Opioid Addiction and Abuse

Opiate is a term used in pharmacology to describe substances that are derived from opium, a chemical that is naturally produced in poppy seeds and plants. Opiates are pain killers that are clinically used in treating mild to severe pain in patients. Due to their intensely soothing effects, opioid painkillers have extremely high rates of abuse and addiction.

Opiates come in two variations, such as short-acting and long-acting. These medications generally take 15 – 30 minutes to activate and last for over 3 hours, depending on the opiate consumed. Due to their highly effective pain relief feature, the US experienced a boom in opiate prescription. Around 259 million prescriptions for opioid painkillers were written in 2012, of which an estimated 2 million patients later formed an addiction to the drug.

Opiates are largely classified into two classifications, namely antagonists and agonists. Antagonists like naltrexone and naloxone are regarded as less addictive than agonists, although the potential for abuse still exists. They are often used as an aid during the detoxification process, due to their effectiveness in blocking receptors from responding to opioids and endorphins.

Agonists imitate the effects of naturally occurring endorphins in the body and produce an opioid effect by interacting with specific receptor sites. The most commonly prescribed agonists may include morphine and fentanyl. These drugs are commonly used in medical settings, as they are highly effective and addictive. Hydrocodone, oxycodone, heroin, and buprenorphine are also a few other forms of agonists. Many of the substances in this category have a very high potential for abuse and addiction.

The most common opioid agonists are:

While opiates are naturally produced compounds, opioids are traditionally referred to synthetic or semi-synthetic substances of similar chemical structure to opiates. The effects produced by opiates and opioids are very similar to one another, hence why both terms are frequently interchanged.

Opiates and opioids function by triggering the mu receptors in the brain while also depressing the central nervous system. When one of these drugs are activated, they release the feel-good chemicals known as endorphins that produce relaxation and calmness. These sensations are the primary cause of abuse and addiction among users.

Opiates produce euphoric and tranquilizing effects when taken in quantities larger than prescribed. The euphoric calmness experienced when taking these drugs is often the cause of abuse. Similar to the dangers of many addictive substances, prolonged use of opioids can cause severe physical and psychological health issues. The effects of these drugs are generally felt within 15 to 30 minutes and may persist for several hours.

The side effects of opiates are determined based on factors such as the type of opioid consumed, the quantity of drug consumed, the duration of abuse, and the method of administration.

The immediate side effects of painkillers are:

• A relaxed state of the mind and body
• Calmness
• Increased or false confidence
• Shallow breathing
• Impaired judgment
• Flushed skin
• Nausea
• Vomiting
• Constipation
• Blurry vision
• Drastic weight loss
• Hallucinations
• Euphoric state
• Lightheadedness

The other long-term side effects of opiates are:

• Damages to the veins (from intravenous use)
• Emotional instability
• Acute constipation
• Lack of concentration
• Depression
• Anxiety
• Insomnia
• Liver damage

An addiction to these painkillers often begins once a patient has been prescribed medications for pain management following an accident or injury. However, over time, the patient may develop a tolerance to the drug and may require higher and higher doses to achieve its pain-relieving effects. Increasing the dosage of drugs in this manner can lead to physical dependence. When a patient develops a dependence on the drug, they may find it difficult to function on a daily basis without its effect. This is caused when the body stops producing its natural chemicals and starts depending on the chemicals produced by the drugs. Abrupt cessation of the medication during this period may cause severe and intense sensations referred to as withdrawal.

The formation of dependence and tolerance is usually closely followed by the formation of addiction. When a person’s drug-seeking behavior is completely out of control and begins to compromise his or her physical and psychological health, it is indicative of a full-blown addiction. Addiction is a neurological disease that looks inescapable to a person suffering from it. Patients struggling with opioid addiction are highly advised to seek medical and professional treatment to avoid relapse.

• More than 50 percent of people who abused prescription painkillers in 2013 had received the drug from a friend or relative, according to the National Survey on Drug Use and Health.
• Forty-six people die each day from an overdose on a prescription painkiller.
• An estimated 23 percent of people who used heroin in 2014 has also developed a co-occurring painkiller addiction.

Although opiates are generally consumed as oral capsules or tablets, they are also available in different forms that can be ingested in various manners. The use of opiates without a prescription or beyond what was prescribed is considered abuse. It is also considered abuse when patients consume the medication in a manner that increases their effectiveness without the doctor’s approval. For instance, crushing tablets into powder and snorting them or dissolving them into liquid and injecting them are all forms of abuse.

Snorting or injecting opiates generates an immediate rush that is not achievable through oral consumption of the pill. However, this instant rush can give rise to life-threatening complications such as respiratory failure and drug overdose.

