Talk:Oxymorphone

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 27 September 2018 and 14 December 2018. Further details are available on the course page. Student editor(s): MichelleBretschneider, Saellee, Kwong89, Tarynng5. Peer reviewers: Wjisksi007.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 05:58, 17 January 2022 (UTC)

dependence liability

if its 6-8x as potent as morphine that means its 3-4x as potent as heroin. on wiki's heroin & morphine pages it says "extremely high" for dependence liability yet for oxymorphone which is 3-4x and 6-8x as potent, and yet it says only "high" dependence liability. heroin is legal in most european countries for medical use, and i dont understand how more potent opioids can be said to be less addictive, fentanyl, oxymorphone and hydromorphone are all legal for prescriptions and are all at least 2x if not MUCH more potent than heroin. are the dependence liability ratings on the wikipedia pages from the FDA or what source?

even in the illict use section of this Oxymorphone wiki page it says: "Until its removal from the United States market in the early 1970s, oxymorphone in the form of Numorphan 10 mg instant-release tablets was one of the most sought-after and well-regarded opioids of the IV drug using community. Known popularly as "blues" for their light blue color, the tablets contained very few insoluble binders — making them easy to inject — and were extremely potent when used intravenously. "Blues" were also considered to be especially euphoric; comparable to or better than heroin"

dependence liability should be extremely high for both or for at least oxymorphone if heroin & morphine are going to have that.

• Not quite - the current version is time-release only, making it virtually impossible to convert to an injectable for drug users. The low efficiency of orally administered opiods (hence, higher cost), further decreased through time-release, makes this drug much less euphoric and desirable for addicts. If anything, the time-release formula makes it more suited for substitution treatment. —Preceding unsigned comment added by 128.195.186.78 (talk) 11:21, 27 September 2007 (UTC)

Not Quite- You are so very wrong about thisItalic text. This drug is high, extremely addictive. The time release is being by passed by high school kids. (I will not say how I don't want to teach someone that may not kwow.) I have a 18 year old daughter that will be enjoying her 19th birthday in rehabilation due to the highly additive nature of this drug when used outside of doctors supervision. So don't beleive that this time release is component makes this drug anyless addictive. Don't fool yourself.--Fatherwithrehabdaughter (talk) 02:25, 10 May 2008 (UTC)Link title --Look, all opioids are addictive. But wiki is about producing accurate *scientific* data, not anecdotal data. Just because a drug is extremely potent, does not mean it is extremely efficacious or extremely addictive. 122.164.57.6 (talk) 03:46, 20 September 2008 (UTC)

• Speaking as an oxymorphone addict, and having friends who are addicted to this: the dependence potential is EXTREMELY high. First off, there are most certainly IR forms of oxymorphone, I don't know why you would say otherwise. I have a huge stock of Opana IRs I bought up last year. I also don't understand this statement in the article: "It differs from morphine in its effects in that it generates less euphoria, sedation, itching and other histamine effects" Less euphoria? Morphine produces virtually no euphoria for me at any dose (never has), nor anyone I know, whereas oxymorphone feels so good you think you might die. Also, even if there were only ER versions, that doesn't mean it's not abusable, addictive, or even injectable. Oxycontin, for example (and yes I know it's a different chemical) has a time release which is rendered ineffective merely by crushing it up. People I know who are addicted to oxymorphone are injecting huge amounts (hundreds of mg a day or so) of it, after having been dependent for a long time. —Preceding unsigned comment added by 24.235.73.151 (talk) 14:12, 29 November 2009 (UTC)

I added a CITATIONS NEEDED tag to the end of the line, "It differs from morphine in its effects in that it generates less euphoria, sedation, itching and other histamine effects". I might remove it eventually because this seems pretty anecdotal. --SlimNm (talk) 01:20, 23 December 2010 (UTC)

• I'd also like to take issue with this statement "However in cases where real physical pain is present, almost invariably the body prevents the development of true addiction to oxymorphone for a combination of psychological, neurological, and endocrinological reasons." I think a source needs to be cited. "a variety of reasons" is very vague. I was originally taking oxymorphone for severe post-surgical pain, and become severely addicted (not just dependent) to it. —Preceding unsigned comment added by 24.235.73.151 (talk) 14:19, 29 November 2009 (UTC)

