Gerald Hurowitz, M.D.·Published 27 March 2012·8 min read
Key points
He was dark-haired and handsome, popular with his friends and doted on by his family.
But when his mother got divorced and moved to be near family in rural Scott County, Indiana, Coomer began running with a crowd there that abused prescription painkillers to get high.
One night last July, Coomer tried something new - Opana, a powerful opioid painkiller containing oxymorphone.
"It's a nightmare every single day," said his mother, Melissa Himmelheber, 43, who wiped away tears as she showed pictures of her lost son.
Back in high school in Houston, Texas, C.J. Coomer got good grades and played football. He was dark-haired and handsome, popular with his friends and doted on by his family.
But when his mother got divorced and moved to be near family in rural Scott County, Indiana, Coomer began running with a crowd there that abused prescription painkillers to get high. His weight dropped from 210 pounds to just 140 pounds (64 kg), he couldn't work, and was constantly borrowing money.
One night last July, Coomer tried something new - Opana, a powerful opioid painkiller containing oxymorphone. He overdosed and died at the age of 24.
"It's a nightmare every single day," said his mother, Melissa Himmelheber, 43, who wiped away tears as she showed pictures of her lost son. "This is a family that was extremely close. Now we're just picking up the shattered pieces."
Prescription drug abuse is the new scourge of rural America. It now leads to more deaths in the United States than heroin and cocaine combined, and rural residents are nearly twice as likely to overdose on pills than people in big cities, according to the Centers for Disease Control.
What is Opana? Opana (oxymorphone) is a opioid pain reliever. It is similar to morphine. An opioid is sometimes called a narcotic.
Opana is used to treat moderate to severe pain. The extended-release form of this medication is for around-the-clock treatment of pain.
Opana may also be used for purposes not listed in this medication guide.
While methamphetamine addiction has long been associated with small towns, prescription painkillers have overtaken meth as the most abused drugs in places such as southern Indiana, according to local authorities.
CONTRAINDICATIONSOPANA® ER is contraindicated in patients with a known hypersensitivity to oxymorphone hydrochloride, morphine analogs such as codeine, or any of the other ingredients of OPANA ER; in patients with moderate or severe hepatic impairment or in any situation where opioids are contraindicated such as: patients with respiratory depression (in the absence of resuscitative equipment or in unmonitored settings), acute or severe bronchial asthma, hypercarbia, and in any patient who has or is suspected of having paralytic ileus.
OPANA ER is not indicated for pain in the immediate post-operative period or if the pain is mild, or not expected to persist for an extended period of time. OPANA ER is only indicated for post-operative use if the patient is already receiving the drug prior to surgery or if the post-operative pain is expected to be moderate or severe and persist for an extended period of time. Physicians should individualize treatment, moving from parenteral to oral analgesics as appropriate (see American Pain Society guidelines). OPANA ER is not indicated for pre-emptive analgesia (administration pre-operatively for the management of post-operative pain).
Written and revised by
Gerald Hurowitz, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
Opana is the hot new prescription drug of abuse, sometimes with tragic consequences.
At least nine people have died so far this year from prescription drug overdoses in Scott County, Indiana. Most of the fatalities involved Opana, according to county coroner Kevin Collins.
Before 2011, only about 20 percent of the cases referred to the coroner were overdose deaths, and most of those were suicides rather than accidents. Last year, prescription drug overdoses accounted for 19 deaths, or about half of all deaths referred to the coroner in this county of just 24,000 on the southern tip of Indiana, about 30 miles from Louisville, Kentucky.
"We're seeing a lot of 25-year-olds who are dead for no apparent reason," said Collins, who is so disheartened by the overdoses that it is one reason he won't run for reelection in May.
{pagebreak}
POTENT, DEADLY
Law enforcement officials are alarmed by the rise of Opana abuse, which they said started after Oxycontin was changed in late 2010 to make that drug more difficult to snort or inject for a heroin-like high. Oxycontin is a brand of oxycodone.
Opana abuse can be deadly because it is more potent, per milligram, than Oxycontin, and users who are not familiar with how strong it is may be vulnerable to overdosing.
Opana, known by such street names as "stop signs," "the O bomb," and "new blues," is crushed and either snorted or injected. Crushing defeats the pill's "extended release" design, releasing the drug all at once.
"This Opana pill has really kicked us in the rear," said Indiana State Police Sergeant Jerry Goodin. "We've never seen an addiction like this."
Like other effective centrally-acting analgesics, some of the additional effects of oxymorphone can include euphoria, anxiolysis, promotion of sociability, and other similar effects that can cause psychological addiction to the drug. Also, like all other opiates, oxymorphone is physically addictive and can cause opiate withdrawal symptoms.