A drug overdose is a devastating, yet all too common occurrence of opioid painkiller abuse. Overdose is usually a result of taking too much of a substance at any given time or combining multiple substances, particularly other central nervous systems depressants, such as benzodiazepines and alcohol. This form of abuse is referred to as polydrug abuse. Drug overdoses are the leading cause of accidental death in the United States, with 38 percent of all overdose deaths linked to painkillers.

The signs of an overdose may include:

• Confusion
• Constricted pupils
• Nausea
• Vomiting
• Shallow breathing
• Clammy skin
• Extreme drowsiness or the inability to wake up
• Intermittent loss of consciousness

For many patients, survival from an overdose becomes the defining moment that led them to seek treatment. However, some may still remain reluctant to rehabilitate and often wake up from an overdose only to use again.

The other adverse risks of opiate abuse are:

Here are a few physical and behavioral warning signs to look out for:

• Needle marks on the arms and legs, indicating intravenous use (injections)
• Pinpointed pupils
• Finding it difficult to stay awake or sleep at proper times
• Flushed and itchy skin
• Losing interests in social activities or events that were of interest before
• Dramatic mood swings that might cause personality shifts
• Acting or making decisions on impulses
• Undertaking risky activities, such as driving under the influence of drugs
• Consulting many doctors to get more prescriptions (doctor shopping)

Recognizing an addiction to opiates can be challenging, especially since there is only a faint line that differentiates between abuse and addiction to opiates. The primary characteristic of addiction is the intense craving or powerful urge to consume the drug despite the negative consequences. A person with an addiction may find it strenuous to control substance use and may fail miserably at quitting the drug on their own.

Besides the adverse health risks, opiate abuse can also cause:

• Losing your job due to prioritizing drug habit over work commitments.
• Running into financial troubles by squandering money on prescriptions.
• Facing legal charges for possessing painkillers without legitimate prescriptions.
• Estranged relationships with family, friends, or domestic or romantic partners.

Withdrawal occurs when a person abruptly stops taking a drug or drastically reduces the doses of the drug. Withdrawal symptoms depend on various factors, such as the type of painkiller being abused and the person’s existing opiate tolerance, polydrug abuse, and their history of mental and medical health. The majority of opiate withdrawal symptoms may project flu-like symptoms, such as fever, nausea, and vomiting.

Although withdrawal symptoms are usually not life-threatening, they can still cause an enormous deal of physical and psychological distress to the person suffering. Due to the severity of these symptoms, people who desire to quit opiates tend to relapse back into old habits. This, however, is a dangerous pattern as those who continually relapse tend to develop violent behaviors. Attempting to quit painkillers cold turkey on one’s own is tough and risky. Hence it is strongly recommended to seek qualified detox practitioners to resolve opiate addiction safely and soundly.

Opiate withdrawal symptoms range from moderate to severe and are most pronounced in patients with severe substance abuse or addiction. Various factors contribute to the type of withdrawal symptoms a person experiences. These factors may include the patient’s current health, underlying mental or behavioral disorders, family history of drug dependence, the substance’s length, and potency, and how the substance was administered. Withdrawal symptoms of opiates are generally felt within 24 hours of the last dose.

Opiate withdrawal symptoms may include:

• Agitation
• Anxiety
• Muscle spasms
• Insomnia
• Runny nose
• Profuse sweating
• Abdominal cramps
• Stomach pains
• Diarrhea
• Constricted pupils
• Unstable blood pressure
• Nausea
• Tremors
• Vomiting

The four stages of opiate withdrawal include:

• Anticipatory withdrawal
• Early-acute withdrawal
• Fully-developed acute withdrawal
• Post-acute withdrawal syndrome (PAWS).

Each opiate holds a unique half-life. A half-life of a drug refers to the length of time it takes for the drug to reach half its starting level of potency. As a result, depending on the opiate consumed and the method of consumption, withdrawal symptoms may take root at different times. According to the Drug Enforcement Administration (DEA), heroin is considered to be the fastest-acting opioid with the shortest half-life. According to the American Pain Society, short-acting prescription opioid drugs, such as immediate-release oxycodone (OxyContin) and hydrocodone (Vicodin), all include half-lives of approximately 4-6 hours.

Doctors may prescribe medications during detox to help ease long-term complications associated with opiate withdrawal, such as opiate cravings. Over time, the patient will be gradually weaned off this medication once they overcome the stage of acute withdrawal symptoms. Medications can continue to be part of the treatment plan as the patient continues to seek treatment in an inpatient rehabilitation center.