-It depends on the quality of the heroin to say whether oxymorphone is more potent. Heroin that is more pure would be more effective than a low milligram amount of Opana. Doing a lot of any drug will increase its effectiveness. Taking between 20-80 mg of Opana could be comparable to a few mg of Heroin depending on purity. I will say that Opana is definitely the most potent pain pill out there besides Fentanyl. I disagree with the statement that Hydromorphone is more potent than Heroin. Heroin is illegal for a reason, if that was true then we should all be able to get prescriptions of smack. —Preceding unsigned comment added by 204.52.215.151 (talk) 00:28, 13 June 2010 (UTC)

• Potency is a measurement of how much of a given substance is required for it to be biologically active. Fentanyl is much more potent than morphine, and morphine is much more potent than tramadol. Potency has nothing to do with dependence liability. Heroin is probably active at 2-5mg, yet fentanyl is active at 25mcg, and heroin has a much higher dependence liability than fentanyl. Just because the substance is more potent does not mean it is more euphoric. Heroin is known to be more euphoric than most opioids because the acetyl groups allow it to quickly pass the blood-brain barrier and thus the levels raise faster. Studies show that addicts given many different opioids and asked to identify heroin will almost always identify only heroin and morphine. This is noted in the heroin article. In short, potency is misunderstood by most people and does not equal dependence liability. Dependence liability has to do with the ratio of positive effects (euphoria, analgesia, etc) against negative effects (nausea, vomiting, etc). We've been tinkering with the morphine molecule for over 100 years trying to vary the effects here and there (less euphoria, more analgesia, etc), so of course different substances have different dependency liabilities regardless of potency. That is, after all, the entire point. 69.250.33.145 (talk) 18:18, 23 July 2011 (UTC)

Image

note:the image of oxymorphone is a not right, the single bonded o's hould be OH's, as in dihydroxy. (comment moved from page by Dirk Beetstra ^{T C} 08:53, 13 November 2006 (UTC)).

Origin of propenyl and cinnamyl ester info

Where did this chemistry info about propenyl and cinnamyl esters come from? I've studied opioids extensively and have never heard of this. I would be hard pressed to find research to back it up. I would think if those groups were known to be potent, there would be research. Furthermore, acetic acid can form an ester with the hydroxy groups, but since cinnamyl and propenyl groups are not carboxylic acids, they cannot form an ester bond. If one were to condense cinnamyl and propenyl alcohols with the 6 and 14 hydroxys, you would have a propenyl ether and cinnamyl ether.-Junky getting a PhD—Preceding unsigned comment added by 144.92.229.97 (talk • contribs)

I'm not sure who added the info about the SAR but it's accurate. I have a couple of journal articles about the development and testing of the compounds mentioned in the article and would post them as citations if I could find them but they are currently unavailable due to computer trouble. I will post them as soon as I can find them, unless someone beats me to it. Also, it would be nice to know what's being measured when the article says such and such a derivative is "(x) times more potent than" the parent compound (or morphine? the article's not clear about that either), how exactly it's more potent. As an analgesic? In the rat tail-flick test? The formalin test? In vitro K_i values for opioid receptors? MOR, KOR, DOR, ORL-1? Et cetera.

The figures come from here:

Greiner E, Spetea M, Krassnig R, Schu¨ llner F, Aceto M, Harris LS, Traynor JR, Woods JH, Coop A, Schmidhammer H (2003) Synthesis and biological evaluation of 14-alkoxymorphi- nans. 18. N-Substituted 14-phenylpropoxymorphinan-6-ones with unanticipated agonist properties: extending the scope of common structure-activity relationships. J Med Chem 46:1758–1763 —Preceding unsigned comment added by 90.203.62.197 (talk) 18:32, 17 December 2010 (UTC)

