Opana (Oxymorphone) at a glance: schedule, half-life, and class
- Generic name
- Oxymorphone hydrochloride
- Brand names
- Opana (immediate release); Opana ER was withdrawn in 2017
- Drug class
- Semi-synthetic opioid agonist
- US legal status
- Schedule II, prescription only
- Approved uses
- Pain severe enough to require an opioid when other treatments are inadequate
- Forms
- Immediate-release tablets; extended-release generics
- Onset
- 30 to 45 minutes
- Half-life
- About 7 to 9 hours
- Broken down by
- The liver, mainly by glucuronidation (little CYP450 involvement)
- Reversal agent
- Naloxone
Opana uses: what oxymorphone is prescribed for
Oxymorphone is approved for adults with acute or chronic pain severe enough to require an opioid when other treatments are not enough. It is also a metabolite of oxycodone, formed in small amounts in the liver.[1]
In 2017 the FDA asked the maker of the reformulated Opana ER to remove it from the market. Despite an abuse-deterrent coating, people crushed and injected it, which was linked to an HIV and hepatitis C outbreak in Scott County, Indiana, and to a rare blood disorder called thrombotic microangiopathy.[2]
Opana dosage: how oxymorphone is usually prescribed
The figures below come from the FDA-approved label and describe how prescribers typically use oxymorphone. They are not personal dosing advice. A prescriber sets the dose for each person and adjusts it over time.[1]
| Product | Typical adult dose | Notes from the label |
|---|---|---|
| Immediate-release tablets, opioid-naive adults | 5 to 10 mg every 4 to 6 hours as needed | Take on an empty stomach, at least 1 hour before or 2 hours after eating |
| Extended-release tablets | Only for opioid-tolerant patients with daily, long-term pain | Swallow whole; crushing or chewing can release a fatal dose |
| Mild liver impairment or kidney impairment | Start at the lowest dose | Contraindicated in moderate or severe liver impairment |
| Older adults | Start at the low end of the range | Blood levels are higher after age 65 |
Opana (oxymorphone) side effects and risks
FDA boxed warnings
- Addiction, abuse, and misuse, which can lead to overdose and death.
- Life-threatening slowed breathing, especially when starting treatment or after a dose increase.
- Accidental ingestion, especially by children, can cause a fatal overdose.
- Use with benzodiazepines or other central nervous system depressants, including alcohol, can cause profound sedation, slowed breathing, coma, and death.[3]
- Prolonged use during pregnancy can cause neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated.
Common side effects include nausea, constipation, drowsiness, dizziness, itching, and sweating.[1]
Food and alcohol: food raises blood levels by about 50%, which is why it is taken on an empty stomach. Alcohol can sharply increase levels and must be avoided.[1]
Injection harms: injecting tablets designed to be swallowed can cause HIV and hepatitis C transmission, serious infections, and damage to small blood vessels and kidneys.[2]
Opana interactions: what not to mix with oxymorphone
Choose what it would be combined with:
| Combined with | What happens | Label guidance |
|---|---|---|
| Benzodiazepines (alprazolam, diazepam, clonazepam) | Profound sedation, slowed breathing, coma, death | Boxed warning; avoid unless no alternative |
| Alcohol | Stronger sedation and slowed breathing | Avoid |
| Gabapentin, pregabalin, sleep medicines, muscle relaxants | Additive sedation and breathing problems | Use caution; lower doses |
| MAO inhibitors (within 14 days) | Serotonin syndrome or opioid toxicity | Not recommended |
| Mixed agonist-antagonists (butorphanol, nalbuphine, pentazocine) and buprenorphine | Reduced pain relief; can trigger withdrawal | Avoid |
| Anticholinergic drugs | Severe constipation, urinary retention | Monitor |
This is not a full list. A pharmacist can check a complete medication list, including supplements and over-the-counter products.[1]
Opana overdose: signs of oxymorphone overdose and what to do
Oxymorphone overdose causes extreme sleepiness, pinpoint pupils, slow or stopped breathing, limp muscles, cold clammy skin, and unconsciousness.[1][4]
If someone may have overdosed
- Call 911 if the person is unresponsive, cannot be woken, has blue or gray lips, or is breathing slowly or not at all.
