When you have a headache or pulled a muscle at the gym, you might take an over the counter pain reliever. There are plenty to choose from for when we have the normal aches and pains of everyday life. Sometimes however, when we have a major injury, are recovering from surgery or have another cause of severe pain we may need something stronger. A physician may prescribe an opioid based pain reliever. Opioids are narcotics that produce pain relief and sedation. While useful for treating moderate to severe pain that won’t respond to an over the counter medication, they must be used with caution since they have a high abuse potential and can lead to serious side effects.
The class of opioid related drugs includes those that are sometimes referred to as natural as they are made directly from parts of certain poppy plants such as morphine and codeine. Others, termed synthetic opioids, are compounds that include active ingredients which are chemically manufactured and not found in nature, such as heroin.
Our brains and other parts of our body produce natural opioids and thus, have opioid receptors. External opioids work by binding to these receptors and stimulate them. Since they are recognized as if they were naturally occurring opioids, over the long term with continued use the body decreases production of its own opioids, and the external drugs substitute for them. The higher the dose taken and the longer the duration of the abuse the less opioids the body will produce on its own. If the person decides to cut down or stop taking the drug the ability to experience pleasure based on their own internal mechanism for generating the chemical basis that leads to these feelings is lacking or has been significantly decreased. Thus, in comparison to the feelings they’ve become used to from the drugs, the lack of pleasure seems extreme enough to create a distressing negative mood state. Thus, once dependence has occurred leading to the person taking increasing amounts it is extremely difficult to decrease the dose or stop taking it altogether due to the resulting negative emotions being experienced as intolerable.
In addition to sedation, euphoria and pain relief, opioids can lead to confusion, nausea, and shallow respiration. Even when taken at the dose prescribed opioids can have dangerous results since many are formulated to be released into the body over time at a slow, steady rate. Since this means there is not sudden a rush, people looking to intensify the effects may take several more doses before the first dose has cleared the body. This can lead to overdose and death since there’s no sudden signal letting the person know they are in danger and need help. Others looking to create a rapid and intense effect may grind the tablets and snort them or mix the powdered drug with water to inject. This can also lead to serious and sometimes deadly outcomes since people often misjudge the potential for overdose due to basing the amount used on the effects when taken orally.
When the delivery method is altered, this also increases the likelihood that other prescription or non-prescription medications will be used or abused, such as stimulants, to offset the feelings of drowsiness and increase alertness in order to fully enjoy the opioids effects. This can lead to further complications and physical consequences. If you or a loved one is struggling with an opioid addiction, it is crucial to seek opioid abuse treatment as soon as possible.
Opioid addiction and dependence is growing steadily each year in the U.S. The estimated lifetime prevalence rate of opioid addiction is .37 percent in individuals 18 years or older. However, as many individuals using opioids are incarcerated, this is likely an underestimate of the true prevalence.
A gender difference has been noted in the use of opioids though the actual magnitude of this difference is dependent on the drug used. Overall, estimates of use are about twice as high in men vs. women (.49 percent compared to .26% respectively). For prescription opioids however, this ratio has been estimated to be 1.5 to 1, or one and a half times as many men abusing these drugs as women. The rate for heroin abuse increases significantly, however, and use of this drug has been estimated to be three times as high in men compared to women. Adults under the age of 30 have the highest prevalence rates (.29 percent) occur among adults under the age of 30. Rates decline with increasing age until reaching an estimated prevalence or .09% in those over the age of 64.
Those with opioid related problems frequently experience other conditions as well. Over 40% of those addicted to opioids have a co-occurring psychiatric and/or substance related disorders. The most common are:
- Major Depressive Disorder
- Antisocial Personality Disorder
- Anxiety Disorder
- Post-Traumatic Stress Disorder
- Bipolar Disorder
- History of Conduct Disorder during Childhood or Adolescence
- Cannabis Abuse
- Alcohol Abuse
- Stimulant Abuse
- Benzodiazepine Abuse
Individuals who inject the drug frequently have co-occurring medical conditions including viral ailments such as HIV and Hepatitis C or bacterial infections.