As for the 14- derivatives of oxymorphone, I'm pretty sure they are ethers and not esters. Again, I would have to check the referenced (though not cited) articles in order to be certain. Another modification that increases potency that isn't mentioned is the substitution of a phenethyl group for the N-methyl group. As far as I know, no one has synthesized and tested N-phenethyl-3-acetyl-14-cinnamoyloxymorphone yet, so its effects are idle speculation at this point. Porkchopmcmoose 02:40, 31 December 2006 (UTC)

I have also run across the cinnamic acid esters at the 14 position of oxycodone, but not oxymorphone. I'm afraid my citation was from an online module of a US university degree paper & it's no longer on-line. A Citation would be appreciated.

Found the reference...

so which is it re: euphoria?

On the other hand oxymorphone can generate a serious narcotic habit rather quickly in those who take it recreationally in that it has powerful euphorigenic (contradiction to first paragraph which says it has less euphorigenic properties than morphine.)properties which some rank as the highest amongst narcotics, many placing it above morphine, heroin, hydromorphone, and dextromoramide.

somebody seems to have edited this and noted that the opening paragraph is inconsistent with this further down in the abuse section. which is it? i've never abused it, so i couldn't comment. :) 76.111.68.88 (talk) 02:48, 24 June 2010 (UTC)

So I fixed this and a bunch of other stuff. I'm a long term opiate patient (not a junky) and have been prescribed just about everything under the sun. Right now, I'm taking Opana, so I figured I'd expand that section a little, and clean up the wording I mentioned above. And yeah, it was a slobbery mess. 76.111.68.88 (talk) 10:43, 21 July 2010 (UTC)

I am an expert when it comes to Oxymorphone. I have used it via every route of administration over the last 5 years. I will tell you that this drug is extremely euphoric; however, that euphoria doesn't last long. Only a short few months after initially taking it, I had my dosage tripled from what it originally was. Tolerance developed quickly and euphoria quickly disappeared with daily use. The only way to feel the euphoria again was to wait a few days between doses. I remember telling myself when I first got the medication, "This is the best, most euphoric chemical on the face of the planet." Now, it's like every opiate where if I don't take it every 6 hours I get the most intense withdrawals. The euphoria is gone, but I can get it back if I want to wait a few days and endure extreme torture to get my tolerance to go down. Tolerance builds up the fastest I have ever seen with this medication, and even waiting a week will make your tolerance drop as fast as it went up. However, it returns to where you left off within 4 consecutive usages, so there is basically no way to return to how the drug first worked without months of abstinence. My primary route of administration is insufflation, and I still feel that this is the most euphoric administration route after IV. I also know many others who use this drug daily with stories very similar to mine. — Preceding unsigned comment added by 68.4.207.142 (talk) 17:20, 24 June 2012 (UTC)

'extended release' dangerous with alcohol... but does not 'cause dose dumping'?

How can this be, if it's not contraindication of mixed downer drugs (it says: 'extended release' specifically as being the kind that is dangerous) how is this danger not from dose dumping? Does it mean Opana ER cannot be dose dumped through simply crushing? This needs to be clarified. 65.102.29.207 (talk) 00:24, 23 July 2010 (UTC)

This information is from the package insert of generic oxymorphone extended release tablets:

In Vivo Oxymorphone Hydrochloride Extended-Release Tablets Formulation-Alcohol Interaction

Although in vitro studies have demonstrated that oxymorphone hydrochloride extended-release tablets do not release oxymorphone more rapidly in 500 mL of 0.1N HCl solutions containing ethanol (4%, 20%, and 40%), there is an in vivo interaction with alcohol. An in vivo study examined the effect of alcohol (40%, 20%, 4% and 0%) on the bioavailability of a single dose of 40 mg of oxymorphone hydrochloride extended-release tablets in healthy, fasted volunteers. The results showed that the oxymorphone mean AUC was 13% higher (not statistically significant) after co-administration of 240 mL of 40% alcohol. The AUC was essentially unaffected in subjects following the co-administration of oxymorphone hydrochloride extended-release tablets and ethanol (240 mL of 20% or 4% ethanol).

