Opioids and Addiction
Introduction
The United States is undergoing one of the most serious health crises of the modern world – the opioids epidemic. In 2017, more than 70,000 Americans died from a drug overdose, and almost 70% of these deaths were opioid-related. An average of 130 people died each day from an opioid drug overdose and deaths related to synthetic opioids rose by more than 45% from 2016 to 2017.1 Overdose deaths by prescription opioids increased by more than 10% among Americans ages 65 and older from 2016 to 2017.
Another astonishing statistic is that a total of 702,568 Americans died from drug overdoses from 1999 to 2017, with almost 400,000 of these deaths (56%) involving opioids.1 Many of these deaths could be prevented with a holistic drug rehab program.
A Brief History of Opioids
The use of derivatives from the opium poppy plant goes back to ancient times. It was thought that Homer’s Helen of Troy gave opium to men. People in ancient Iraq then called Sumeria, cultivated opium from poppy plants in the 3rd millennium BC. In 1500 BC, opium was used to stop children from excessive crying. In the very early days of modern medicine, sponges soaked in opium were used to stop pain during surgery.2
Once syringes were invented in the 1850s, they were used to administer morphine during surgery, control pain after surgery, and manage chronic pain.2
HEROIN ENTERS HISTORY
In 1898, heroin was derived from the opium poppy plant in a quest to find a less addictive opiate.2 Heroin was declared a safe, non-addictive alternative to morphine, but we now know that was untrue.
In 1939, meperidine was discovered. In 1946, methadone was first synthesized.2 Since methadone has a slower onset, is slower-acting, less intense, and lasts longer, it was declared as a treatment for morphine addiction.2
OPIOIDS IN PAIN MANAGEMENT
In the last two centuries, changes were made regarding opioid use in pain management and the attitudes towards addiction. In 1999, attempts were made by many governments to control the spread and use of opioids. Starting in 1989, opioid medication-assisted therapy for opioid addiction was developed using morphine and methadone, and later in 2006, buprenorphine.3
For many years, the American medical community regarded long-term use of opioid drug therapy as a good way to treat chronic pain.3 During the 1990s, the spread of opioid addiction from the growing recreational use of prescription opioids caused a major shift in this mindset.3
The National Survey on Drug Use and Health (NSDUH) sounded the alarm on this epidemic. The NSDUH reported:
- Among the number people who were abusing painkillers, those who used prescription opioids for the first time rose from about 628,000 people in 1990 to 2.4 million in 2004.
- Visits to an emergency room that were related to prescription opioid abuse rose 45% from the years 2000 to 2002.
- Admissions into treatment programs for opiate use disorders rose 186% from 1997 to 2002.3
Opiates vs. Opioids
Opiates and opioids are terms used for compounds that bind to opiate receptors in the body. Opiate drugs are derived from the opium poppy plant and include heroin, opium, morphine, and codeine.
Opioids are similar to opiates, but opioids are synthetically manufactured drugs that induce similar effects. Opioids include semi-synthetic opiates that are drugs synthesized from natural opiates. An example of a semi-synthetic opioid is heroin made from morphine. There are also synthetic opioids, for example, fentanyl and methadone.
Opioid drugs include:
Both opiates and opioids reduce pain. Opioids are powerful drugs that carry an extremely high potential for dependency, misuse, and abuse. Most times, the terms opiates and opioids are used interchangeably. This article will use the terms opiates and opioids interchangeably.
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Which Drugs are Considered Opioids?
Heroin: A highly addictive, pain-relieving drug derived from morphine. Heroin is mainly used illicitly to produce euphoria.
Opium: An addictive drug derived from the juice extracted from the opium poppy plant. It is a narcotic and used as a pain reliever.
Codeine: A pain relieving drug that induces sleep and is derived from morphine.
Fentanyl: An extremely potent opioid drug used to treat severe pain.
Diaudid / Hydromorphone: An opioid used to treat moderate to severe pain.
Hydrocodone: A medication used to relieve moderate to severe pain.
Methadone: A drug mainly used in short-term detox and long-term medication-assisted treatment (MAT).
Morphine: A pain-relieving narcotic drug derived from opium that is used to relieve pain.
Oxycodone: A synthetic painkilling drug that is much like morphine in its effects.
How Do Opioids Work?
Opioids act by attaching to certain proteins in the body called opioid receptors. These receptors are found throughout the brain and body. They work to regulate pain through the nervous and immune systems.
These receptors also affect the neurochemicals known as endorphins. Endorphins help modulate pain as well as play a role in our reward and reinforcement systems. Endorphins also affect our moods and stress level.
When an opioid is taken for pain, it attaches to receptors which produces pain relief. Other side effects may also occur that are nervous system related, such as constipation, itchiness, pupil constriction, drowsiness, mental fogginess, and slowed breathing.