- Give naloxone (Narcan or a generic nasal spray, sold without a prescription) into one nostril. If there is no response after 2 to 3 minutes, give another dose.
- If you are trained, give rescue breaths. Otherwise place the person on their side so they do not choke.
- Stay with them. Naloxone can wear off before oxymorphone does, so the overdose can return even after the person wakes up.
- Most states have Good Samaritan laws that protect people who call 911 for an overdose from some drug charges.
Opana withdrawal timeline: how long oxymorphone withdrawal lasts
People who take oxymorphone regularly for more than a few weeks become physically dependent, even when they take it exactly as prescribed. Dependence is not the same as addiction, but it means stopping suddenly causes withdrawal.[1]
- 8 to 24 hoursEarly symptomsAnxiety, restlessness, yawning, sweating, runny nose, watery eyes, and muscle aches.
- Days 1 to 3Peak withdrawalDiarrhea, stomach cramps, nausea and vomiting, goosebumps, dilated pupils, fast heartbeat, and strong cravings. Rarely dangerous in healthy adults, but dehydration can be serious.
- Days 5 to 10, then weeksLingering symptomsPoor sleep, low mood, low energy, and cravings can continue for weeks. Tolerance falls quickly, which raises the risk of overdose if use restarts.
Warning: After a break, the body loses tolerance within days. Returning to a previous dose of oxymorphone can cause a fatal overdose.
The FDA warns against stopping opioids abruptly in people who are physically dependent. A prescriber can taper the dose gradually, often by 10% or less per month for long-term users, and medicines such as clonidine or lofexidine can ease symptoms. For opioid use disorder, buprenorphine and methadone cut the risk of death roughly in half.[5]
How to get prescribed Opana (oxymorphone) legally in the US
In the United States, oxymorphone is a Schedule II controlled substance. The only legal way to get it is with a prescription from a clinician registered with the Drug Enforcement Administration (DEA), filled by a licensed pharmacy. Depending on state law, that can be a physician, nurse practitioner, or physician assistant.[6]
- Refills: Schedule II prescriptions cannot be refilled. A prescriber can issue several prescriptions at once, each dated with the earliest fill date, for up to a 90-day supply.[7]
- Telehealth: federal flexibilities let DEA-registered clinicians prescribe Schedule II to V medicines after a telemedicine visit, without a prior in-person exam, through December 31, 2026. A permanent DEA rule was under final review in late 2026. State rules can be stricter.[8]
- Monitoring: prescribers and pharmacists in most states check a prescription drug monitoring program, a database of controlled-substance prescriptions, before prescribing or dispensing.
- Pharmacies: a legitimate pharmacy always requires a valid prescription, has a licensed pharmacist available, and is licensed in the state it ships to. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm a pharmacy is real.[9][10]
- Cost: generic immediate-release oxymorphone is available but costs more than generic oxycodone or morphine.
Traveling: keep the medicine in its original pharmacy container and carry a copy of the prescription. Check the rules of the destination country before travel, because many countries restrict controlled medicines or require a permit.
Can you order Opana (oxymorphone) online legally?
Yes, but only with a valid prescription and only from a pharmacy licensed in your state. Many licensed pharmacies, including mail-order pharmacies run by insurers, fill oxymorphone prescriptions online and ship them. Buying oxymorphone from a website that does not require a prescription is illegal, and the product is often fake.[9][11]
- See a licensed clinicianA clinician evaluates you in person or by telemedicine and decides whether oxymorphone is appropriate.
- The prescription goes to a pharmacyPrescriptions are usually sent electronically, straight from the prescriber to the pharmacy you choose.
- The pharmacy checks and fills itA pharmacist verifies the prescription and your identity, then dispenses the medicine in person or by mail.
Signs that an online seller is illegal:
- It sells oxymorphone with no prescription, or after only a short online questionnaire.
- It takes orders through social media, messaging apps, or email.
