Opioid addiction

Opioid addiction : types, symptoms and treatments

The worldwide opioid epidemic or the opioid crisis is a hot topic on social media and in medical circles. Precisely what is the opioid crisis, what substances are we talking about and what treatment options are available for opioid addiction?

What is the opioid crisis?

Abuse of opioids has grown at such an alarming rate that it is referred to as a health epidemic. Opioid abuse has led to a growing number of deaths from overdose and hospitalisation. Reports say the death rate from opioid abuse has ramped up to over 40 000 a year or 115 per day in the United States alone. Drug overdose from prescription drugs is now the leading cause of accidental death in the United States.

What is opioid addiction?

Someone with an opioid addiction abuses a classification of a drug derived from opium or a synthetic version of opium. Opioids are synonymous with pain relief and are highly effective in managing pain. However, they are highly addictive if misused or abused.

Prescription opioids that are most commonly abused are:

• hydrocodone (Vicodin®)
• oxycodone (OxyContin®, Percocet®)
• oxymorphone (Opana®)
• morphine (Kadian®, Avinza®)
• codeine
• fentanyl
• heroin

What are opioids?

Opioids are a class of medication prescribed for pain and the treatment of terminal illnesses such as cancer. About 20 percent of people who go to doctors in the United States will get a prescription for a medication called an opioid. You’ll also hear prescription medicines referred to as opiates.

This type of pain medication is made from natural opium or manufactured synthetic opium. Morphine and codeine are examples of opiates that contain two natural products of opium. However, the majority of this class of drugs are manufactured synthetic versions of morphine.

What is the difference between opioids and opiates?

Opioids and opiates are used interchangeably because these substances essentially produce the same effects. However, there is a difference between opioids and opiates with regards to how they are made.

Opiates

Opiates are substances with active ingredients that are naturally derived from opium. Common opiates include morphine and codeine, which are directly made from the opium found in poppy plants.

Opioids

Opioids are synthetically manufactured substances that mimic the “natural” effects of opium. Some opioids are entirely synthetic, while others are only partially synthetic, meaning they still contain natural opium.

What causes opioid or opiate addiction?

Opioids and opiates both work by activating Mu receptors in the brain and depressing the central nervous system. Mu receptors control physical functions such as stress, temperature, respiration, endocrine activity, gastrointestinal activity, memory, mood, and motivation. Because these receptors bind to opioids, they are also commonly known as opioid receptors.

Opioid receptors are found in the nervous system, where they are embedded in the outer membrane of nerve cells (neurons). When opioids bind to the receptors, the contact triggers a series of chemical changes within and between neurons that causes feelings of pleasure and pain relief.

When the receptors become activated by the drugs, they release “feel-good chemicals” known as endorphins. Increased endorphin levels lead to feelings of bliss, relaxation, calmness and pain relief. Endorphins ‘mute’ your perception of pain and boost feelings of pleasure.

Endorphin surges create a temporary but powerful sense of well-being. When an opioid dose wears off, you may find yourself wanting those good feelings back as soon as possible. The craving for the endorphin reward is what makes opioids or opiates highly addictive.

Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor. However, there is a high risk of abuse and addiction because they trigger euphoria in addition to pain relief. Abuse of opioids can lead to dependence and addiction, overdose and death.

Source: NIDA

What are the common signs of opioid abuse?

Fentanyl

Brand names: Actiq, Duragesic, Sublimaze, Subsys, Abstral and Lazanda nasal spray

Fentanyl is a synthetic chemical similar to morphine but is 50 to 100 times more potent. Like morphine, fentanyl is used to treat patients with severe pain, especially after surgery. Individuals who ingest fentanyl at unprescribed levels experience intense euphoria and a sense of relaxation similar to a heroin “high.”

Street names for fentanyl include Apache, China girl, China white, dance fever, TNT and crush.

Most common physical signs of fentanyl abuse include:

• slowed breathing
• seizures
• headaches
• dizziness
• blurred vision
• constipation
• nausea and vomiting
• itching
• euphoria
• mellowness
• drowsiness

Hydrocodone

Brand names: Vicodin, Norco, Lortab and Lorcet.

Hydrocodone is a prescription opioid prescribed for moderate to severe pain. It is a semi-synthetic opioid typically used for short-term pain relief following dental surgery or for injury-related pain. Ongoing use of hydrocodone is habit-forming. In fact, in as little as five days of prescribed use, the risk for developing a chronic hydrocodone addiction increases significantly.

Most common physical signs of hydrocodone abuse include:

• blurry vision
• confusion
• constipation or diarrhea
• dry mouth
• itchy skin
• lightheadedness
• nausea and vomiting
• nodding in and out of consciousness
• pinpoint pupils
• reduced breathing rate
• seizures
• sleepiness
• slowed heartbeat
• slurred speech
• warm, flushed skin

Hydromorphone

Brand names:  Dilaudid, Exalgo and Hydrostat IR.

Hydromorphone is a semi-synthetic opioid used widely for acute pain, chronic cancer pain and, to a lesser extent, in chronic nonmalignant pain. Hydromorphone is dangerous because tolerance builds up quickly, which leads many patients to escalate their doses.

Taking larger doses of prescription drugs with hydromorphone can cause shallow or decreased breathing, circulatory collapse or respiratory failure. This type of prescription drug can have devastating consequences, such as seizures, stroke and fatal overdoses.

