Opioids are a class of drugs that are often used as painkillers. They have addictive potential and thus are controlled use drugs under the U.S. Drug Enforcement Administration. Some opioids are illegal altogether, such as heroin or synthetically produced fentanyl. Opioid drugs are derived from opium, and they can take many different forms with different potencies and distribution methods.
The National Institute on Drug Abuse (NIDA) reports that opioid addiction is a serious crisis in the United States, with an economic burden of more than $78 billion a year that results from prescription misuse alone. Opioid overdose rates have increased, with more than 33,000 Americans dying from opioid overdoses in 2015 and an estimated 2 million people struggling with opioid-related substance addiction that same year.
Opioids include illegal drugs, such as opium and heroin, and prescription drugs. Among them are:
drugs act on the body’s opioid receptors found in the nervous system,
which are embedded in the outer membrane of nerve cells in the body.
This interaction triggers a series of chemical changes within and
between the neurons, and it leads to pain relief and feelings of
Your body naturally produces some opioid substances, called endogenous opioids, which are designed to fit into your nervous system’s opioid receptors. When opioid substances from outside the body, called exogenous opioids, enter the bloodstream, they will also react with these same opioid receptors in the nervous system.
The National Institutes of Health states that the endogenous opioid system contains genes that may also impact the potential for addiction to develop in any particular individual. This endogenous opioid system is closely related to the body’s internal regulation system that is associated with pain, reward, and addictive behaviors.
Genetic differences among individuals can contribute to how much of a medication is needed to achieve relief from painful symptoms, and these differences may contribute to the associated risk of addiction in an individual.
While scientists do not fully understand the impact of genes on the potential for addiction, genes do play a role in the transmission of chemicals throughout the body and the receptivity of neurons to these neurotransmitters.
In addition to genetic factors, other environmental factors, such as substance abuse history, other mental health conditions, and risk factors such as childhood abuse or past trauma, may also contribute to the potential for addiction to develop.
Other factors may include personal differences in impulsivity and pleasure seeking, as well as external risk factors, such as poverty, access, and proximity to opioid drugs.
Opioids are considered to be one of the most addictive classes of drugs available. This is because the effect of opioid drugs on the brain are so strong, and the withdrawal symptoms are so painful that people can become habituated to the drug on a physical level quite quickly if they are not careful to use prescribed medication only as intended.
NIH advises that opioid addiction is a chronic disease that can cause major problems in the lives of people who become addicted, including devastating medical, social, economic, and emotional problems. Opioids act on the nervous system and the brain to produce relief from painful conditions, but they can also cause a sense of euphoria and contribute to compulsive drug-seeking behaviors.
When opioid drugs act on the opioid receptors in the brain that register pleasurable sensations, tolerance and dependency can develop over time.
Tolerance for opioid drugs occurs when higher and higher doses are needed to produce the same effect as the drug continues to be used.
Dependency refers to the impact of opioid drug use, which results in withdrawal symptoms, including muscle pain, cramping, gastrointestinal problems, and anxiety.
Opioid addiction occurs when compulsive, drug-seeking behaviors accompany physical and psychological symptoms of withdrawal, resulting in increasingly dangerous and/or illegal behaviors to obtain more of the desired drugs.
Many people who initially begin using opioids with a prescription for legitimate medical issues find themselves caught up in an escalating cycle of use. This cycle takes them from tolerance to dependency and then finally to full-blown addiction.
Prescription opioids are often the source of addiction that leads to the use of illegal heroin or illegally manufactured synthetic fentanyl. NIDA reports that about 21 percent to 29 percent of people who receive opioid prescriptions misuse the medication; of this group, 8 percent to 12 percent ultimately develop an opioid use disorder.
Furthermore, about 4 percent to 6 percent of those who misuse prescription opioids will shift to using heroin or other illegal opioids at some point. This happens because the addiction to opiates is so strong that when people cannot access their prescription opioids, they turn to illegal forms of the drug to prevent or manage their withdrawal symptoms.
Again, as people use opioids over time, they can build up a tolerance for the drug. In practice, this may mean that a person starts to take their medication a little bit sooner than the prescribed regimen because they begin to experience some symptoms of pain. Then, as they slowly begin taking their medication sooner than recommended, they run out of the drug sooner.
When a person
runs out of their prescription but still experiences distressful pain or
symptoms of withdrawal, they may turn to other ways to obtain more of
the drug. This could mean resorting to illegal activity, such as doctor
shopping or seeking out street drugs.
shopping is when someone seeks appointments with multiple doctors and
uses different pharmacies to obtain prescriptions for the same drug.
