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Opioid Addiction

Opioids are a class of naturally occurring and synthetic substances that have been used for both medicinal purposes and for recreation for more than a century. Opioids are unique among other medicinal and recreational drugs because they mimic chemicals that occur in our brains: endorphins. 

However, opioids are much more powerful than your own endorphins. They do the same things endorphins do, like regulate pain.  They do it at a much greater degree, which makes them useful in treating moderate to severe pain. Opioids also cause other effects like intoxication, sedation, and euphoria. 

Drugs that cause euphoria are often abused recreationally, and opioids are among the topmost commonly abused drugs in the United States. Opioid abuse can lead to chemical dependency, addiction, and overdose. 

In 2017, opioids were involved in 47,600 overdose deaths. Between prescription opioid misuse and the use of illicit heroin, there are an estimated two million Americans that are struggling with some level of opioid use disorder each year. Only a fraction of those that have an opioid use disorder receives treatment. 

Though opioid addiction is a chronic disease, it’s also one that’s treatable with the right therapy options for your individual needs. If you or someone you know has been using an opioid, it’s important to recognize the signs and symptoms of opioid use disorder. Read more about opioid addiction and how it can be treated. 

What Are Opioids?

Opioids are a class of prescription medications that are used to treat moderate-to-severe pain that results from surgeries or severe injuries. They are either man-made or occur naturally, but their synthetic makeup is derived from opium, which comes from the poppy plant.

Medical treatment for pain is widely viewed as the starting point for the use of these potent medications. In the 1990s, doctors began to treat pain as a serious medical issue and prescribed OxyContin and Percocet to help people who sought relief from chronic, enduring pain. 

This classification of drugs, which includes the illegal drug heroin, reduces the number of messages the brain receives about pain, and changes how the opioid user processes it. This happens when opioids interact and bind with opioid receptors on the nerve cells in the body and brain. 

Opioid medications are for short-term use only. They are considered safe for the limited time specified in a doctor’s prescription. However, that does not keep people from abusing the drug for its euphoric highs and effective pain relief. Prescription drug abuse means users:

  • Take more of the medication than prescribed
  • Take opioids without a prescription
  • Take them in a way that is inconsistent with their purpose and design

On the streets and in the recreational drug scene, which is where a large number of deaths occur, opioids are called a variety of names, depending on the drug itself. 

How Opioids Affect the Brain

All opioid medications bind to the Mu-opioid receptors, known as MORS, in the brain once they are ingested. NIDA explains that once these receptors are activated in the brain’s reward center, which is responsible for repeated drug use, “they stimulate the release of the neurotransmitter dopamine, causing a reinforcement of drug-taking behavior. 

The consequences of activating opioid receptors with externally administered opioids, such as heroin (versus naturally occurring chemicals within our bodies), depend on a variety of factors: how much is used, the location in the brain or body it binds, how strongly it binds and for how long, how quickly it gets there, and what happens afterwards.”

Large amounts of dopamine are released and flood the brain each time drug use occurs. Prolonged use minimizes pleasure over time, and abusing opioids only depletes the brain of dopamine. Chronic opioid users will find that they need to use more of the drugs because the brain’s response doesn’t respond as it did when use first started. 

The brain comes to rely on an outside source for its dopamine production, which becomes a problem when use is stopped. When users go through this period, they experience depression, anxiety, and even suicidal thoughts. 

Common Prescription Opioids

Opioid prescriptions are used to treat pain from surgeries, injuries, and chronic diseases. Most people that use them as directed, never experience chemical dependency or addiction. 

However, misusing prescription opioids can quickly lead to addiction and other consequences. Plus, studies show a link between the misuse of prescription opioids and used heroin.

 The National Institute on Drug Abuse (NIDA) reports that nearly 80 percent of the people that use heroin reported misusing prescription opioids first. Abused prescriptions often come from family members and friends that get more pills than they need and give the rest to someone who doesn’t have a prescription. If you have one of the following, prescriptions, it’s important to treat them with care:

Codeine – An opiate liquid pain reliever and cough suppressant prescribed to treat mild-to-moderately severe pain for short-term treatment. Street names for this drug include Captain Cody, Cody, Lean, Sizzurp, and Purple Drank.

Demerol – Known generically as meperidine or pethidine–Demerol is a fast-acting narcotic pain reliever commonly used as an anesthetic pain reliever for pregnant women who are in labor. On the streets, Demerol may be called demmies for short.

Darvocet – This medication, a combination of propoxyphene and acetaminophen, was taken off the market in 2010 by the U.S. Food and Drug Administration (FDA) after concerns arose about its effects on the heart. This drug has been linked to serious side-effects, and people are at risk of developing an opioid addiction.

Dilaudid – Known as hydromorphone hydrochloride generically, Dilaudid is derived from morphine and most commonly used in hospital settings. Dilaudid abusers often crush, chew, snort, or inject it when it is in a dissolved form so they can get the intense rush that occurs immediately after it enters the bloodstream. D, Dillies, Footballs, Juice, and Smack are some slang names for Dilaudid.