There was a highly variable effect on Cmax with concomitant administration of alcohol and oxymorphone hydrochloride extended-release tablets. The change in Cmax ranged from a decrease of 50% to an increase of 270% across all conditions studied. Following concomitant administration of 240 mL of 40% ethanol the Cmax increased on average by 70% and up to 270% in individual subjects. Following the concomitant administration of 240 mL of 20% ethanol, the Cmax increased on average by 31% and up to 260% in individual subjects. Following the concomitant administration of 240 mL of 4 % ethanol, the Cmax increased 7% on average and by as much as 110% for individual subjects. After oral dosing with a single dose of 40 mg in fasted subjects, the mean peak oxymorphone plasma level is 2.4 ng/mL and the median Tmax is 2 hours. Following co-administration of oxymorphone hydrochloride extended-release tablets and alcohol (240 mL of 40% ethanol) in fasted subjects, the mean peak oxymorphone level is 3.9 ng/mL and the median Tmax is 1.5 hours (range 0.75 to 6 hours).

Co-administration of oxymorphone and ethanol must be avoided.

Oxymorphone may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression because respiratory depression, hypotension, and profound sedation, coma, or death may result.

End package insert.69.250.33.145 (talk) 21:09, 23 July 2011 (UTC)

The statement that OPANA ER includes orthos protection including a small amount of naltrexone is not supported by the drug's package insert as reprinted in the Physicians Desk Reference. —Preceding unsigned comment added by 216.184.23.238 (talk) 23:03, 10 March 2011 (UTC)

"empathogen"

In the article, under the illicit use section, it has a kind of slant that it has empathogenic, anti-depressive properties. It seems like the article is glorifying the drug. Now, I for one agree with these things, and do think opioids have these types of uses and should be talked about more. However, it kind of seems ridiculous that the main place for all this info is some random opioid. It seems that they removed that part from the oxycodone article -- I think we should either remove it from here, move it to the opioids article, or put it back in the oxycodone article. For consistency, y'know? 69.142.35.12 (talk) 09:23, 23 May 2011 (UTC)

This drug DOES have anti-depressive properties superior to any other opiate I've used, even Oxycodone. It gives you energy, happiness, analgesia, etc. all in one little pill. I'd honestly say this medication should not be used on it's own as an antidepressant, but in a patient with pain and depression, it would be a superior choice over other medications like morphine that make the user more drowsy and "out of it." Source: personal use for 5 years, second-hand experience from 10+ users. — Preceding unsigned comment added by 68.4.207.142 (talk) 17:25, 24 June 2012 (UTC)

Pain research has shown that chronic pain tends to lead to clinical depression. Alleviate the pain, the depression subsides. That doesn't make an opioid analgesic an anti-depressant, only a treatment for the cause of the clinical depression.Wzrd1 (talk) 02:52, 27 October 2012 (UTC)

Oxymorphone tautomers

http://www.bluelight.ru/vb/attachment.php?attachmentid=4825&d=1188845386 Nagelfar (talk) 23:32, 3 March 2012 (UTC)

New CDC alert on recreational use and thrombotic thrombocytopenic purpura

Uncertain if including the information would improve the article. It appears that some of the compounds in the newest formulation may be involved. Uncertain at present if the polyethylene oxide (PEO), polyvinyl alcohol, and talc formulated in to prevent pulverizing the tablet is responsible or not. The URL to the health alert network article is: http://emergency.cdc.gov/HAN/han00331.asp Wzrd1 (talk) 02:56, 27 October 2012 (UTC)

Opana abuse leads to HIV outbreak

Adding information on the HIV outbreak in Indiana due to the injection use of Opana. Tarynng5 (talk) 04:33, 17 October 2018 (UTC)

UCSF SoP CP 133 Proposed Edits

Update the list of side effects to include common side effects of taking the medication. This will also include common DDIs (drug-drug interactions) and Drug-Disease interactions/considerations.

