The United States is currently going through an increase in opioid addiction and overdose that has come to be known as the opioid crisis. However, today, there are a number of medical and clinical interventions that can be used to treat opioid addiction. Read more about the addiction crisis and what can be done to treat addiction.
What Are Opioids?
Opioids are a class of drugs that were originally derived from the opium poppy plant. It is commonly used to treat pain symptoms from injuries, surgery, and chronic pain. Opioids have been used for centuries and may be one of the oldest known drugs in the world. The drug can be used as both a pain reliever and an anesthetic.
It was first isolated and marketing in the 19th century. Medically, it was widely used in the form of morphine, an isolated form of opium that was first discovered in 1804. It was heavily used on battlefields throughout the 19th and 20th century. However, it’s euphoric effects were sought after as a recreational drug, and in 1919, non-clinical use of opioids was outlawed in the United States.
In the 20th century, new forms of opioids were synthesized that increased to potency and effects of the drug. Heroin is twice as strong as morphine, but new drugs were created that were 100 and even 10,000 times as potent as morphine.
Despite its effectiveness as a pain-killer, it comes with some serious side effects including, significant potential for dependence, tolerance, addiction, withdrawal, and overdose.
Opioid addiction is as old as the drug itself, and we have only begun to understand the disease of addiction relatively recently. As new forms of opioids are being introduced to the black market, prescription opioids surge, and transnational criminal organizations flood the U.S. with illicit opioids. The opioid epidemic has continued to grow.
How Do Opioids Work?
Opioids are a potent and effective pain-relieving compound that is able to work at every point on the path pain messaging takes from the site of pain to the brain. Here’s a brief explanation of how opioids work in the body to relieve pain.
When something causes damage to your body, like touching the flame on a candle, a special neuron (nerve cell) called a nociceptor responds by sending a message to the spine that there is a potential threat. Then the spine passes that message to the brain to get you to stop touching that candle.
The pain message travels like all nervous systems messages do, by being passed from neuron to neuron by chemical messengers called neurotransmitters. These chemicals are sent by one neuron and attach to the receptor on the receiving neuron. The problem with pain is that it doesn’t always stop when you’ve treated the cause. Burns still hurt after you take your hand off the flame and treat the wound.
And that’s not the only problem with pain.
Once the message reaches the brain, your reward and learning centers go to work to make sure you never damage yourself in that way again. However, sometimes, your brain overreacts to pain, causing you to develop psychological trauma, anxiety, and phobias. Opioids are able to mitigate both pain and psychological response to pain.
Opioids bind to the respective receptors on both the sending and receiving neurons. This causes the sender to send fewer pain signaling chemicals, and the receiver accepts fewer pain signals, as well. This significantly dampens your body’s ability to feel pain. The resulting relaxation and euphoria can also soften the psychological response to pain and limit the risk of feeling traumatized.
However, with repeated use, your body can become tolerant of opioids and come to rely on them to maintain a normal neurochemical balance, which causes dependency. When your reward center feels the effects of the intense euphoria, it too may respond by confusing opioid use with other rewarding activities you need to survive, like eating and sleeping, which can lead to addiction.
Why Do We Have Opioid Receptors?
Opioids are derived from an alkaloid found in the opium poppy plant native to the Eastern Mediterranean. So why does a compound found inside a plant have specific receptors to bind to inside the human central nervous system? Actually, opioids are naturally found in a variety of living organisms, including humans, in the form of endorphins (a term that comes from a combination of ‘endogenous’ and ‘morphine’).
Endorphins naturally produce a response to pain in the body as a method of regulating the pain response. In fact, you may have even felt the effects of an endorphin release if you’ve ever done some intense aerobic activity. A “runner’s high” is the relaxed and mild euphoria that comes when exercise releases endorphins.
When endorphins are released in the body, they bind to opioid receptors and activate them. Once the pain message has done its job and alerted you to a problem, endorphins mitigate pain messaging as much as possible. Although, the response is limited and opioids from the poppy plant and its analogs are much more potent.
