Extended-Release Opioids: Dangers, Differences, Precautions

Extended-release or sustained-release opioids tend to contain higher doses. They’re formulated to gradually release into the patient’s body over an extended time, typically either a 12-hour or 24-hour period.

However, this time-release mechanism can be bypassed depending on the technology used. Crushing, snorting, and injecting extended-release tablets greatly increases the risk of life-threatening overdose.

The Current Opioid Overdose Crisis

As of 2015, an estimated 1 6 million people worldwide have been affected by opioid use disorders. A majority of heroin users begin taking opioids as legally prescribed pain-relieving tablets. In 2016, the United States recorded over 42,000 deaths due to opioid overdose.

This number grows every year. Many of the deaths are attributed to recreational use. The illegal manufacturing of the potent synthetic opioids like fentanyl are largely to blame. Fentanyl is 80 to 100 times more potent than morphine. It is commonly mixed in illegally pressed pills and sold as Xanax or various other street drugs.

However, many of the deaths are due to recreational users who take legally manufactured synthetic opioids in ways that are not recommended by physicians.

A Safer Extended-Release Oxycodone

Efforts are being made through the coordinated efforts of pharmaceutical companies and the FDA to reformulate extended-release tablets to reduce the likelihood of overdose. Collegium Pharmaceutical’s Xtampza ER is a sustained-release version of oxycodone. Xtampza ER is used to treat moderate to severe chronic pain in opioid-tolerant patients. It’s made in sustained-release capsules of 9 mg, 13.5 mg, 18 mg, 27 mg, and 36 mg. The pills are designed to release a percentage of the drug immediately upon ingestion, with the majority of the drug being released gradually over a 12-hour period.

The patient takes two pills a day for around-the-clock pain relief. Taking more than 36 mg in a single dose or exceeding 72 mg in a 24-hour period dramatically increases the risk of overdose.

According to a recent study presented at PAINWeek 2017 in Las Vegas, Nevada, Xtampza ER’s new formulation has a lower abuse potential than immediate-release oxycodone. Typically, extended-release opioids have a higher abuse potential due to their higher drug content. When crushed, the total drug content is released into the system all at once, increasing the risk of overdose.

The opposite proved to be the case with Xtampza ER. Researchers evaluated the pharmacokinetics of crushed and intact extended-release oxycodone compared to crushed immediate-release oxycodone.

Participants were asked to rank the euphoria of the high along with its pain-relieving effects. Researchers used various metrics, including pupil constriction to determine the strength of the drug’s effects. In general, the smaller the patient’s pupils, the higher the intensity of the effects. When all the numbers were crunched, immediate-release oxycodone had an overall higher risk of drug abuse and overdose.

This is a great accomplishment, considering that sustained-release opioids tend to have a significantly higher abuse potential, especially when crushed.

A Safer Version of Opana ER

In similar fashion, Endo Pharmaceuticals came out with a reformulation of their extended-release oxymorphone hydrochloride tablets in 2012. Opana is derived from morphine but is significantly more potent. Opana ER was first approved in 2006. Just like Xtampza ER, it’s intended for the management of moderate to severe chronic pain that requires 24-hour pain relief.

In 2012, Endo Pharmaceuticals changed the formulation of Opana ER to make it more difficult to manipulate for snorting or injecting. The new formulation met the FDA’s regulatory standards for approval. Following the drug’s release, the FDA determined that the new formulation did not meaningfully reduce Opana ER’s abuse potential.

Endo suggested adding additional warnings to the Opana ER’s label to highlight the potential of drug abuse. However, since the drug’s 2012 release, more evidence has surfaced indicating additional risk factors.

FDA Requests Removal of Opana ER

The 2012 reformulation of Opana ER is significantly more difficult to take via injection. However, taking it through this route is still possible, and severely opioid-dependent users continue to crush, dissolve, and inject the substance.

Common side effects of Opana ER include nausea, vomiting, heart palpitations, sedation, drowsiness, and respiratory depression. When Opana ER is taken intravenously, these adverse effects can become intensified.

Clinically significant respiratory depression is more likely to occur when Opana ER is injected. This can lead to carbon dioxide toxicity, oxygen-deprivation, coma, critical organ failure, irreversible paralysis, brain damage, and death.

In 2015, state officials in Indiana to emergency action following an epidemic of HIV in Austin, Indiana. The epidemic was spread primarily by drug users who were injecting oxymorphone intravenously. This event was one of the final strikes against extended-release oxymorphone tablets like Opana ER. Following this event, the FDA formally recommended the removal of Opana ER from the market.

