Opioid misuse and overdose has become an epidemic in the United States. The Centers for Disease Control and Prevention (CDC), in cooperation with state, local, and federal agenices and authorities, continues coordinated efforts to reduce the negative impact of the opioid epidemic, but to date, the success of their efforts has been modest, at best.
Anyone can become addicted to opioids. Preventing and getting treatment for opiate addiction – called opioid use disorder (OUD) – both start with learning the effects of opiates and why they are so addictive.
What Are Opiates?
An opiate is any drug that is derived naturally from papaver somniferum, the flowering opium poppy plant. The most well-known examples of opiates are:
The term opioid is broader, and refers to any substance that binds to opioid receptors in the brain. Opioids can be natural or synthetic, making it an umbrella term that covers opiates as well. All opiates are opioids, but not all opioids can be classed as opiates. In many cases, the terms have become functionally interchangeable.
The term opioid is most often used to refer specifically to man-made prescription painkillers, like:
- Hydrocodone (Vicodin®)
- Oxycodone (OxyContin®)
- Hydromorphone (Dialudid®)
- Meperidine (Demerol®)
How Do Opioids Work?
So, why are opiates addictive? There are nerve cells all over the body which contain opioid receptor proteins. These receptors are present in the gut, spinal cord, and brain.
When taken in any form, opioids bind to these receptors and activate them, which leads to a variety of strong effects.
Opioids in the Brain
In the brain, opioids produce an immediate sensation of calm, well-being and relaxation. When someone takes an opioid, they start to feel sleepy and may experience a rush of euphoria if they take more than a prescribed, therapeutic amount. These effects can impair coordination, which is why prescription opioids come with a warning not to operate motor vehicles after taking them.
Opioids in the Spinal Cord
In the spinal cord and central nervous system (CNS), opioids affect the way nerves communicate pain to the brain. After binding to the receptors, opioids either dull pain or eliminate it altogether. Opioids are highly effective in controlling pain, which is why they are widely used in prescription form.
Opioids in the Gut
One unwanted side effect of pain management with opioid medications is opioid-induced bowel dysfunction (OIBD). OIBD is a collection of multiple gastrointestinal movement disorders, with constipation being the most common. Opioids binding to receptors in the gut causes the muscles to slow or stop contracting, leading to significant backup. With chronic opioid use, OIBD can become debilitating.
How Do People Become Addicted to Opioids?
No matter how the opioid is obtained, the development of addiction proceeds the same way. Addiction starts in the midbrain. When opioids bind to receptors in this area, they turn off a group of cells called GABAergic neurons. By turning off these neurons, opioids trigger a flood of a neurotransmitter called dopamine.
Dopamine release results in a sudden surge of pleasure, immediately reducing feelings of anxiety and stress. The brain’s reward center remembers these effects and categorizes opioids as rewarding, reinforcing a person’s desire to use them.
What Is Tolerance?
If someone listens takes illicit opioids for long enough, or is on a long-term prescription, tolerance develops. Drug tolerance is a state in which a person needs to consume more of a substance at one time to feel the same effects they did when they began taking the substance.
In order to continue achieving pain relief or a sense of euphoria, a person will gradually need more and more opioids. Eventually, the brain adapts to the chronic presence of opioids and alters its production of a compound called cyclic AMP. When exposed to opioids over a long period of time, the brain starts producing three to four times more cyclic AMP, which is an issue because it prepares neurons to send more electric pulses.
In the absence of opioids, the excess cyclic AMP results in the physiological extremes associated with drug withdrawal. At this point, people realize that stopping opioids leads to pain and other intolerable symptoms, and continued drug use becomes about staving off withdrawal, rather than achieving any sort of pain relief or pleasure.
Contributing Factors to Addiction Potential
It takes just a couple of weeks for a person to become physically dependent on an opioid. However, many people transition from physical dependence to true disordered use based on a number of factors that are difficult to quantify. However, the three most common factors that can predict opiate addiction are:
1. Chronic Pain
More than 20 percent of American adults have chronic pain, with eight percent of all adults having high-impact pain that interferes with their ability to live everyday life. While prescription painkillers are effective in the short term, they are not well-suited for long-term treatment due to the development of tolerance.
A significant amount of long-term opioid use starts with a prescription to manage acute pain. If the pain persists and becomes chronic, the patient may seek to increase their dosage. Now that opioid prescribing guidelines are tightening, it’s becoming common for doctors to refuse to prescribe or increase dosages of these medications. This can lead to patients “doctor shopping” or turning to illicit sources to obtain opioids for their pain.