Still, opioids are so effective and powerful in humans because we have built-in mechanisms that are designed to accept them. We have receptors through the central nervous system, the peripheral nervous system, and in the gastrointestinal tract. Opioids are effective but more powerful than our bodies are used to, which gives them the potential to cause dependence and addiction.
What are the Different Opioids?
There are several different types of opioids used for a variety of reasons. While some treat occasions of acute pain, others are geared toward pain-management and long-term therapy. Doctors can prescribe most of these drugs, which are meant to be ingested, but pharmaceutical-grade fentanyl is available in a patch.
The most common opioids include:
- Codeine
- Fentanyl (Actiq, Duragesic, Fentora)
- Hydrocodone (Zohydro, Lorcet, Lortab, Norco, Vicodin)
- Hydromorphone (Dilaudid, Exalgo)
- Meperidine (Demerol)
- Methadone (Dolophine, Methadose)
- Morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR)
- Oxycodone (OxyContin, Oxecta, Roxicodone, Percoset, Endocet, Roxicet)
What are the Signs of Opioid Addiction?
If you are worried that you may be developing a dependence or addiction to opioids or if you think a loved one may have a problem, there are several signs to look out for. The most common sign that you may be developing a problem with opioids is tolerance.
If you take opioids for recreation or even for medical purposes, it’s important to consider dependence as a significant threat. If your normal dose no longer seems to be effective, or if you’ve started to take larger or more frequent doses to achieve the same effects, you may be developing a tolerance to the drug.
If you start to feel withdrawal symptoms when you haven’t had a dose, or if the dose was too small, it is most likely a sign of dependence. Symptoms such as drug cravings, nausea, vomiting, diarrhea, muscle pain, restlessness, sweating, anxiety, or increased heart rate are all signs of withdrawal. Finally, if you continue to use the drug even after it has caused significant problems in your life like marital issues, job loss, or health concerns, you may have become addicted.
If you believe that a loved one might be struggling with an opioid use disorder, there are several signs you might be able to observe, including:
- Isolation
- Strange mood changes
- Lying about drug use
- Legal troubles
- Failing work or school performance
- New social groups
- Trying and failing to stop or cut back on drug use
Should I Detox?
Nearly 15,000 people died due to prescription drug overdose, and opioid addiction is a serious topic. The withdrawal symptoms are often intense and must be given proper attention.
The safest and most comfortable way to transition into a life of sobriety is to go to medical detoxification. Doctors will steer you through the worst of the withdrawals and overcome your dependence to opioids. Specialists will provide medication that helps your uncomfortable symptoms.
The team of highly dedicated professionals will monitor the client around the clock and provide comfort in a time of need — those attempting withdrawal alone often relapse due to the irresistible cravings.
What is Involved in Opioid Addiction Treatment?
Opioid addiction can be treated with a variety of approaches. However, there are a few factors that need to be involved in addiction treatment for it to be effective and lasting.
According to the National Institute on Drug Abuse, addiction treatment needs to be tailored to the individual. There is no one treatment plan that will work across the board. Addiction is complicated and can have several underlying issues that contribute to it and feed into it.
For instance, addiction commonly comes with co-occurring mental health issues. In fact, around 7.9 million people experienced a substance use disorder and a co-occurring mental health issue, according to a 2014 National Health survey.
In order to treat addiction successfully, multiple needs must be met. Addiction can affect your health, social life, job, income, living situation, and more. Treatment show provides avenues for you to address psychological, emotional, physical, and social issues.
Behavioral therapies are an integral part of addiction treatment because they can address a variety of needs (i.e., cognitive, emotional, psychological), and they are the most recommended treatment option. Medications like Suboxone are also an important part of addiction for some people and has shown to keep people in treatment for longer, getting the help that they need.