Opana does have euphoric effects, and they are short-lived. This is one of the crucial elements of a drug that can generate a serious narcotic habit rather quickly in those who take it for recreation and require more doses to maintain a stable level of euphoria. These effects however, barring enhancement with alcohol or other substances or means of administration other than oral, are less pronounced than that of morphine, fentanyl or dilaudid however, as mentioned previously, when taken intranasally the euphoric effects are far more pronounced.
The significant antidepressant and empathogenic properties of oxymorphone and other dihydromorphinone class semi-synthetic opioids is currently of interest to both the underground and the medical establishment, the latter of whom are "re-discovering" the anti-depressant effect and its relatively low ratio of toxic effects and lack of association with patient suicide attempts (see the oxycodone discussion for further information and footnotes) and Opana ER has been proposed as an alternative to methadone and other extended-release and/or long lasting drugs like Morphine, extended-release dihydrocodeine, buprenorphine, and 24-hour hydromorphone tablets for opioid detoxification and maintenance.
Oxycontin's new pills make it harder to crush them into a powder as they instead become gummy and cannot be readily snorted or injected. This drove abusers to switch to Opana or to generic, immediate-release forms of oxycodone, according to John Burke, president of the National Association of Drug Diversion Investigators. Drug abuse experts have also found an increase in heroin use.
Endo Pharmaceuticals, which produces Opana, announced in December that it would reformulate Opana. The new pill is being manufactured now.
The new formulation makes it difficult to crush and it turns viscous or "gooey" if an abuser tries to add liquid to it, said company spokesman Kevin Wiggins. When used properly, Opana is indicated for chronic low back and osteoarthritis pain, and cancer pain.
But the old form of Opana is still available, and pharmacy and home robberies are on the rise as addicts search for a way to get their fix, according to police.
"We're pretty much consumed by it," Shane McHenry, a detective with the Dearborn County Sheriff's Department in southern Indiana, said of Opana. He said users who cannot afford Opana sometimes travel to Cincinnati to get heroin, which is cheaper in smaller amounts.
Fort Wayne, Indiana reported about 11 pharmacy robberies related to Opana since Endo announced the reformulation, according to Fort Wayne police spokeswoman Raquel Foster. The thief would hand the pharmacist a note, as in a bank robbery, threatening harm if Opana was not delivered.
{pagebreak}
MANY SOURCES
The Opana problem has been reported by abuse experts around the country. In Florida, for example, the number of oxymorphone-related deaths rose to 493 in 2010, an increase of 109 percent from the previous year, according to Jim Hall, director of a drug abuse center at Nova Southeastern University in Florida.
Some users and dealers get painkillers from so-called "pill mills" - storefront pain clinics that sell drugs for cash up front, often to out of-state buyers who take them for resale.
But the other way users get pills is from their doctors, or by buying from seniors looking to supplement a fixed income. One Opana pill brings up to $90 on the street depending on dosage, so it is tempting to sell, said Scott County Sheriff Dan McClain.
A woman in her late 70s was arrested in Austin, Indiana for exchanging pills for work around her house, McClain said.
In clinical trials there were several adverse events that were more frequently observed in subjects 65 and over compared to younger subjects. These adverse events included dizziness, somnolence, confusion, and nausea.
"Most of what I see is people with a prescription from their doctors and they need the money," said Austin, Indiana Police Detective Lonnie Noble. He said the appetite for Opana is "more aggressive" than it was for Oxycontin.
Nashville, Tennessee Detective Michael Donaldson, who also has seen an increase in Opana abuse, said many small towns have "dirty doctors" willing to give out unneeded prescriptions.
Scott County is one of the poorest areas in Indiana, with a median household income of $39,588 in 2010. It was a hot spot for oxycodone retail distribution in 2010, with 48.79 per capita dosage units - the highest in the state, according to Lori Croasdell, a coordinator for CEASe of Scott County, a drug abuse prevention group.
A northern section of Austin in Scott County showed signs of poverty and neglect. Run-down trailers and houses with broken windows and peeling paint were mixed in among well-kept homes and tidy gardens.
McClain said the drugs cause a vicious cycle of poverty, since abusers cannot hold a job. "Most of them sleep until noon, get up, and try to find a way to get another pill," said McClain.
One reason for the rise in prescription pill abuse is that Americans feel they can fix any problem - pain, depression, anxiety, hopelessness - with a pill, according to Shane Avery, a Scott County doctor. And some doctors, who may mean well but fear being sued for undertreating pain, give out pills better suited for cancer patients to soothe a backache, Avery said.
"The people who abuse prescription medications know how to doctor shop," said Collins, the Scott County coroner.
News