2. Mental Illness
One study estimates that the 16 percent of Americans who struggle with mental illness receive more than half of all the opioids prescribed.
The euphoric effect of opiates is particularly dangerous to those with mental health disorders, as these individuals may find substance use improves their mood. Self-medication with opioids is dangerous, though, and can lead to a substance use disorder, in addition to any preexisting mental health disorder,
3. Lack of Patient Education
Prescribing physicians are almost always well-intentioned when they prescribe opioids. However, many doctors do not fully explain the potential consequences of opioid use, up to and including the development of an OUD.. Patients often trust their doctors implicitly and assume a legal prescription is safe to use. Some patients with chronic pain may also find their doctors are reluctant to prescribe opioids or continue their current course of treatment, but don’t always explain why.
Essential Facts and Statistics of the Opioid Epidemic
It helps to look at the opioid epidmemci in a timeline contiaining three waves, as defined by the CDC:
- Wave One: Opioid prescribing greatly increased in the late 1990s, bringing a steady increase in overdose deaths involving prescription opioids.
- Wave Two: The second wave began in 2010, when heroin overdose deaths began to skyrocket.
- Wave Three: The most recent wave began in 2013, with increases in overdoses involving fully synthetic, illegally manufactured opioids.
One of the most crucial things to understand about the crisis is the interplay between legal prescriptions and illegal street drugs. The National Institute on Drug Abuse (NIDA) brings us these disturbing figures:
- Between 21 and 29 percent of people with an opioid prescription end up misusing the medication.
- Between eight and 12 percent of people with a prescription develop an opioid use disorder (OUD).
- Approximately four to six percent of the people who misuse prescription opioids make the transition to heroin use.
- Approximately 80 percent of the people who use heroin started by abusing prescription opioids first.
The rate of opioid overdoses has continued to expand at a rapid rate. The most recent available data, collected in 2016 and 2017, paints a worrying picture:
- Opioid overdoses grew by 30 percent in 52 areas within 45 states, starting in July 2016 through September 2017.
- The Midwest saw a 70 percent increase in overdoses in the same time frame.
- In large cities, opioid overdoses increased by 54 percent in 16 different states.
It’s clear that all parts of our nation are experiencing the fallout from this public health crisis. Rural areas have been disproportionately affected, in part because of a lack of access to physical and mental healthcare and addiction treatment services. Some effects include a rise in neonatal abstinence syndrome (NAS) due to drug use during pregnancy and the increased spread of diseases like HIV and hepatitis C due to greater use of injected opioids.
The Department of Health and Human Services (HHS) is working to address the crisis on five major fronts:
- Improving access to services for treatment and recovery.
- Encouraging the use of overdose-reversing drugs such as Narcan®.
- Expanding understanding of the crisis by utilizing more surveillance of public health.
- Supporting the latest research on addiction and pain management.
- Promoting new guidelines and better practices for pain management.
As the epidemic continues its stranglehold on the nation, it’s becoming even more important for individuals to become educated on the addictive potential of opioids.
Signs and Symptoms of Opioid Addiction
So, how can you tell when you or someone you love is addicted to opioids or heading down that path? People with opioid addiction are often still able to hold down a job or make reasonable academic progress even as their addiction worsens. By the time someone displays more obvious signs, like loss of a job, their addiction is severe enough to be life-threatening. Look out for these early signs:
- Regularly ignoring the dosage of prescription given by the doctor.
- Taking the drug for the pleasure it can produce, rather than for pain management.
- Taking the drug when not in pain or “just in case.”
- Exhibiting mood swings from euphoria to hostility.
- Experiencing altered and often disturbed sleep patterns.
- “Borrowing” medication from other people.
- “Losing” a prescription in order to obtain a second one.
- Trying to get multiple physicians to write the same prescription to create a backup supply of medication.
- Impaired decision-making that may put themselves or others in danger, such as driving under the influence of opioids.
One of the first signs that someone is abusing a drug is social withdrawal. As opioids become the primary focus in a person’s life, their relationships with friends and family are often the first things to go. If you feel that someone you care about is suddenly making excuses not to get together, it may be a good idea to check in with them and see if they are displaying other signs of addiction. Some of the physical effects of opioid abuse include:
- Impaired motor coordination
- Slow and shallow breathing
- Flushed and itching skin
- Weight loss
- Nausea and vomiting
Someone abusing opioids will likely try to keep these symptoms hidden, but the worse the abuse gets, the more trouble they will have trying to appear normal. If you notice any combination of these physical and behavioral signs, it’s time to investigate treatment options.