Update "the medical use" section that would go over treatment algorithms and guidelines of the use of this drug. For instance, would it be used 1st line, 2nd line, last line, etc, and in under what particular circumstances would a prescriber start a patient on this opiod medication. Will clean the section into a more reader friendly, and organized format. (Sae Lome lee) — Preceding unsigned comment added by Saellee (talk • contribs) 04:54, 17 October 2018 (UTC)

UCSF Student Updates/Edits Log

Edit October 17 2018

Update common dosing forms and amounts, as well as recommended dosages for patient use with their indications based on medical guidelines. The way it currently is on the WikiPage under society and culture only goes into the brand names. I want to maybe make a table, delving more into an easy way to look at the brand name offered (or generic) and know what dosage form the medication comes in, followed by regular dosing practices. MichelleBretschneider (talk) 04:43, 17 October 2018 (UTC)

Edit Nov 1, 2018

Added the "Availability" heading with "Brands and Forms" and "Oxymorphone Dosing" subheaddings. Decided not to go into depth on dosages for use as that is more patient and doctor specific. The information I was going to add to "Society and Culture" I instead just added here. Also added "Indications" table under "Medical Uses" heading for easier/faster information gathering. MichelleBretschneider (talk) 02:51, 2 November 2018 (UTC)

Expanded abuse stories under "Society and Culture" heading. Added more details to the headlining story about HIV outbreak in Indiana linked to oxymorphone abuse. Tarynng5 (talk) 03:41, 2 November 2018 (UTC)

Revised the "Medical Use" section by clarifying the indications for immediate use. Made clear that chronic opioid treatment therapy for patients is not recommended per the CDC, and that this particular drug should not be the 1st line. Took out the possible nasal formulation possibility as it is not an available option at this time. Added citations for the controlled substance class. — Preceding unsigned comment added by Saellee (talk • contribs) 04:02, 2 November 2018 (UTC)

Added the "Special Populations" heading. Described some considerations when certain populations are prescribed oxymorphone and some monitoring parameters when they're on it. — Preceding unsigned comment added by Kwong89 (talk • contribs) 01:54, 4 November 2018 (UTC)

Edit Nov 19, 2018

Made edits based on feedback from peers. Was unable to link "IR" and "ER" to a page that would describe them, since no such pages on Wikipedia exist. Instead added a sentence on what they mean and how to find out more information on this information at the bottom of the 'Brands and Forms' section. Added links to other wikipedia articles for key words used in 'Brands and Forms.' Updated the sources to remove any lexicomp sources, specifically for the dosing table. Removed table stating indications under 'Medical Uses' as I was unable to find proper citation (readily available outside of lexicomp/closed publication guidelines) for most of the indications stated in the table initially, and removing those un-citable indications left only 2 indications, which were appropriately stated in the paragraph above and served no purpose being re-stated in a table. Removed the sentence in 'oral dosage forms' that duplicated a statement made twice already in the page about the removal of Opana ER from the market in order to prevent redundancy. MichelleBretschneider (talk) 05:30, 20 November 2018 (UTC)

Pharmacy Student Peer Reviews

Peer Review by Group 14:

1. Does the draft submission reflect a neutral point of view? If not specify In my opinion, the draft submission does reflect a neutral point of view. Facts were used and backed up with citations from guidelines on pain management. It showed the benefits and risks of using oxymorphone, which is consistent with the neutral content.

2. Are the points included verifiable with cited secondary sources that are freely available? If not specify So far - cited secondary sources are freely available. Oral dosage forms were accessed via Lexi-Comp and may not be freely available to the public. Can consider referencing package insert. Henryhuang24 (talk) 04:22, 8 November 2018 (UTC)

3. Are the edits formatted consistent with Wikipedia's manual of style? If not, specify The new section that was added, which was the "availability" section did not seem to follow Wikipedias manual of style because a few of the sentences were not cited. My impression was that every single sentence, or every other sentence, had to be sited, with the citation after the period. Other than that, the sources in the medical use section seem to be cited appropriately and the actual source seems legitimate have a lot of good information.Dmorovati91 (talk) 21:08, 7 November 2018 (UTC)

4. Is there any evidence of plagiarism of copyright violation? If yes, specify.

From comparing the passages on "Medical Uses" with the original sources, I believe the authors were able to present the concepts in lay language, with minimal medical jargon. It may be helpful to distinguish between ER and IR formulations or link to a wikipedia page that explains this. However, in "Special populations," I think there needs to be more editing to prevent copyright violation and increase use of lay language for the general audience. This following line is very close to the original passage.

