Injected Opana Tablets Causing Serious Blood Disorder

Last week, FDA officials announced that people who inject Opana tablets may develop TTP (thrombotic thrombocytopenic purpura), a serious and potentially deadly blood disorder.

Opana, which contains oxymorphone, is one of the most popular illicitly used prescription opioids in my area of Western North Carolina. Per milligram, oxymorphone is a little more potent than oxycodone. Opana became more popular with addicts as OxyContin became harder to find on the black market. Then in 2012, OxyContin was re-formulated to make it harder to inject. In 2011, Opana was also re-formulated to make the tablets crush-resistant.

However, the addicts I’ve admitted into addition treatment sometimes describe how they defeat the crush resistance of Opana ER, and those IV users are at risk for developing this disease of TTP. So far, there are no reports of TTP in patients who take the medication by mouth or by snorting it.

TTP, which stands for thrombotic thrombocytopenic purpura, is a blood disorder where platelets don’t function normally. They clump together in some places, like small blood vessels, where they can cause strokes, heart attacks, and kidney failure. In other areas of the body, bleeding can be seen, because the platelets aren’t available to help blood clot normally. The bleeding often occurs under the skin, causing the purpura which gives the disease its name.

Purpura

Since the early 1990’s, patients with TTP have been successfully treated with plasma exchange. With this process, somewhat like dialysis, the patient’s plasma is replaced with donor plasma. This procedure usually needs to be repeated every day until a response is seen, which may take weeks. Sometimes an immunosuppressant medication must also be prescribed. The mortality is very high (more than 80%) if not treated.

For now, it’s not known what component of the Opana ER tablets causes TTP. Patients have told me they add various substances to help the tablet dissolve, which I’m not going to describe here, and I wonder if these agents could play a role.

This week we’ve heard about the damage caused by corticosteroids that were contaminated by a fungus. At least that medication was intended to be injected. Oral tablets are not sterile. They contain fillers and stabilizing agents that wreak havoc when injected into the blood vessels of the body. Some addicts feel that pharmaceutical grade tablets are safer than other illicit opioids, but a non-sterile tablet can cause all kinds of damage. TTP is just the latest in a long list of medical problems that occur with intravenous drug use.

If you are injecting tablets, be kind to yourself: get treatment.

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9 responses to this post.

  1. I live in Western North Carolina and Yes it became a prevalent drug a few years back and was my last drug of choice prior to getting on MMT. My experience with Opanas was before they made them rubbery and less dissoluble. Although I did not inject them I found them only effective when they were crushed and snorted…otherwise I was forced to do way too many…So I might can understand the propensity one might have to inject the drug.

    When I went to my doctor appointment at the clinic…and I talked about my use had went exclusive to Opanas I was worried when the doctor seemed puzzled and ask me what Opanas were and well I called them out as oxymorphine which of course gave him an idea…It was the clinic director that was able to more firmly describe them and their abuse to the doctor well 4 years later….I am sure he is highly educated on them now. I hate it because what cost me 3 dollars a piece 4 years ago is costing my friends still caught in the grips of active addiction 30 dollars now and well families and lives are being destroyed by this drug. I do have friends that have now started injecting them and this article is very much appreciated as it will become a tool of mine to encourage who when I can that this is a greater concern then they know. So Thank you Dr. Burson.

    I feel so fortunate looking back and then being presented with these facts right now that I have chosen the MMT modality of recovery. I am not blinded by the addiction to these very pills any longer and I escaped a near hit. My route of administration with most all opiates had developed to snorting and I suffer some nasal/septum problems now that prior to my last to years of exclusive opana abuse I did not have evident. I wonder if this could be associated to what is going on with the injection of opanas since the nasal passages have the capillaries so exposed and closely surfaced???

    Reply

  2. Posted by Travis on October 20, 2012 at 2:47 am

    I’ve gotta assume that it’s the binders/fillers in the pills or like you said, something extra put in in the dissolving process. Wasn’t there a formulation of Oxymorphone around in the 70’s that was eventually taken off the market because of heavy abuse? I don’t recall this phenomenon back then..

