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    Opioid addiction

    Opioid addiction : types, symptoms and treatments

    The world-wide opioid epidemic or the opioid crisis is a hot topic on social media and medical circles. Exactly 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 being referred to as a health epidemic. Opioid abuse has led to a growing number of deaths from overdose and hospitalisation, with reports saying the death rate from these drugs has ramped up to over 40 000 a year or 115 per day in the United States. 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 drug that is derived from opium or a synthetic version of opium. Opioids are synonymous with pain relief and are extremely effective in managing pain. However, they can be highly addictive if used incorrectly or abused.

    The 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 that is prescribed for pain and the treatment of terminal illnesses such as cancer. About 20 percent of people who go to doctors in the US will get a prescription for medication called an opioid. You’ll also hear it referred to as an opiate.

    This type of pain medication is made from natural opium or man-made synthetic opium. Morphine and codeine are examples of opiates which contain two natural products of opium. The majority of this class of medicine are man-made synthetic versions of morphine.

    What is the difference between opioids and opiates?

    Both terms – opioids and opiates – are used interchangeably because these substances largely 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 both 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 fully 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 are a class of receptors that control different 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 lead to feelings of pleasure and pain relief.

    When these receptors become activated by one of these drugs, they release “feel good chemicals” known as endorphins. The release of endorphins caused by opiate or opioid use leads to feelings of relaxation and calmness as well as pain relief. Endorphins ‘mute’ your perception of pain and boost feelings of pleasure.

    The surge of endorphins creates 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. Basically, 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, because they produce euphoria in addition to pain relief, they are often misused or abused. Abuse of opioids can lead to dependence and addiction, overdose incidents 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 powerful synthetic opioid that is 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. It’s a prescription drug that is also made and used illegally. Those ingesting fentanyl at unprescribed levels experience an intense euphoria and 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 man-made semi-synthetic opioid that is 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 that has been 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 a hydromorphone like Dilaudid may lead to shallow, decreased breathing, circulatory collapse or possibly respiratory failure. Dilaudid abuse can have devastating consequences, such as seizures, stroke and fatal overdoses.

    Most common physical signs of hydromorphone abuse include:

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

    Methadone

    Methadone is a powerful drug used for pain relief from an injury, surgery or long-term illness. Methadone is also widely used for the treatment of drug addiction, known as replacement therapy. It blocks the high from drugs like codeine, heroin, hydrocodone, morphine, and oxycodone. Methadone can give a similar feeling and keep you from having withdrawal symptoms and cravings. While methadone is used as a way to curb addiction and reduce cravings, it is a heavily-regulated drug.

    Most common physical signs of methadone abuse include:

    • constricted pupils
    • discoloration in the nails and fingertips
    • dizziness
    • hypertension
    • nausea and vomiting
    • respiratory depression (in extreme cases, potentially fatal)
    • loss of consciousness

    Meperidine

    Brand names : Demerol.

    Meperidine is an opioid painkiller that is also referred to as pethidine. It is classified as a narcotic analgesic and used to treat moderate to severe pain, with effects similar to morphine or oxycodone. Although Demerol is only one-tenth as potent as morphine, it is short acting and has a high risk of abuse.

    Most common physical signs of meperidine abuse include:

    • constant fatigue
    • nausea and vomiting
    • profuse sweating
    • disorientation
    • breathing difficulties, 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 with chronic pain or terminal illnesses. Some brands of oxycodone are made with acetaminophen or aspirin for the relief of aches and pains, headaches, fever etc.

    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 a codeine-based cough syrup. Codeine belongs to a class of medications called opiate analgesics and to a class of medications called antitussives.

    Codeine use often starts out 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. This is despite the fact that codeine is very similar chemically to drugs such as morphine and hydrocodone. Though less potent, codeine provides effects similar to morphine.

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

    Most common physical sings 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.

    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 gave rise to the medicalization of opioids.

    Morphine has the most abundant natural opioid found in opium drugs 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 synthesized 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 illegal opioids, heroin is mostly a synthetic man-made drug that’s sold on the streets illegally.

    What treatment options are available for opioid addiction?

    A buprenorphine/naloxone combination and an extended-release naltrexone formulation are effective in treating opioid addiction. However, naltrexone requires full detoxification and should only be used as part of an addiction treatment plan which includes 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 can be highly addictive and life-threatening, but it is possible to recover from opioid addiction. It’s highly recommended that people with an opioid addiction have a medical detox in a clinical environment because withdrawal symptoms can be extremely uncomfortable and even life-threatening.

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

    Typical 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 changes to how your brain works. Early medical intervention and treatment can help you avoid some of the long-term health conditions that are 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 recovery. Your opioid addiction treatment plan should also include counseling and therapy at an inpatient or outpatient addiction care facility.

    We’re here to help.

    Contact us today if you’d like a confidential and free chat with one of our highly-trained addiction professionals at White River Manor in South Africa.

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