In 2017, Endo Pharmaceuticals voluntarily removed Opana ER from the market due to the high rates of overdose and risk factors associated with recreational drug use.

How to Take Opioids Safely

All opioids carry with them a high potential for misuse, addiction, and overdose. Substances like oxycodone, oxymorphone, morphine, codeine, and fentanyl are classified as Schedule II controlled substances by the FDA. The manufacturing and distribution of these drugs are tightly regulated. Most have limits as to how much can be produced each year.

The North American opioid overdose epidemic began in the late-1990s and has been growing exponentially ever since. In response, hospitals and physicians have taken the initiative to reduce the rate at which opioids are prescribed.

Patients should only be prescribed opioids when milder, non-opioid pain-relievers are ineffective. The minimum effective dose of opioids should always be prescribed. Doses can be gradually increased every few days until the minimum effective dose is achieved. In general, only opioid-tolerant individuals should be prescribed extended-release versions of opioids.

When it’s time to stop taking opioids, doses should be reduced gradually to minimize symptoms of opioid withdrawal. Discontinuation of opioid use should always be conducted under medical supervision for the best possible outcome.


If you or someone you love is struggling with opioid dependency, Stonewall Institute Treatment Center is more than happy to answer any questions you may have. Call us today at 602-535 6468 or email us at info@stonewallinstitute.com.

How to Talk to Your Kids About Addiction

Proposing a conversation upon your children about another’s substance addiction is never easy. Whether the addict is a parent, sibling, or other close relatives, a child’s comprehension on the subject remains vague. Therefore, the adult intending to initiate such a conversation is going to have to explain the situation properly and efficiently enough for a child’s understanding.

Statistics show that more than 28 million children have at least one alcoholic parent. These children have been shown to grow up with emotional, behavioral, and academic problems. This is due to the fact that these children grow up facing issues the average child doesn’t have to handle. With addiction’s arbitrary inclinations, substance-abusing parents are more likely to threaten their children to abuse, neglect, and the witness of domestic violence.

Over time, these effects play their role, and children of addicted parents end up four times as likely to become drug addicts themselves. Depending on their environment, there’s the strong chance they won’t understand a life outside of their drug infested home. However, there are steps that can be taken to avoid this. One of the most important being the proper conversation.

To whoever decides to take this task upon themselves, you should be aware of a child’s developmental stages in coordination to living within an addict’s home. For example, if the addicted parent(s) never gave their children proper discipline, there’s the impregnable possibility that they will grow up with a shortfall in self-discipline and an understanding of their responsibility.

Emotions within a child as such can be confusingly sporadic. Often, the case of resentment becomes an issue. Especially as a child enters their adolescent years. With these emotions in mind, the conversation about addiction can get tricky. What you are about to undertake is the explanation of addiction’s destruction to a young, fragile mind that has already witnessed much of the horror. We should attempt to put that horror into perspective and a clear understanding for the child’s sake.

Listed below are different factors to keep in mind when preparing for the conversation. Obviously, everyone’s situation is different and no two conversations will be alike. But these factors have remained consistent in terms of how to handle a child born into an addicted family.

  • Cue Yourself Properly

    There’s a time and a place for this conversation. Preferably, within a private setting and following a pinnacle moment of the addict’s abuse. The talk should be one without distractions and remain in a relaxed manner.

    If there’s a plan set forth to help the addict, use the opportunity as a way to speak with the child. Bringing up that a solution is set in place is a reassuring factor to the overall discussion. If any major changes are to be expected within the child’s life, to shy away from bringing them up. Be sure to always let the child speak if they desire to and let him/her learn to open up to such a dilemma.

  • Remember the Child’s Age

    The maturity of the child has much to do with the way you’ll speak of the matter to them. They may be too young for big language or too old for skimpy details. Be upfront and speak the truth, but keep in mind two important aspects.

    1. The amount of information a child can retain truly depends on their age and understanding.
    2. The details of the situation may (or may not) be inappropriate for certain periods of time. For example, if the child’s parents have recently overdosed on a substance and the child has yet to enter preteen years, you’ll want to go about the situation in an illustrative, yet, forgiving manner.

    Remember to always end the conversation with a sense of hope. No matter how old a person is, hope can be a leading factor in how someone handles with the emotions of an addicted parent.

  • Educate Yourself

    If you are fairly unaware of how addiction works outside of the obvious traumas, it’s vital you teach yourself about the situation. The internet offers research on any regard to the subject. A look through Stonewall Institute’s blog will even give you much information on a variety of topics.

