Opiate and Opioid Addiction and Abuse

Humans have been cultivating opium plants, and using its derivatives for medicinal and recreational purposes since ancient times. In the early 19th century, German scientist Friedrich Sertürner isolated morphine, the active narcotic painkiller in opium. Morphine became popular for its uses as a pain reliever and sedative, but also led to widespread addiction among patients. It also precipitated the development of other opiate derivatives including heroin, codeine, oxycodone, methadone, and others, as scientists looked for a safer alternative to morphine.

By the early 19th century, opiate addiction had reached epidemic proportions in the U.S., and Congress began passing laws to control the use, sale, and importation of heroin and opium. However, the manufacture and sale of some synthetic opioids in the form of prescription painkillers, remains legal, and is a contributing factor in the current opioid epidemic in the U.S.

Legal opiate drugs include:

• Morphine – Used to treat moderate to severe pain
• Meperidine – Treatment for moderate to severe pain, usually before and during surgeries
• Codeine –  Prescribed to treat mild to moderate pain, and as a cough suppressant
• Hydrocodone (Vicodin, Lortab) – Combination medication that relieves moderate to severe pain
• Oxycodone (Percocet, Oxycontin) – Prescribed to treat moderate to severe pain
• Fentanyl – Used to relieve severe ongoing pain. Prescribed in transdermal patch form

Illegal opiate drugs include:

• Heroin (black tar, brown powder, white powder)
• Opium

When physicians prescribe opioid-based medications, it is typically to relieve moderate to severe pain following surgery or injury. Opioids bind to receptors in the brain, spinal cord, and other areas of the body, interrupting pain messages that the body sends to the brain. Because they are so powerful, they can block severe pain that has not responded to other treatments.

prescription opioids come in pill or capsule form, and are only meant to be taken for a short time. Side effects of prescription opioids include nausea, vomiting, constipation, drowsiness, dizziness, or lightheadedness.

Opiates affect the brain’s chemistry by binding to receptors and triggering the release of endorphins, which create feelings of pleasure, satisfaction, and reward, and block pain signals sent from throughout the body.

The drugs typically create an endorphin rush that is more intense than what the brain would produce normally, meaning naturally-produced endorphins are no longer enough to make the person feel satisfied. Over time, the brain will stop producing endorphins entirely, so that the only way a person can achieve feelings of pleasure is by ingesting opiates. Additionally, the brain tends to develop tolerance to opiates quickly, meaning that you will need an increasingly higher dosage to produce the same effects.

In many cases, individuals who are initially prescribed legal narcotic medications like oxycodone or hydrocodone will turn to illegal opiates like heroin after developing a dependence on the drugs, because heroin is cheaper, more easily accessible, or provides the more intense high they seek.

A number of factors contribute to developing an opioid addiction, including personal history, the length of time one takes opioids, and the dosage. However, the powerful nature of these drugs can lead to anyone, including those with no history of addiction or who take opioid medication prescribed, to develop an opiate addiction.

Steps in the development of opiate addiction include:

• Tolerance: As the brain becomes used to the presence of opiates, it will require increasingly higher dosages to produce the same effects
• Withdrawal: When the brain stops receiving the dose of opiates it depends on to function, it impacts many systems throughout the body. Withdrawal symptoms include muscle aches, trouble sleeping, diarrhea, abdominal cramping, nausea, rapid heartbeat, and high blood pressure.
• Psychological dependence: Because the brain is no longer producing its own endorphins, it craves the artificial boost that opiates provide. The only way for individuals to feel pleasure or satisfaction is by using opiates, creating a psychological dependence on the drug.

There are some common physical, psychological, and behavioral signs to look for if you suspect that someone is abusing opiates. They include:

Physical signs of opiate abuse:

• Constipation
• Lightheadedness
• Drowsiness
• Constricted pupils
• Dry mouth
• Nausea and vomiting
• Shallow breathing
• Slowed heartbeat
• Low blood pressure

Psychological signs of opiate abuse:

• Irritability
• Mood swings
• Depression
• Suicidal thoughts

Behavioral signs of opiate abuse:

• Neglecting family, work, school or other obligations because they are high or preoccupied with obtaining opiates
• Borrowing or stealing money, or committing other illegal acts to pay for opiates
• “Doctor shopping,” or visiting multiple physicians to obtain prescriptions for opioid painkillers
• Changes in diet and weight loss
• Avoiding social interactions with family and friends to hide drug use
• Losing interest in relationships, work, and hobbies not related to opiates
• Becoming irritable, angry, or violent when confronted about opiate use

When abused over long periods of time, opiates can also have a number of serious side effects, including:

• Increased risk of HIV, hepatitis and other bloodborne illnesses due to intravenous injection
• Weakened immune system
• Respiratory infections
• Gastrointestinal issues
• Brain damage
• Vein collapse
• Dental problems
• Impotence
• Depression and suicidal thoughts

Overdose and death

The most dangerous possible side effect of opiate abuse is overdose and death. Often overdoses occur when people ingest too much of an opiate, or an opiate that is laced with other drugs or harmful components. Opiates trigger receptors in the brain that regulate breathing and heart rate, causing them to slow down. When an individual overdoses on opiates, it can lead to:

• Unconsciousness
• Slow or stopped breathing
• Decrease in heart rate
• Low blood pressure
• Brain damage

There are now products on the market like Narcan that can reverse the effects of an opiate overdose, although individuals who overdose should still seek medical treatment.

Once an individual addicted to opiates recognizes the need for treatment, the first step in the process is detoxification. This is when the individual stops taking opiates, and the body removes all traces of opiates from its system.

Because of the intense physical and psychological dependence that opiates trigger, the detox process is usually unpleasant, and potentially dangerous, as the body and brain readjust to a lack of opiates. Withdrawal symptoms usually set in within the first 24 hours of detox, and can include:

• Insomnia
• Restlessness
• Mood swings
• Irritability
• Anxiety
• Depression
• Runny nose
• Lacrimation, or teary eyes
• Excessive sweating
• Muscle aches and spasms

Withdrawal symptoms that appear within two or three days of ceasing opiate use are more severe, and include:

• Nausea
• Vomiting
• Diarrhea
• Abdominal cramping
• Rapid heartbeat
• High blood pressure
• Paranoia

Because of the severity of these withdrawal symptoms, it’s recommended that individuals undergo detoxification under the care of a trained medical professional, to ensure their safety. Many drug treatment facilities include detox as part of the recovery process, and have staff who are trained in caring for patients during this process.

There are some medications available to help individuals cope with the withdrawal and detox process, although these drugs also have their own risks, and should only be used under the supervision of a medical professional. These medications include:

• Methadone
• Buprenorphine (Naloxene and Suboxone)
• Clonidine

There are a number of treatment options available for individuals recovering from opiate addiction, including:

• Inpatient or residential rehabilitation centers
• Outpatient rehabilitation programs
• Individual mental health and addictions counseling
• Group therapy programs

The type of treatment that works best depends on the individual’s specific needs and limitations, and should be decided in consultation with a physician, counselor, and trusted friends or family. All types of treatment options are designed to help individuals learn to live without relying on illegal or prescription opiates. They will also address underlying issues that may have led to abuse in the first place. Recovery from opiate addiction is an ongoing process, and may involve attending support groups or residing in a sober living facility for a period after rehab. Although relapses can occur, it’s important to not get discouraged, and continue working towards a healthy, sober life.

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