If you have had a medical need for a co-occurring active infection, injury, disease, or dangerous withdrawal potentially from drugs like benzodiazepines or alcohol, you may need medical detox. After you complete inpatient services, you can continue your commitment to recovery in intensive outpatient (IOP) and outpatient services (OP).
In outpatient care, you will have more independence and flexibility when it comes to the balance of life and treatment, but you will continue to have the support you need. In IOP, you will receive nine or more hours of clinical services every week. You will participate in therapy options tailored to your needs until you progress to the next level of care. In OP, you will receive less than nine hours of treatment each week. This phase is helpful for those who are transitioning into life outside of treatment.
After treatment services, you should continue to pursue goals in recovery through aftercare programs and support groups.
How Dangerous are Opioids?
Though opioids are extremely effective at mitigating pain symptoms, they are extremely dangerous when abused. While it is possible for some people to become addicted to the regular prescribed use of opioids, the majority of addiction cases occur when prescriptions are misused. Still, there are a vast number of opioid prescriptions in the U.S.
In 2016, a total of 214,881,622 opioid prescriptions were filled by pharmacies all over the United States for everything from chronic pain to post-wisdom tooth removal. Many people who misuse opioids get them from family and friends who no longer need them.
Prescriptions aren’t the only sources of opioid misuse. According to the Drug Enforcement Administration’s 2017 threat assessment, the U.S. has also seen a surge of heroin and synthetic opioids coming from drug trafficking. With opioids coming from both prescriptions and illegal markets, its availability is exceedingly high, increasing the rate of addiction and overdose.
How Does Opioid Overdose Happen?
Opioids like heroin aren’t typically very dangerous when you take an appropriate dose. Adverse symptoms can include itchiness, sedation, nausea, constipation, and euphoria. It starts to become dangerous when you take a high dose, causing significant respiratory depression. The problem is that it’s very difficult to always get an appropriate dose from illegal sources. Opioid overdose can happen in three ways:
- You build a tolerance to opioids and get used to a higher dose than the average person. Then, you have to stop using for a while for whatever reason. This can happen when you go in for a medical procedure, spend time in prison, go through detox, or carry out a pregnancy. By getting off of opioids for a while, you lose your tolerance. If you relapse by taking the dose that you used to be adapted to, you overdose because you’re no longer tolerant to opioids.
- Your opioid source supplies you with a diluted supply of opioids. Heroin dealers routinely cut their supply with inert substances to increase profits. Even if your dealer doesn’t, their supplier might. If you one day get a bag of purer heroin, the dose you are used to might actually be much higher than an appropriate dose. Your “normal dose” might result in an overdose when you encounter heroin that’s closer to pure.
- Your heroin is contaminated with a more powerful opioid. The recent skyrocketing of opioid overdoses is largely because of a powerful synthetic opioid called fentanyl. It’s 100 times more powerful than morphine and 50 times more powerful than heroin. Two to three milligrams is enough to kill the average person. That amount is nine times smaller than a single grain of rice. It’s incredibly difficult to measure out a safe dose of fentanyl without training and the right equipment. In street-level heroin, if fentanyl is involved, it’s likely that it’s in an exceedingly high amount. Even experienced opioid users can overdose.
What Happens In An Opioid Overdose?
During an opioid overdose, your breathing will begin to slow to dangerous levels, and in some cases, it just stops. Opioids slow your nervous system down, which generally slows breathing. It’s not known how this happens in specific terms, but some believe that it opioids inhibit your body’s ability to detect carbon dioxide in the body and the breathing response isn’t triggered. Opioid overdose can also cause unconsciousness and dilated pupils. If someone is displaying these symptoms, it’s important to call an ambulance immediately.
Opioid Abuse Statistics
- 63,000 people experienced fatal drug overdoses in 2016—66 percent of those were due to opioids
- In 2016, 19,400 people were killed by synthetic opioids like fentanyl
- Nearly 250 million opioid prescriptions were written in 2013