Some of the common medications used during detox are:

Addiction treatment often takes place at an inpatient or outpatient rehabilitation facility. These facilities provide a variety of programs such as individual and group therapies, medications, and other essential support and guidance to help patients positively change their lives. Treatment centers are an ideal solution to recovery as they help patients address their physical and psychological dependencies as well as any co-occurring disorders they may have. These rehab facilities often provide medical detoxification services on-site to help alleviate the effects of withdrawal.

An individual’s treatment experience often depends on the type of rehab chosen, the severity of the addiction, and the existence of any co-occurring conditions, such as a mental health disorder. Patients undergo an evaluation by an addiction specialist where topics such as the patient’s past and current substance abuse, relevant medical conditions, and home life during this process are thoroughly discussed. The results of these questions help health professionals develop the most effective treatment plan possible for each patient.

Opiate addiction treatment usually involves a mix of therapies and counseling sessions, such as:

• Individual behavioral therapy or cognitive behavioral therapy is considered as one of the most effective methods used in addiction treatment. CBT is utilized to identify and acknowledge behavioral responses to specific triggers and replace these behaviors with new, healthier responses to cope with those triggers. These one-on-one therapy sessions provide patients with a safe environment that promotes open communication without any fear of judgment.
• Group therapy participation gives rise to certain camaraderie, as participants all share a mutual understanding of what each one is going through. The mutual respect participants have for each other allows individuals to reveal and share their personal stories and create a possibility for healing.
• Certain treatment centers also provide specialized counseling sessions. These may be most fitting for anger management, stress management, or grief therapy and offer coping strategies to help strengthen the ability to cope with problems in a positive and productive manner rather than being plagued with the urge to use drugs or alcohol.
• Family therapy is a vital element of recovery, found in most addiction rehab facilities. Addiction disables the whole family, often resulting in toxic codependency or extreme rage and resentment. Many personal and emotional issues are resolved and discussed during family counseling sessions. Healing as a family goes a long way as patients require their support once they leave the rehab.
• In addition to counseling, rehabs also host speakers who share their own experiences. This offers residents a sense of optimism for their future. Certain times, speakers explore practical issues such as rebuilding post-treatment careers or offering inspirational speeches to uplift spirits.

Patients are most often advised to continue their recovery at a rehabilitation center after detox. Most of these treatment programs fall into two categories: inpatient rehabilitation and outpatient rehabilitation.

An inpatient rehabilitation center is a residential treatment program that focuses on offering around-the-clock medical and emotional support in a structured, drug-free environment to allow patients to commit solely on their sobriety. Patients are motivated to play an active role in their recovery by engaging in the on-site activities and therapies offered promptly by the center.

On the contrary, an outpatient rehabilitation center presents a more flexible recovery option for patients who wish to remain at home during treatment. Patients in an outpatient rehabilitation program visit the local treatment center several times a week to participate in therapy sessions, support group meetings, and drug education seminars. Each outpatient program component focuses on teaching patients how to rebuild their lives free of drugs and alcohol.

It is crucial to bear in mind that outpatient rehabilitation is best suited for those with a mild addiction as they may still be surrounded by environmental triggers that may promote a relapse. Patients with chronic addiction, however, should strongly consider an inpatient program. Intensive outpatient treatment is usually suggested as an aftercare plan for three months following an inpatient program.

The first few months of post-rehab can be extremely difficult for some patients, as it can be challenging to manage recovery alongside re-adjusting to a normal routine. It is crucial to develop an aftercare plan containing ongoing therapy sessions, support group meetings, and healthy lifestyle habits to continue and maintain one’s sobriety.

Aftercare is an essential part of the recovery process, as it aids patients to stay motivated as they embark on a life-long recovery journey. An aftercare plan helps solidify the lessons learned in rehabilitation and tame any temptations that a person may face during the first few months and years of the recovery process. It is generally recommended for patients to move to a standard outpatient program that meets at least once a week as a group and provides at least one individual session per week.

Aftercare services may include:

• Individual and group therapy sessions
• 12-step meetings similar to Narcotics Anonymous
• Family support groups similar to Al-Anon
• Alternative recovery meetings similar to SMART recovery

Apart from aftercare programs, patients are encouraged to participate in sober activities or hobbies that provide a psychological and social outlet for patients.

Sober activities and hobbies ideal for a recovering patient:

• Recreational sports
• Volunteering
• Playing musical instruments
• Taking up fitness classes, such as yoga or kickboxing
• Cooking favorite foods
• Arts and crafts
• Dance sessions/therapies
• Exercise programs