    More often than not, a child will have many questions upon addiction. It shouldn’t be underestimated that they’ll probably believe whatever the adult has to say. Without proper answers, you’ll find yourself misleading. If you truly don’t have an answer, there’s no reason not to look one up together.

  • Remain Honest

    Never let yourself mock-up an explanation or work around certain matters that may be sensitive towards the child. Lying is another way of underestimating a child’s intelligence. Though they may believe a lie or two, it’s unfair to place them in such a position. Though it has been said many times, honesty can go a long way.

  • Liberate Humiliation and Create Perspective

    There are many instances where children will blame themselves for their parent’s downfalls. It’s important a child realizes it isn’t their fault. With this, an addict’s behavior and intentions have more of a possibility of coming into perspective.

    Through this perspective, a child holds the potential of realizing that they are facing troubles on their own. And that these struggles are not their faults. It’s key to make sure they realize they are not alone in this struggle. More often than not, the person attempting to give this conversation has, likewise, been through much due to another person’s selfish decision.

    This can be an enlightening moment to bring up what’s called “The Seven C’s”. The National Association for Children of Alcoholics” have created this list as a way for children to better understand their situation.

    1. I didn’t CAUSE it.
    2. I can’t CURE it.
    3. I can’t CONTROL it.
    4. I can take CARE of myself.
    5. By COMMUNICATING my feelings,
    6. Making healthy CHOICES, and
    7. By CELEBRATING myself.

  • Remain Open to the Child’s Words

    Children who are put in such a position may feel disconnected from many around them. If so, you should attempt to understand this disconnection and give them time to open up to you. The emotions they must combat are strong and patience is a vital factor in helping their comprehension.

  • Look for Other Support

    Sometimes we can’t give a child everything they need. No matter how hard we try, there are areas of understanding beyond our own comprehension. And professional help becomes a possibility. Whether it be a counselor, teacher, therapist, or religious leader, a child may find their comfort in places outside of you.

    If you or anyone you know is looking for a treatment plan or you would like more information on how to properly talk to children about addiction, please, give us a call at 602-535-6468 or email us at info@stonewallinstitute.com.

Kyle Penniman Addiction Counselor Arizona

Kyle Penniman is an addiction counselor treating addicts and alcoholics at Stonewall Institute in Phoenix. As an addiction recovery therapist, Kyle Penniman understands the complexities of substance abuse treatment. He searches out the needs of the individual and focuses on what triggers that individual to use drugs or alcohol. Then he instructs the client on a relapse prevention program to help maintain sobriety. To find out more, call Kyle Penniman at 602-535-6468 or you can visit him online at www.stonewallinstitute.com.

CEO & Clinical Director of Stonewall Institute Kyle Penniman

Kyle Penniman is CEO & Clinical Director of Stonewall Institute in Phoenix, Arizona’s best outpatient addiction treatment program. Kyle Penniman is an innovative addiction counselor who has developed an Intensive Outpatient Program that is both an effective and affordable addiction treatment program. If you or a loved one wants to learn how to maintain a clean and sober life, get the best alcohol and drug counseling you can find. Call Kyle Penniman at 602-535-6468 or visit the website at www.stonewallinstitute.com.

Kyle Penniman – Alcohol Counseling Services Arizona

Kyle Penniman of Stonewall Institute in Phoenix provides complete counseling services for alcohol treatment. With many years of clinical experience in alcohol treatment, Mr. Penniman offers the best alcohol treatment outpatient program in Arizona. As an addiction counselor, he offers evidence-based alcohol treatment that exposes underlying issues that can sabotage the ability to sustain long-term sobriety and recovery. If you are struggling with alcohol abuse and it is affecting your life, call Kyle Penniman at 602-535-6468 or visit the website at www.stonewallinstitute.com

Treatment for Crystal Meth Addiction Arizona

Stonewall Institute is an Arizona LGBTQ Affirmative Drug Rehab dedicated to helping anyone who has been caught up in an addiction to crystal meth.  We understand the special stressors gay addicts must deal with, and our addiction counselors are specially trained to help our clients feel respected and comfortable.  Our Intensive Outpatient Program takes place in an upscale office environment –not a hospital or institution.  If you need help with kicking crystal meth, our IOP accepts insurance and we offer a convenient payment plan.  Call today to make an appointment at 602-535-6468 for a complete clinical evaluation for substance abuse and visit our website at www.stonewallinstitute.com.