Most common physical signs of hydromorphone abuse include:

• constricted pupils, pinpoint pupils

• pinpoint pupils
• depressed, slowed breathing
• loss of alertness
• drowsiness
• mood swings

Methadone

Methadone is used for pain relief from an injury, surgery or long-term illness. The drug is also widely used for the treatment of substance addiction, known as replacement therapy. Methadone blocks the high from codeine, heroin, hydrocodone, morphine, and oxycodone. Methadone is used to treat addiction by reducing cravings. The drug is heavily regulated because of the high risk of dependence.

The most common physical signs of methadone abuse include:

• constricted pupils
• discoloured nails and fingertips
• dizziness
• hypertension
• nausea and vomiting
• respiratory depression (potentially fatal)
• loss of consciousness

Meperidine

Brand names: Demerol.

Meperidine is an opioid painkiller, also known as pethidine. It is classified as a narcotic analgesic and used to treat moderate to severe pain, with effects similar to morphine or oxycodone. The prescription drug is only one-tenth as potent as morphine, but there is still a high risk of abuse.

Most common physical signs of meperidine abuse include:

• constant fatigue
• nausea and vomiting
• profuse sweating
• disorientation
• breathing difficulties or slowed breathing
• constant itching
• unusual sleeping patterns
• drowsiness, lightheadedness
• intense mood swings; depression, anxiety, agitation, irritability
• zoned out; in a daze
• dry mouth
• headaches
• constipation
• exacerbated mental illness symptoms

Oxycodone

Brand names: OxyContin, Percocet, Percodan and Roxicodone

Oxycodone is a powerful painkiller and one of the most commonly abused prescription drugs in developing countries. Oxycodone offers much-needed relief to people suffering from chronic pain or terminal illnesses. Some brands of oxycodone are made with acetaminophen or aspirin and help relieve aches and pains, headaches and fever.

Most common physical signs of oxycodone abuse include:

• dilated pupils
• apathy
• drowsiness
• dizziness
• short attention span
• sense of calmness
• happiness
• reduced anxiety
• confidence
• relaxation
• euphoria

Codeine

Brand names : Tylenol, Phenflu, Calcidrine and Fioricet

Codeine is used to relieve mild to moderate pain associated with colds and flu. It’s commonly used to reduce coughing in the form of codeine-based cough syrup. Codeine belongs to a class of medications called opiate analgesics and to a class of drugs called antitussives.

Codeine use often starts innocently with a prescription for a codeine-based cough syrup. Because codeine is less regulated than some opiates such as morphine and OxyContin, getting and abusing it is relatively easy. Although less potent, codeine provides effects similar to morphine.

Codeine abuse can lead to respiratory failure, coma and even death. This risk is exceptionally high when codeine is combined with other central nervous system depressants such as alcohol or other opioids.

Most common physical signs of codeine abuse include:

• euphoria
• apathy
• drowsiness
• relaxation

Heroin

Heroin is an opioid street drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. People inject, sniff, snort or smoke heroin. Some people mix heroin with crack cocaine; a practice called speedballing.

The most common physical signs of heroin abuse include:

• mood swings; depression, anxiety, euphoria, paranoia
• agitation and irritability
• weight loss
• scabs or bruises as the result of picking at the skin
• delusions, disorientation, hallucinations
• lack of personal hygiene
• periods of hyperactivity followed by periods of exhaustion
• increased sleeping
• slurred speech
• shortness of breath
• frequent respiratory infections
• dry mouth
• forced, pressured speech
• warm, flushed skin
• constricted pupils
• extreme itching
• track marks on arms and legs; wearing long pants and shirts, even in warm weather

What caused the opioid crisis?

In 1853, the hypodermic needle was invented, and after that, doctors began using morphine for minor surgical procedures to treat neuralgia. This event gave rise to the medicalisation of opioids.

Morphine had the most abundant natural opioid found in prescription drugs at the time, and it was one of the first medicines used for chronic pain relief. As science advanced, the medical world found a way of replicating the effects of morphine with synthetic versions of the substance.  

For example, methadone was developed due to the scarcity of morphine. Heroin was synthesised as an alternative to morphine in 1898, and the German chemical company Bayer sold heroin as a cough suppressant. However, heroin proved to be highly addictive and later was made illegal to produce. Today, like many illicit opioids, heroin is primarily a synthetic drug sold on the streets illegally.

What treatment options are available for opioid addiction?

Effective treatment for opioid addiction is a combination of buprenorphine and naloxone and an extended-release naltrexone formulation. However, naltrexone requires complete detoxification and should only be used as part of a medically supervised detox.

These medications help many people recover from opioid addiction in conjunction with inpatient or outpatient psychotherapy.

How is an opioid overdose treated?

An opioid overdose can be reversed with the drug naloxone when given right away. Effective medications exist to treat opioid use disorders, including methadone, buprenorphine and naltrexone.

Is it possible to recover from opioid addiction?

Prescription opioids are highly addictive and life-threatening, but it is possible to recover from opioid addiction. It’s recommended that people with opioid addiction undergo medical detox in a clinical environment because withdrawal symptoms are uncomfortable and sometimes life-threatening.

Opioid withdrawal ranges from moderate to severe depending on the type of opioid and duration of opioid abuse.

Common opioid withdrawal symptoms include:

• nausea and vomiting
• diarrhea
• insomnia
• anxiety
• increased body temperature
• racing heart
• muscle and bone pain
• sweating
• chills
• high blood pressure

Opioid use disorder is a chronic medical condition because it can create long-term brain structure and function changes. Early medical intervention and treatment can help you avoid long-term health conditions common with opioid addiction. The sooner you get help, the better.

Medical detox from opioids and medication to help with cravings is only the first step on the path to full recovery. Your opioid addiction treatment plan should also include counselling and holistic therapies at an inpatient or outpatient addiction care facility.

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