- It asks for payment in cryptocurrency, gift cards, or money transfers.
- It has no US street address, no state pharmacy license, and no pharmacist to speak to.
- Its prices are far below those of ordinary pharmacies, or it ships from another country.
The FDA's BeSafeRx tool links to each state's license lookup, and the National Association of Boards of Pharmacy lists verified online pharmacies.[9][10]
Opana price: how much does Opana (oxymorphone) cost without insurance?
Generic immediate-release oxymorphone is available but costs more than generic oxycodone or morphine.
What you pay depends on the strength, the number of doses, your insurance plan, and the pharmacy. Cash prices for the same prescription can differ several times over between pharmacies in the same town, so check current prices before you fill it.
Ways to pay less, legally:
- Ask the prescriber whether a generic oxymorphone is available. FDA-approved generics work the same way as the brand and usually cost much less.
- Compare cash prices between pharmacies before you fill the prescription.
- Use a free prescription discount card, such as GoodRx or SingleCare, when you pay cash. These cards cannot be combined with insurance on the same fill.
- For brand-name medicines, check the manufacturer's savings program or patient assistance program.
- Check your insurer's mail-order pharmacy, which may charge a lower copay.
Warning: A price far below what licensed pharmacies charge, especially with no prescription required, is a strong sign of an illegal seller and counterfeit medicine.[9]
Is Opana legal? Oxymorphone legal status in other countries
| Country | Status |
|---|---|
| United Kingdom | Class A |
| Canada | Schedule I of the Controlled Drugs and Substances Act |
| Australia | Schedule 8 controlled drug |
| International | Schedule I of the 1961 Single Convention on Narcotic Drugs |
Laws change and differ in detail. Check current rules before carrying any controlled medicine across a border.[12]
Common questions about Opana (oxymorphone)
Is Opana (oxymorphone) stronger than oxycodone?
Yes. By mouth, oxymorphone is about twice as potent as oxycodone per milligram, so doses are not interchangeable.
Why was Opana ER taken off the market?
In 2017 the FDA concluded that the risks of the reformulated Opana ER, mainly from people injecting it, outweighed its benefits, and asked the maker to stop selling it.
Should Opana (oxymorphone) be taken with food?
No. The label says to take it on an empty stomach, because food raises blood levels and can increase side effects.
How long does Opana (oxymorphone) stay in your system?
Its half-life is 7 to 9 hours. Urine tests usually detect it for 1 to 4 days, but standard opiate screens may miss it, so specific tests are used.
Can naloxone reverse an Opana (oxymorphone) overdose?
Yes. Naloxone reverses oxymorphone, but repeat doses may be needed, especially with extended-release tablets.
Can you buy Opana (oxymorphone) without a prescription?
No. Opana (oxymorphone) is a Schedule II controlled substance in the US, so it is illegal to buy or possess it without a valid prescription. Websites and social media sellers that offer it without one are not legal pharmacies, and the DEA warns that pills sold this way are often counterfeit and can contain fentanyl. The legal route is a visit with a licensed clinician, in person or by telehealth, and a prescription filled at a state-licensed pharmacy. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm an online pharmacy is real.
Sources
- Opana (oxymorphone) prescription information. DailyMed, US National Library of Medicine.
- FDA requests removal of Opana ER for risks related to abuse. US Food and Drug Administration, 2017.
- FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines. US Food and Drug Administration, 2016.
- Information about naloxone and nalmefene. US Food and Drug Administration.
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022. Centers for Disease Control and Prevention, MMWR.
- Controlled Substance Schedules. DEA Diversion Control Division.
- 21 CFR 1306.12, Refilling prescriptions; issuance of multiple prescriptions (Schedule II). Electronic Code of Federal Regulations.
- Prescribing controlled substances via telehealth. US Department of Health and Human Services.
- BeSafeRx: Your Source for Online Pharmacy Information. US Food and Drug Administration.
- Safe Pharmacy. National Association of Boards of Pharmacy.
- One Pill Can Kill. US Drug Enforcement Administration.
- International drug control conventions. United Nations Office on Drugs and Crime.