Long-Term Effects of Opioid Use
Because opioids affect so many systems in the body, they can cause serious damage in the long-term. Even those who take opioids only according to prescription can suffer adverse effects, so those who abuse them are at even greater risk for damage. Opioids can cause long-term damage to the:
Heart disease is the number one cause of death in the United States, and we now know that opioid use can contribute to this condition. A recent review found these drugs can change heart structure, lead to a chronically slower heartbeat, and contribute to an increased risk of cardiovascular disease and death.
Opioids depress the respiratory system, leading to suppressed breathing and reduced oxygen circulation. Deaths that occur due to overdose actually happen because the person stops breathing. Long-term use of opioids can lead to sleep-disordered breathing like sleep apnea or retention of carbon dioxide. It’s important to remember that building up a tolerance to the pain-relief and euphoria aspects of opioids does not mean a person has built up any resistance to the respiratory effects of the drugs.
One poorly understood but common result of chronic opioid use is an increased risk of fractures. This may be due to impairment of motor coordination causing a greater number of falls, or it may be directly caused by a mechanism of the opioids themselves. While this is a more significant issue for the older population, it is an effect that requires more study.
Withdrawal From Opioids
Whether someone has been using opioids for a few weeks or several years, the biggest barrier to getting and staying clean is withdrawal. A longer duration of use or higher concentrations of use can make symptoms worse, but all people who go through withdrawal from opioids experience the following:
- Nausea and vomiting
- Gastrointestinal distress and diarrhea
- Irritability and anxiety
- Muscle aches and cramping
Although opioid withdrawal is very rarely life-threatening, it can be excruciating in its early acute stages. Many describe it as the worst flu possible. Quitting opiates cold-turkey almost universally results in failure and immediate relapse. If someone does manage to make it through acute withdrawal, they’re often not equipped with the knowledge and tools they need to stay sober and manage cravings they may experience later.
Management of withdrawal symptoms is a crucial aspect of an effective treatment program. This involves learning appropriate coping strategies and may include the use of medications to make withdrawal more comfortable.
Types of Opiate Addiction Treatment
To prevent overdose and avoid the long-term health consequences of opioid abuse, it’s essential for anyone with OUD to seek treatment. There are multiple levels of care available. Understanding those levels is the first step in finding the right opiate addiction treatment. Some common treatment options include:
Intensive Outpatient Program (IOP)
In an outpatient treatment program, participants receive intensive addiction treatment that lasts for a few hours each day. When the treatment day is over, participants can return home to tend to their work, family, or school responsibilities. These programs are ideal for people with children or who go to work or school due to the flexibility they allow. Outpatient programs provide the same basic treatment as partial hospitalization programs, including:
For many people with less severe OUD, the relative freedom of outpatient programs is a benefit, as it allows them to receive necessary treatment without upending their lives completely.
Partial Hospitalization Program (PHP)
Partial hospitalization programs are the most rigorous and intensive form of treatment you can receive outside of a residential or inpatient program. These programs occupy roughly the same amount of time as a full-time job, requiring more time spent at the treatment on more days of the week. This treatment format increases the intensity of treatment received while still allowing participants to go home at the end of the day.
For those who have not had success with outpatient treatment in the past or for whom relapse is a significant concern, inpatient drug rehab is the most intense and focused course of action. Patients live at the treatment facility 24/7 for a set period of time, allowing for constant supervision and a one hundred percent focus on recovery.
The benefits of inpatient treatment include access to a highly trained staff around the clock and treatment completely tailored to each individual.
How to Get Help for Opioid Addiction
If you or someone you care about struggles with opioid use disorder, don’t let fear keep you from seeking life-saving treatment. Take the first step and call an accredited treatment center. There are caring professionals on the other end of the line who are there to help you, a friend, or a loved one begin the recovery journey.
Beacon House is the premier alcohol and substance use disorder treatment center in Northern California. We have a team of experts with extensive experience in evidence-based treatment and offer a variety of drug and alcohol treatment programs. We understand the value of individualized treatment, which is why we tailor our programs to meet the diverse needs of individuals.
To learn more about treatment at Beacon House, give us a call. You can also fill out our contact form and we’ll reply as soon as possible. Start your recovery journey today!