Fentanyl – This synthetic opioid is commonly used intravenously in medical settings as an anesthetic, but it is also used in the recreational drug scene and ramping up the risks with its deadly effects. The extremely potent drug is used to cut other drugs, such as heroin. Authorities say its emergence and use with other drugs is increasing opioid-related overdose death rates. On the streets, fentanyl is referred to as Apache, China Girl, China White, Dance Fever, Tango and Cash, and Friend.

Hydrocodone – Sold under the trade name Vicodin, Norco, Lorcet, and Lortab, hydrocodone is a semi-synthetic opioid derived from codeine. The effects of the euphoria associated with hydrocodone make it easy for people using the drug to develop an opioid addiction. Street names include Vike and Watson-387.

Methadone – Methadone is an opioid medication used to treat opioid addiction, but not without effects if used improperly. While it reduces withdrawal symptoms of other opioids, people can become dependent on it during addiction treatment. Using methadone with other opioids can lead to dangerous side effects.

Morphine – Morphine is an opiate that occurs naturally in plants and animals. It treats acute and chronic pain; however, it is highly addictive. Morphine is the most abundant analgesic opioid in opium, and its use is prevalent in medical settings. It can also be used illicitly and causes intense physical dependence. Slang names for morphine are M, Miss Emma, Monkey, White Stuff.

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Oxycodone – This narcotic pain reliever is a semi-synthetic opioid and one of the most commonly abused drugs of abuse. It causes euphoria, drowsiness and immediate pain relief contributes to the current opioid epidemic. Oxycodone immediately relieves pain, which can cause addiction in people who abuse it, and physical dependence, which can happen to people who have legitimate prescriptions for it.

OxyContin – Oxycontin is a brand name for oxycodone and Roxicodone. People with opioid addiction bypass OxyContin’s time-release feature by crushing up the medication to swallow it, snort it, or inject it to get its full effects immediately. When the medication is used properly, the time-release feature helps people manage pain more effectively during a 24-hour period. Street names for OxyContin include O.C., Oxycet, Oxycotton, Oxy, and Hillbilly Heroin. 

Percocet – This medication is a combination of the opioid pain reliever oxycodone and acetaminophen. It treats acute to moderate pain and must be administered as a prescription drug. The use of an opioid and non-opioid pain reliever makes this drug especially harmful to the body. It is still highly addictive, and it has a high abuse risk. This drug is called Percs for short on the recreational drug scene.

Suboxone – Suboxone, a combination of buprenorphine and naloxone, comes in the form of a super-thin strip that resembles a breath strip. It alleviates the symptoms of opioid addiction withdrawal almost immediately. It is commonly used in opioid detox for people with addiction and dependency. It is a partial opioid that attaches to the brain’s opioid receptors, but it doesn’t activate them. That’s because naloxone (brand name Narcan) blocks the drug’s highs.

Tramadol –  Tramadol comes in a generic and brand form. Ultram is the brand name for tramadol.  Tramadol treats moderate to severe pain. It is a narcotic-like pain reliever, but not a narcotic. Tramadol has a side effect that mimics antidepressant medication. According to Drugs.com, misuse of tramadol can cause dependence and addiction.  

Heroin, a highly addictive illegal opiate derived from morphine, is also included in the opioid class drugs that are responsible for thousands of overdose deaths in the United States. It also may be called an opiate because it is processed from a naturally occurring plant.

What Are the Signs of Opioid Addiction?

If you spot any of these signs in yourself or someone you know, they may be battling opioid addiction. People who are addicted to opioids typically exhibit the following symptoms:

  • Battling strong, persistent opioid cravings
  • Engage in “doctor shopping,” or change doctor’s frequently so they can get more prescriptions
  • Increased isolation and strained interpersonal relationships
  • Coping with withdrawal symptoms
  • Using opioids to avoid uncomfortable withdrawal symptoms
  • Hiding opioid use from loved ones, colleagues
  • Inability to stop
  • Feeling unable to function without the drug
  • Mixing opioid medications with alcohol or other drugs
  • Using opioids despite the consequences, such as losing a job, custody

Treating Opioid Addiction

Opioid addiction is deadly, but it doesn’t have to be. Countless licensed and reputable drug rehabilitation centers with opioid addiction recover from drug use. The process typically starts with a medical detoxification that medical professionals monitor around-the-clock. Clients may be slowly tapered off the drugs they are using to ensure they are safe and as comfortable as possible. Gradually reducing the drugs used gives the body time to adjust to their absence.

Detox

A medical detox is complete when medical stability is attained, a process that can take three to seven days, or longer if needed. Clients are evaluated during the detox period. When the results are in, clients are presented with treatment recommendations based on their evaluation.

Residential

The treatment settings that are recommended include a residential treatment program where clients address the physical and psychological sides of addiction. These treatment programs often are customized to an individual’s needs and preferences. Inpatient treatment, which can last from 28-90 days in a facility, depending on the program, involves individualized therapies that can help the person overcome their addiction. Treatment also can incorporate 12-step programs, holistic therapy, family therapy, and group counseling.