From the original source: "Mothers who are physically dependent on opioids may give birth to infants who are also physically dependent." In "Special Populations": "Mothers who are physically dependent on oxymorphone during pregnancy may give birth to infants that are also dependent."

I suggest including a description or links to concepts for the medical terms in this section such as "cognitive impairment," "neonatal withdrawal symptom," and "narrow therapeutic window". For example, "neonatal withdrawal symptom" could be hyperlinked to the wiki article "neonatal withdrawal." These terms are familiar to health professionals, but the intended reader may not have a background in this. Jessicali cp133 (talk) 22:13, 7 November 2018 (UTC)

Peer Review by Group 30:

1. Does the draft submission reflect a neutral point of view? If not, specify…

The draft submission appears to mostly reflect a neutral point of view. The addition of the Special Populations section serves the role of informing readers in an unbiased manner about different factors to be aware of when considering the use of oxymorphone, such as an individual's age, pre-existing condition(s), and child-bearing status. The Abuse section was revised in great detail, which provides pertinent background information regarding the high addictive potential of oxymorphone and how abuse of it contributed to the opioid epidemic. However, there seems to be a greater emphasis on the urge for the FDA to remove this drug from the market due to its abuse potential, as the same information is mentioned in the second introductory paragraph, Availability section, and at the end of the Abuse section. While it is important for readers to be cognizant of its abuse potential, mentioning this under the Abuse section alone should suffice. Overall, it was easy to read through, and it provided a broad scope of the pros and cons of oxymorphone. Carolyntang1 (talk) 22:31, 8 November 2018 (UTC)

2. Are the points included verifiable with cited secondary sources that are freely available? Under special populations, the source cited at the end of the last paragraph is not accessible to the public. Every other edit has a free available secondary source to verify. Jasperhai (talk) 01:58, 9 November 2018 (UTC)

3. Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify…

• Overall the edits follow Wikipedia’s manual of style.
• I would recommend not using contractions (ex. change “fentanyl’s occasional severe side effects” to “the occasional severe side effects of fentanyl”).
• “Centers for Disease Control and Prevention” should have “(CDC)” following to adhere to the rule of writing out both the full version and the abbreviation at first occurrence
• Do not use the word “current” when talking about street price. wiki states what is current now may not be current in the future.
• Also remove “currently” from the Oxymorphone Oral Dosage Forms section
• not sure why citation 11 under Brands and Forms is in parentheses
• I would remove the SubQ abbreviation under Brands and Forms because it is not really a standard abbreviation
• Make sure all citations are at the end of the sentence (citation 39 in abuse section) Emilyhsu94 (talk) 18:38, 8 November 2018 (UTC)

4. Is there any evidence of plagiarism or copyright violation? If yes, specify…

• There seems to be similar word choice between the original resource and the wikipedia article in the line about physical dependence of oxymorphone in mothers during pregnancy. "Mothers who are physically dependent on oxymorphone during pregnancy may give birth to infants that are also dependent." The rest of the edits show no signs of plagiarism or copyright violation.
• I would recommend against use of the word "recently" in describing the withdrawal of Opana ER from market and instead simply stating the approximate date
• Avoid using "inside net" resources, including Lexi-Comp through the UCSF library Tiffanygu (talk) 04:27, 9 November 2018 (UTC)

5. Has the group achieved its overall goals for improvement? If not, specify… Yes, the group has achieved all initial goals outlined in the talk page while maintaining a neutral point of view, using secondary sources that are freely available, adhering to the the Wiki manual of style, and avoiding plagiarism. Justin Sims — Preceding unsigned comment added by Wjisksi007 (talk • contribs) 04:17, 9 November 2018 (UTC)