Brain changes can lead to a decrease in the responsiveness to opioids (tolerance). The nervous system effects from opioids can also influence moods, either a state of unease or the opposite – euphoria.
Powerful reinforcement occurs from the pleasurable effects and pain relief opioids produce. An association develops between taking the drug and its physiological and perceptual effects. The result is repeatedly taking opioids to gain those effects. Cravings occur when time has passed with no drugs. These behaviors and biochemical reactions taken together drive addiction development.
Health Risks
THE SHORT-TERM HEALTH RISKS OF OPIOIDS
Opioids have short- and long-term health risks. Opioids are mostly prescribed because they work well at quickly relieving pain. Other effects that people experience when they take opioids include “feeling high” (euphoria), mood swings, sleepiness, and confusion. Death from opioid overdose can occur when a person takes a single, large dose.4
Other short-term opioid health risks include:
Opioids can also affect the health of the musculoskeletal, immune, endocrine, and central nervous systems.
THE LONG-TERM HEALTH RISKS OF OPIOIDS
There are also long-term health effects from opioids that comes with taking them for long durations.
The first effect is dependence.5 When three or more of the following factors exist together, dependence has developed:
OPIOID OVERDOSE
A dangerous health risk from opioids is an overdose. Once a person is dependent on these types of drugs and their tolerance increases, larger doses must be taken to gain the same previous effects. When a certain threshold is crossed, slowed breathing and decreased heart rate can result in death.
BRAIN HEALTH EFFECTS
Opioids have neurological side effects. Slowed breathing caused by opioids can deprive the brain of much-needed oxygen. Oxygen deprivation can affect the mental and nervous systems, cause coma, or lead to permanent brain damage.6
Another long-term effect of opioid use disorder includes the deterioration of brain tissue and nerve fibers. This can lead to difficulties with decision-making, a decline in a person’s ability to control their behavior, and can lead to abnormal reactions under stressful conditions.6
Additional long-term health risks from opioid use disorder include:
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Misconceptions About Opioids
Let’s take a look at some of the common myths surrounding opioids.
MYTH: HEROIN USERS ARE YOUNG, POOR, AND UNINSURED
The CDC reports a sharp increase in heroin use for both men and women in the United States. These increases cut across almost all age groups and income levels. The largest increases for heroin use have occurred in groups where it has not been seen before: women, the privately insured, and people in higher income brackets.7
MYTH: ALL OPIOID DRUGS ARE THE SAME
Opioid drugs have different potencies, vary in how quickly they act, and differ on how long they last. An opioid like oxycodone takes effect fast but also wears off quickly. An opioid, like methadone, takes longer to take effect and lasts longer. The opioid fentanyl is a very powerful opioid drug that is 50 to 100 times more powerful than morphine, according to NIDA.8
The more powerful the opioid, the higher the risk for overdose and addiction, even at lower doses. Keep in mind that overdose and addiction can happen from any opioid use, but more potent opioids can be more dangerous and deadly when abused.
MYTH: IF YOU TAKE AN OPIOID PAINKILLER AS PRESCRIBED, YOU WON’T DEVELOP AN OPIOID USE DISORDER
Any lengthy use of opioids can cause tolerance and dependence, even when they are taken for chronic pain relief as prescribed. When the medications leave the body, the resulting withdrawal symptoms can be hard to handle emotionally and physically.
This withdrawal can cause people to self-medicate, increase the dosage, or take opioids between doses. This can also result in the misuse of opioids to produce euphoria or “high”. This affects reward centers in the brain and frequently causes continued abuse. Addiction can soon follow because any nonmedical use of opioids can lead to an opiate use disorder.
MYTH: REPLACEMENT OPIOID MEDICATIONS ARE JUST TRADING ONE ADDICTION FOR ANOTHER
Most people cannot suddenly stop taking opioid drugs because of the withdrawal symptoms that follow. To combat this, abused opioids are replaced with longer-lasting ones, such as buprenorphine or methadone. Since these drugs last in the system longer, smaller doses are required. Smaller doses produce fewer effects, and euphoric highs will not occur.
Buprenorphine is typically mixed with naloxone that activates if the medication is abused. Naloxone blocks the euphoric and pain-relieving effects of buprenorphine if it is abused, so it discourages misuse.
Replacement opioids are slowly and carefully tapered down during detox and treatment until they are not needed any longer. Opioid replacement therapy is used along with counseling, therapy, and support services throughout treatment to help foster long-term recovery. This is always done under careful supervision by a physician.