Outpatient

Another popular option is outpatient treatment for people who may be in the early stages of opioid addiction or have a mild case of it. Outpatient therapy does not require an on-site stay at a treatment center and arrangement that gives clients more flexibility as they work drug treatment into their schedules. Clients are still required to attend structured sessions three to five times a week or more.

Medication-Assisted Treatment (MAT) is also an option for people recovering from opioid use disorder. It is designed to help people who have alcohol use disorder (AUD) and opioid use disorder (OUD). It also helps people who have both disorders at the same time. 

One reason medication-assisted treatment is an appealing recovery option is that clients are monitored as they take the medicine and receive therapies that give prepare them for the journey to sobriety. That preparation includes tools and strategies to identify behaviors that can derail the commitment to becoming sober and address them upfront in a healthy manner, so clients stay on track to their goals.

Aftercare services also help many people focus on their recovery goals and reduce their chances of relapsing. Some people pursue follow-up medical care and ongoing therapies to help manage post-acute withdrawal symptoms, known as PAWS, that can emerge after drug dependence has ended.

How Dangerous Is Opioid Addiction?

Opioid misuse and abuse put many people on the road to addiction, which is filled with uncertainties. Using these powerful drugs at higher doses than prescribed can bring coma and death. Opioids can act as depressants and slow a person’s breathing and heart rate. The euphoric effects of opioids are addictive, but with each use, tolerance for the drugs grow, which makes people want to abuse them more. Overindulgence can be deadly. 

That said, not everyone who takes drugs knows they are using opioids. Fentanyl is showing up in more drug combinations involving heroin and the stimulant drug cocaine. Large doses of this drug aren’t needed for it to be deadly. According to the  U.S. Drug Enforcement Administration, illegal fentanyl is 80 to 100 times more potent than morphine. All it takes is two milligrams, which is equivalent to a few grains of table salt, to produce a fatal result.

Quitting the drug abruptly in an attempt to go cold turkey is also a dangerous thing to do. Anxiety, irritability, insomnia, and aching muscles can quickly lead to users to feel depressed, have severe cramps, and vomiting. The recommended course of action is to seek medically supervised detox at an approved facility to avoid debilitating opioid withdrawal symptoms.

Opioid Overdose Is Always a Possibility

Many people who abuse opioids end up overdosing. For many, this will be the end of the road as death often follows these events. Not all overdoses are fatal, but they are serious and life-threatening. Even if overdose survivors pull through, they are still at risk of sustaining permanent injury from the experience. 

Signs of an opioid overdose include constricted pupils and respiratory distress or breathing problems. This is often followed by seizures, vomiting, and spasms that are harmful if left uncontrolled. Respiratory failure often deals the fatal blow. According to the American Society of Addiction Medicine, opioid overdoses account for more than 60 percent of all overdose-related deaths in the U.S.

Narcan, generically known as naloxone, is often on hand to reverse many of these events. It has been invaluable as first responders, family members and friends have used it to immediately reverse the effects of opioid overdose. The medication is sold over the counter and can be administered through the nose or injected directly into the skin. The medication is not foolproof. Sometimes it takes multiple Narcan doses to revive someone. If it does, it does not alleviate the permanent results that come with prolonged opioid abuse. 

Opioids Abuse Statistics

  • Every day, 115 Americans die from an opioid overdose, according to the National Institute on Drug Abuse.
  • Two million Americans have some form of opioid use disorder.
  • 47,600 overdose deaths involving opioids in 2017
  • Roughly 80 percent of people who use heroin first misused prescription opioids.
  • $78 billion – This is how much opioid addiction is estimated to cost the United States every year. Costs include health care, lost productivity, addiction treatment, and criminal justice involvement.

Sources

American Society of Addiction Medicine, (December, 2012). Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine. Retrieved from https://www.asam.org

Blau, M, (June, 2017). STAT forecast: Opioids could kill nearly 500,000 Americans in the next decade. STAT. Retrieved from https://www.statnews.com

Centers for Disease Control and Prevention. (2019, June 27). Drug Overdose Deaths | Drug Overdose | CDC Injury Center. Retrieved from https://www.cdc.gov/drugoverdose/data/statedeaths.html

National Institute on Drug Abuse. (March, 2018). “Opioid Overdose Crisis.”. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

National Institute on Drug Abuse. (2018, January). Prescription opioid use is a risk factor for heroin use. Retrieved from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use

Drugs.com. Tramadol.Medically reviewed by Kaci Durbin, MD. Retrieved from https://www.drugs.com/tramadol.html

U.S. National Library of Medicine. (2019, September 3). Opioid addiction – Genetics Home Reference – NIH. Retrieved from https://ghr.nlm.nih.gov/condition/opioid-addiction#statistics

SAMHSA. (Feb. 7, 2018). “Medication-Assisted Treatment (MAT).” Retrieved from https://www.samhsa.gov/medication-assisted-treatment

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