!

What are blues, buttons, and beans?

On the streets, they call oxycodone a lot of different things. Some of the slang terms include the 30s, 40s, OC, Oxy, Whites, Blues, Greens, and more. 

You are much more likely to hear the drug called by the colors or strengths of the tablets. The well-known Roxicodone brand of oxycodone comes in a blue, 30mg tablet is known as a blue or a 30. If you hear that someone is taking blues or taking 30s, they most likely are talking about oxycodone tablets. They are also often called “Oxys.”

For years, opioid users were quietly crushing their oxy tablets to inject them into a vein. There were tragic stories of people discovered, overdosed with a syringe in their arm with a blue liquid. Due to the rampant abuse of oxycodone, Purdue Pharma took action in 2010.

They reformulated their Oxycontin tablet. The new tablet had a gummy polymer gel matrix inside. This added substance made it nearly impossible to snort or shoot up the tablet after crushing it. 

As a result, some drug users went looking for an alternative pain pill to abuse. Opana ER became the new drug of choice because it did not make its tablet as resistant to drug abuse. Opana extended-release tablets had various street names: Mrs. O, the O Bomb, Blue Heaven, Biscuits, and Stop Signs.

In Indiana, an outbreak of HIV, hepatitis C, and thrombotic microangiopathy led back to Opana ER abuse. This event resulted in the 2017 decision to pull Opana from the market.

What are the long-term effects of oxymorphone use?

When a patient takes oxymorphone for pain and follows the doctor’s orders, it is a relatively safe medication. Patients have safely taken oxymorphone for many years to treat their chronic pain without consequence. However, when abused, oxymorphone becomes a deadly drug.

Oxymorphone overdose can happen to anyone.

When a drug user takes too much of an opioid, their breathing slows down. If they keep going, eventually, they become hypoxic. Hypoxia is when oxygen levels in the body are dangerously low.

Respiratory depression caused by opioids is the primary mechanism of death. As mentioned earlier, oxymorphone is twice as potent as oxycodone. A drug user might mix up the two and take a life-threatening, dangerously high dose.

Combining alcohol with oxymorphone or oxycodone can also be a deadly combination. Alcohol-containing drinks mixed with opioids make respiratory depression even more likely. Similarly, drug interactions with sedative medications can also lead to life-threatening central nervous system suppression and respiratory depression.

Additionally, many well-known brands of opioid tablets on the streets are now counterfeits. These fake pills typically contain fentanyl, yet look just like the real thing. A drug user who crushes and shoots up an Opana tablet may get a deadly dose of fentanyl instead.

How much oxymorphone does it take to overdose?

Unlike other drugs, there is no specific amount of an opioid that is deadly to all people. Different people have different tolerance levels to opiates.

Tolerance is something that develops over time. When a drug user becomes tolerant to an opioid, they increase the dose. This escalation continues over time, and the drug user can handle very high dosages. What might barely work to get one drug abuser high could quickly kill a newcomer.

Another thing to keep in mind is that when someone is clean from opioids for a long time, their tolerance goes back down. In many cases, drug users who were clean for some time went back out and took a deadly dose of their opioid of choice. They thought it would be fine to start back their usual dosage. When tolerance goes down, what was once a “safe” dosage of oxymorphone can become deadly for the same person.

What are the typical signs of oxymorphone abuse?

A person may take too much oxymorphone by eating pills like m&ms, or snorting it into their nose or shooting it into a vein. Regardless, there are common signs of abuse. Constricted pupils are one sign.

Oxymorphone, like other opioids, can cause pinpoint pupils. Another thing to look for is the person “nodding out.” What this means is that the person’s head goes down as they almost pass out. If you are at the dinner table and a family member’s head is slowly going down with their eyes closing, they may be using opioids.

What should make the oxymorphone user be concerned?

Oxymorphone constipation is a problem even for the patient who takes it by prescription. For street users, opioid constipation is also a severe problem that can lead to an ER visit. Worsening addiction is also a problem.

You will find that your whole life is centered around the drug if you are addicted to oxymorphone. How much do you have left? Where are you going to get more?

These thoughts will consume your every waking moment. Other side effects you may experience include itching, headaches, nausea, dry mouth, difficulty sleeping, and more.

If you are shooting up oxymorphone, you have other pressing concerns. Not only can you get a skin infection where you are injecting, but you can also get a deadly heart infection. Endocarditis is a life-threatening infection on the valves of the heart.

The bacteria grow and eat away at the tissue, destroying the heart valves. If you have endocarditis, you may have to stay in a hospital for weeks or longer to take IV antibiotics. You may also require open-heart surgery. Endocarditis can also lead to death, even when it is caught on time and treated.

Can someone addicted to oxymorphone, just quit?

If you are addicted to oxymorphone, you should plan to quit as soon as possible. However, it may not be as simple as putting down the drug. Quitting oxymorphone usually leads to oxymorphone withdrawal.

In the short-term, this means goosebumps, cold sweats, yawning, sneezing, irritability, and anxiety. If you do not have help, you may find the urge to take more to be overwhelming. When it comes to addiction, it is always easy to put off quitting for just one more day. However, if you have support from people close to you and help from your doctor, you can overcome oxymorphone addiction.

Without medical treatment, oxymorphone withdrawal symptoms will continue to worsen over a period of time. After you quit taking the drug, within a day or two, you will start to have side effects. These may include muscle aches, cramping, upset stomach, nausea, and elevated blood pressure.

You may even begin to throw up and have diarrhea. As the withdrawal syndrome progresses, oxymorphone cravings will increase. It is challenging to quit oxymorphone, but it is possible.

Remember thebaine and the drugs that labs synthesize from it? Oxycodone and oxymorphone both come from thebaine. Yet, naltrexone, naloxone, and buprenorphine are also products of thebaine.

It is as if the same thebaine that comes from the opium poppy contains both the problem and the solution.

Naloxone is an opioid overdose reversal drug. As a powerful opioid blocker, naloxone, also known by the brand, Narcan, can turn around a near-deadly overdose in seconds.

Naltrexone, one of the other thebaine-derived drugs, is a drug that can treat alcoholism and opioid use disorder. And, finally, buprenorphine is quickly becoming the gold standard of opioid addiction treatment drugs. Suboxone is the best-known brand of buprenorphine.

Can Suboxone work for oxymorphone addiction?

Yes, Suboxone treatment has a high success rate as part of a comprehensive medication-assisted treatment plan. Many people have overcome their addiction to Opana ER and generic oxymorphone tablets by going in for Suboxone treatment.

How does buprenorphine work to treat oxymorphone addiction?

Oxymorphone, oxycodone, and many other opioids repeatedly bind to opioid receptors in the body. Eventually, some people will become addicted to the euphoric effects of these drugs. Buprenorphine is a potent blocker of the opioid receptor.

And, at the same time, it partially activates the receptor. This unique mixed action treats opioid addiction by preventing ongoing, long-term withdrawal symptoms, and suppressing drug cravings. 

Over time, and with therapy, you can get past your oxymorphone addiction. Putting opioid dependence behind you will allow you to lead a more fulfilling life. You will no longer have to worry about the dangers of oxymorphone abuse.

The brain fog and the obsession with oxymorphone will no longer be a problem. The first step in quitting this dangerous drug is to ask for help. You may start by making a phone call to a doctor who can treat opioid addiction.

Or, you can ask for help from a family member or loved one. They can help you to get the medical care and support that you need to get better.

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