    Reply

  3. Posted by nonya biz on December 10, 2012 at 1:25 am

    as former addict that has abused many types of medication, i can say that without a doubt its the binders that they use. im not bragging by any means, but i was one of the first people that developed and posted an extraction method back when the first generation opanas were released… this was back in 2008.

    the original opana tablets contain a time release agent called timerX. this is a mix of polysaccharides, namely xanthan gum and locust bean gum along with some dextrose. in addition, the tablets also contained PPG (polypropylene glycol), MCC (micro crystalline cellulose), and lactose in the 40s…

    the newer tablets contain a so far unidentified non-ionic surfectant similar to the matrix that is added to psuedoephedrine tablets to prevent extraction by meth chemists. one of these compounds is known as Eudragit (from the manufacturers website, Eudragit is described as “copolymer of ethyl acrylate, methyl methacrylate and a low content of methacrylic acid ester with quaternary ammonium groups.”)

    orally, these compounds are not very well absorbed and are passed out thru you know where… on the other hand, when these compounds are injected, they are not broken down and cause serious problems. the same thing happens to meth cooks that dont do a good job removing these compounds, and TPP is common in the meth scene.

    MCC is a liquid at higher temperatures, but after cooling it resolidifies. this is bad when it reaches the cooler extremities where the capillaries are transferring blood from arteries to veins. i dont have to explain what that means…

    the time release agents of these ER and CR pills behave in a similar method, but not by the same mechanism. the extraction is carried out without water using solvents that i will not name here. if any of the agent is extracted or sucked up the needle, its matrix is activated by the water in the blood stream. these compounds swell up when they come in contact with water, almost to twice their normal size. this is what cases the thrombosis.

    the sad part is that most people that abuse these type pills are not educated enough to understand that these compounds are viscus oily liquids until they come in contact with water. this means that it is nearly impossible to not suck up the agent with the dope. they subsequently inject it and within 12 hours, they notice that their arms will swell and turn red with sever pain. it takes forever for it to dissipate, as the compounds are not readily metabolized and will remain indefinitely if not treated.

    with all that being said, people will continue to abuse them. the new favorite is Palladone, a CR hydromorphone (yes, dilaudid) in a similar matrix, but it is more easy to defeat as they are more expensive and have not been widely prescribed. again, the agents cause the same problems for these abusers as well.

    look up the krokodile problem in the soviet union, or whatever you call the USSR these days. people are dying and having limbs amputated in the quest to get high…

    this is just further proof that the war on drugs doesnt work. education and harm reduction is the answer, not prohibition and abstinence…

    thank you for letting me clog your board up with this over long post. i just like your blog and thought i would share what i know about this issue, as it may help you help others in treatment.

    Reply

  4. This is a Pretty lame and boring blog. Does anyone else besides janaburson read, visit or post here? I got the feeling that janaburson was posing as other people by using aliases just to make it look as if there were actually people reading and responding. I want to see more responses and replies. I’m disappointed. Where else can I go to get more information about Opana besides this site?

    Reply

    • From Urban Dictionary: TROLL: “One who posts a deliberately provocative message to a newsgroup or message board with the intention of causing maximum disruption and argument”
      Begone, troll!!

      Reply

  5. I am a new poster and I have a question about oxymorphone…. The generic version of opana is now available and those do not have the timerx and are crushable, but because they are not made by endo, they do not contain those same fillers, so my question is: do those pose the same risk for top as the endos? I have not heard of any cases of people having any problems injecting those using an extraction method and secondly, it seems like all of those cases were happening ONLY IN ONE STATE and only one concentrated area? I think it was Tennessee? Has anyone ever heard of the occurring anywhere else except in that one particular area?

    Reply

    • Yes, any intravenous use of a pill meant to be taken orally will cause problems. This generic opana is not sterile. For oral consumption, it does not need to be sterile, since the gut has a natural barrier to these bacteria. But when you inject the crushed pill into your body, bacteria go along for the ride and can cause infection in various places. It is never safe (obviously) to inject substances into your vein that were not meant to be there. You can reduce the risk if you use filters. There’s some debate about whether heating the substance is advisable. Heating it may kill some of the bacteria but will put more debris into the solution you inject. Not heating it makes fewer non-drug particles dissolve into the solution but likely you’ll have more live bacteria.

      Reply

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