Direct Genetic Influences – It is recognized that opioid use runs in families. Those with a first degree relative who suffered from an opioid addiction are significantly more likely to develop the same problem compared to others without such a family history.
Indirect Genetic Influences – While the development of opioid abuse has been shown to be associated with individual, family, social, peer, and environmental influences it is believed these factors play out through a genetic mechanism. Inborn temperamental such as preference for novelty and impulsivity have been linked to opioid addiction. Peer influences have also been shown to effect the development of opioid use and dependence though we also know that there is a genetic predisposition that influences our choice of peer groups. Thus, the relationship between heredity and environments is an important consideration in terms of what leads to opioid abuse.
Coping Methods – It has been theorized that a necessary function related to emotion is the ability to regulate extreme mood states. When children are not taught adaptive coping mechanisms for dealing with stress and the associated negative mood states they grow up searching for other ways to decrease their distress. If they encounter opioids through peers or other means, the discovery of the resulting pleasure or sense of elation often results in the adoption of opioid use as their main means of coping.
Modeling – The most common way we learn how to act is through observing those around us. When we grow up in a family who model drug use as the primary means of dealing with distressing experiences and feelings, this is normalized to the point that we come to accept drug use as the best way to avoid distress and unhappiness.
Physiological Predispositions and Stress – We are born with specific physiological features that predispose us to acquire certain conditions or illnesses. However, whether we go on to develop these disorders is determined by environmental influences encountered throughout our life.
Repeated Rewards Experienced in the Brain – An important function of our brains is to ensure we engage in activities that lead to sustaining life such as eating and drinking. This is accomplished by pairing these activities with pleasure. Thus, when someone using an opioid experiences a sense of happiness or elation they want to experience these feelings again. The similarity to what occurs with life sustaining activities, over time and repeated use, causes the brain to interpret opioid use as a life sustaining activity as well. So in addition to the reinforcing qualities of the pleasure experienced, the message that the opioid use is critical to survival is also communicated in the brain, leading to an even stronger perceived need for the drug. It can be extremely difficult to overcome opioid abuse without proper professional treatment.
Signs and Symptoms of Opioid Use
- Continued use despite knowing it is leading to or worsening a psychological problem
- Poor Judgment
- Inability to make decisions
- Inability to Plan
- Poor concentration or attention
- Memory problems
- Opioids are taken for longer or at higher doses
- The individual unsuccessfully tries to cut down on the amount used unsuccessfully
- The individual spends a lot of time obtaining, using or dealing with the consequences of the opioid
- Opioid restricts the individual’s ability to meet their responsibilities in different areas of life
- The individual does not stop using the drug despite knowing it is causing interpersonal problems
- Avoidance of previously important activities
- Continued use in situations which could be hazardous
- Cravings for the drug
- Sleepiness or Sedation
- Numbness or inability to feel pain
- Depressed Respiration
- Small Pupils
- Nausea, Vomiting
- Rashes or flushed skin
- Slurred Speech
- The development of tolerance:
- Needing more of the drug to achieve the desired effect
- When taking the same amount the effects of the drug diminish over time
- Withdrawal symptoms with no longer taking the drug or decreasing the dose
- Drug is taken to avoid withdrawal symptoms
Effects of Opioid Use
There are a number of effects that result from the use of opioids. These include:
- Feeling tired, fatigued, and sedated
- Constricted pupils leading to decreased sight in dim or darkened conditions
- Nausea and vomiting
- Chest pain
- Decreased respiration and trouble breathing
- Physical and psychological addiction
Withdrawal symptoms resulting from the decrease of cessation of the opioid can vary depending on the specific type of opioid taken, the dose and the length of time the individual has been dependent on the drug. Common withdrawal symptoms include:
- Negative mood
- Muscle and joint pain
- Runny nose
- Drug cravings seem intolerable
- Rapid breathing
- Yawning due to decreased oxygen intake
- Increased Salivation
- Goosebumps or chills
- Nasal stuffiness
- Abdominal cramps
- Confusion or disorientation
- Enlarged pupils
- Loss of appetite