This allows the person to access more medication than they can be safely
and legally prescribed, and it can lead to arrest if caught.
A doctor may terminate a relationship with a patient who has abused the system, leaving the patient without access to legal means of obtaining the drug. This can also result in a person turning to street drugs, such as heroin and synthetic fentanyl purchased on the street, to get relief from pain or withdrawal symptoms.
Studies have shown that opiate withdrawal impacts the brain’s ability to form patterns related to reward-seeking and negative reinforcement. This means that when opiate withdrawal begins, the brain perceives the reward from further opiate use to be out of proportion with other forms of pleasure, which contributes to the maladaptive patterns associated with opioid addiction.
There are a few different considerations when it comes to how addictive different opiates are. In general, the more potent the drug is, the higher its potential for abuse and addiction. Additionally, the speed at which the drug enters the bloodstream and affects the nervous system can also contribute to its abuse potential.
Heroin is considered a highly addictive opioid because of its potency and also because most people who use heroin inject the drug, causing immediate entry to the bloodstream. Other forms of opiates, such as the slightly less potent opium, may be smoked, which also enters the body quickly but not as quickly as heroin. Morphine is another opiate that may be injected into the bloodstream or given as a liquid. It is also highly potent and quickly absorbed by the body.
Other opiate medications may come in pill form, such as oxycodone and hydrocodone, and they may be available in controlled-release or immediate-release forms. Controlled-release forms of the drug enter the bloodstream slowly over time. Thus, they have a less potent effect, may reduce side effects, and could lower the risk of tolerance and dependency.
Codeine is considered to be a less potent form of opiate and is more commonly found in some prescription cough syrups. Due to its reduced potency, it has a lower risk of abuse and addiction.
The use of a particular opioid to treat pain or related symptoms should be done with caution and under medical supervision to ensure that risk factors can be assessed and that an appropriate recommendation can be made. Most doctors will try to use the least potent and least addictive drug possible for the presenting pain condition. They aim to prescribe the medication that can best address the patient’s symptoms effectively without exposing the person to the risks of addiction that come with opiate use.
who uses opioid drugs, whether it’s prescription use or illicit
recreational use, can become addicted to opioids. Although not everyone
who has been given a prescription opioid will become addicted, the
potential remains due to the highly addictive nature of the drugs.
everyone who takes opiate medications or illegal opiate drugs for long
periods will develop some level of tolerance and dependency. Individuals
will differ in how long it takes them to progress through these stages
of opioid acclimation.
If the prescribed dose of your medication is no longer effective for you, talk to your doctor. They may prescribe a different medication or explore other pain management options with you.
A study from the journal Neuroscience and Biobehavioral Reviews concluded that a multitude of triggers and behavioral escalation contribute to a debilitating cycle of pain, addiction, and diminished pleasure. Chronic pain that is relieved from opiate use creates a bias toward opiate-induced relief, and this can dysregulate the brain’s ability to sense pleasure and experience rewards from non-opiate events and triggers.
Thus, the body becomes acclimated to using opiates as the primary pleasure source, and it becomes slowly unable to experience pleasure in other ways. This exacerbates chronic pain and traps the individual in an increased reliance on the drugs and an associated diminishing sense of well-being. The resulting discomfort and lack of pleasure contribute to the habit-forming nature of opiate drugs.
an individual develops an addiction or not is due to a combination of
genetic, environmental, and lifestyle factors. It is important to use
all opiate medications as directed and tell your doctor if you suspect
you are developing a tolerance or dependence on prescription medication.
Opiate addiction can be a dangerous problem, leading to overdose and death. Thus, adherence to medical instructions is of paramount importance, especially for those with chronic pain conditions or other short-term conditions that are treated with prescription opioids.
(March 2018) Opioid Overdose Crisis. National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
Drug Scheduling. US Drug Enforcement Agency. Retrieved from https://www.dea.gov/drug-scheduling
Opioid Addiction. U.S. National Library of Medicine. Retrieved from https://ghr.nlm.nih.gov/condition/opioid-addiction#genes
(December 2013) The Downward Spiral of Chronic Pain, Prescription Opioid Misuse, and Addiction: Cognitive, Affective, and Neuropsychopharmacologic Pathways. Neuroscience and Biobehavioral Reviews. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967721/
(March 2016) Inflated Reward Value in Early Opiate Withdrawal. Addiction Biology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312551/