Opioids Withdrawal Symptoms
Within the first 24 hours after the last dose, withdrawal symptoms include:
After 24 hours, more intense symptoms begin and may include:
Detox Controls Withdrawal Symptoms
An opioid detox program works to gradually reduce the amount of drugs in the body to eliminate or minimize withdrawal symptoms. Also, other medications are given as needed to alleviate the discomfort that comes from withdrawal.
Medical Detox Programs
Detox can be done on an inpatient or outpatient basis. In the early stages, a detox can last from several days to about a week to get the individual through the most critical withdrawal symptoms.9
MEDICATION-ASSISTED TREATMENT IN DETOX
A short-term opioid detox involves giving opioid substitute medications, such as methadone or buprenorphine.9 Depending on what medication and how much is initially given, the detox can take anywhere from days to months. Some opioid replacement detoxes can last 7 to 21 days. Other detox methods that use a slower tapering can last up to 6 months or longer.4
THERAPY IN DETOX
Many detox programs use other therapies, such as talk therapy, during detox. This prepares the person for the next step, which is formal opioid abuse treatment. Continued treatment is needed after an initial detox because there is an extremely high chance of relapse.
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Effective Opioid Addiction Treatments
There are many different evidence-based therapies provided in formal treatment settings. These include motivational enhancement therapy, behavioral therapy, coping skills training, counseling, talk therapy, and peer support through group meetings.
Many people in recovery prefer to receive these therapies in a safe and secure setting like a residential treatment facility. Inpatient rehab gives around-the-clock medical supervision and monitoring as well as medication management during detox. Once the short-term detox is done, it is much easier to move from the facility’s detox unit into its residential rehab section. After, a variety of therapies are used to begin the road to recovery.
ASSESSMENT: THE INTAKE INTERVIEW
INDIVIDUAL THERAPY
GROUP THERAPY
Sessions in a group are also a large part of opiate addiction treatment. Group therapy sessions can decrease feelings of isolation and help participants feel like a part of something bigger than themselves. Peer interaction provides motivation and support. Many strong, long-lasting, and rewarding friendships are forged in group therapy sessions.
HOLISTIC / ALTERNATIVE THERAPIES
AFTERCARE SERVICES
After detox and formal treatment programs are completed, individuals are usually enrolled in an aftercare program. This program provides services needed for the person to transition into independent living. Follow-up treatments and therapies are given on an outpatient basis. Aftercare treatment increases the chances of remaining abstinent and reduces the risks of relapse.
Each aftercare program is developed and customized for each person. An aftercare program can include:
- Sober living homes
- Outpatient rehab programs
- Group counseling sessions
- Individual counseling sessions
- 12-step programs
- Alternative therapies
- Dual diagnosis treatment
- Job or education programs
- Medication-Assisted Treatment (MAT)
MEDICATION-ASSISTED TREATMENT (MAT)
Also known as long-term detox services, MAT provides medications on a regular basis, sometimes for months or years to help a person stay sober.
Finding the Right Help for Opiates and Opioids Addiction
If you suspect you or a loved have an opiate or opioid addiction, you should seek help. Withdrawal from opioid drugs without medical help can be very painful and possibly dangerous. Professional treatment for opioid addiction is recommended. Contact your doctor, therapist, or a treatment center for help.
Resources
- Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419–1427. DOI: http://dx.doi.org/10.15585/mmwr.mm675152e1external icon
- Brownstein M. J. (1993). A brief history of opiates, opioid peptides, and opioid receptors. Proceedings of the National Academy of Sciences of the United States of America, 90(12), 5391–5393.
- Rosenblum, A., Marsch, L. A., Joseph, H., & Portenoy, R. K. (2008). Opioids and the treatment of chronic pain: controversies, current status, and future directions. Experimental and clinical psychopharmacology, 16(5), 405–416.
- Baldini, A., Von Korff, M., & Lin, E. H. (2012). A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide. The primary care companion for CNS disorders, 14(3), PCC.11m01326.
- O’Shea, J., Law, F., & Melichar, J. (2009). Opioid dependence. BMJ clinical evidence, 2009, 1015.
- National Institute on Drug Abuse. DrugFacts: Heroin. http://www.drugabuse.gov/publications/drugfacts/heroinexternal icon
- Centers for Disease Control and Prevention. Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013. MMWR 2015; 64(26):719-725.
- National Institute on Drug Abuse. DrugFacts: Fentanyl. http://www.drugabuse.gov/publications/drugfacts/heroinexternal icon
- National Collaborating Centre for Mental Health (UK). Drug Misuse: Opioid Detoxification. Leicester (UK): British Psychological Society; 2008. (NICE Clinical Guidelines, No. 52.) 6, PHARMACOLOGICAL AND PHYSICAL INTERVENTIONS IN OPIOID DETOXIFICATION.
