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Prescription Opioids: The New Epidemic

Prescription opioids are one of the most commonly used pain medications in America. In 2017, more than 1 in 2 Americans received a prescription for an opioid analgesic, and each prescription has filled an average of 3.4 times per patient. Usually used to treat chronic or acute pain that hasn’t responded well to other types of analgesics, opioids are highly addictive, and anyone who uses opioids risks the possibility of becoming addicted. Although the terms opioid and opiate are used interchangeably, they are, in fact, different substances. Opiates are made from the poppy plant while opioids are synthetically produced; both act similarly on receptors in the brain and on the CNS, or central nervous system, and both are equally addictive.

Physiological and Psychological Components of Opioid Addiction

According to the NIH, or National Institutes of Health, the science of addiction is not yet fully understood because two individuals may consume the same amount of a substance and with the same frequency, yet one may become addicted while the other will not. However, opiates and opioids are two of the most insidious of the addictive substances because they produce feelings of euphoria and happiness that mimic those that occur naturally in the body. Over time, the body requires ever-increasing amounts to provide that feeling, and addiction can occur before the user is aware of it. It’s not uncommon for those who start their prescription at the indicated dosage to become addicted to it. Opioid addiction that occurs as a result of other drug use can be precipitated by past emotional trauma or insecurities, whereas opioid addiction that arises as a result of prescription usage often lacks these components, so the treatment regimen may need to be different.

Segue to Addiction

Often, opioid and opiate addiction begin with a prescription dosage that’s intended to alleviate the pain that hasn’t responded well to other types of pain medication. It’s also used after surgery or after a traumatic injury that causes severe pain. The patient starts by using the full dosage as prescribed, but when it provides pain relief as well as euphoria, they begin to crave that feeling. Although there are alternative methods that can be used for pain relief, they may take longer and are not as convenient, so they’re usually not the first option in a society that demands instant gratification. 

When opioids are used, they suppress the body’s production of dopamine and endorphins, the “feel good” substances, that initiate feelings of happiness, satisfaction, and pleasure. Over time, opioid use will cause the body’s production of endorphins and dopamine to cease entirely, so the individual will gradually require more opioids to feel pleasure. Thus begins the first of the three steps to addiction, which are tolerance, physical dependence, and psychological dependence. Unfortunately, those who reach this stage will often resort to heroin to feed their addiction. Those who take opioids over an extended period will create dependence in their brain and will experience withdrawal symptoms when they don’t receive an infusion of opioids. They may become unable to experience pleasure in the usual manner and may prefer to take the drug rather than participate in ordinarily pleasurable activities that they once enjoyed. 

Prescription opioid addiction is increasing dramatically: In the U.S. from July 2016 to September 2017, according to drugabuse.gov, deaths from opioid overdose increased by 30 percent. Those whose opioid use develops into an opioid addiction are more likely to become addicted to heroin since it’s also made from the poppy plant. When opioids no longer satiate the opioid addiction, then heroin is the solution. More than 80 percent of heroin addicts began as opioid addicts, and current estimates place the number of heroin addicts in the U.S. at almost 1 million people; the opioid epidemic is the most devastating in the U.S. since the AIDS/HIV epidemic began in the 1980s.

Origins of Prescription Opioids

When the pharmaceutical companies in the 1990s introduced opioids, the medical community was assured that their patients would not become addicted to the drugs, so they began to be prescribed without reservation. By the time the medical community realized that the drugs were, in fact, highly addictive, the damage was done, and many patients were addicted to the painkillers.

Types of Opioids

There are two classifications of opioids, agonists, and antagonists. Agonists act like naturally occurring endorphins in the body and bind with receptors in the brain. Agonists include:

  • Buprenorphine 
  • Fentanyl 
  • Heroin 
  • Hydrocodone 
  • Morphine 
  • Oxycodone 

Antagonists include:

  • Naloxone 
  • Naltrexone 

Antagonists are less addictive than agonists, and they are sometimes used in the first step of a detoxification process. However, antagonists are still addictive, and anyone who uses them without professional supervision is at risk of addiction.

What is Drug Addiction?

Drug addiction is both neurological and biological, so it affects both the brain and the body. It alters the structure of the brain and how it functions, and it’s a chronic and progressive disease that can be fatal when left untreated. Even those who want to be free of its hold are invariably unable to do so without professional treatment. Common signs of addiction include:

  • Lack of personal hygiene 
  • Loss of interest in usual activities 
  • Acting out 
  • Secretive behavior to hide their addiction 
  • Tremors, sweating, fatigue, nausea 
  • Relationship problems 
  • Job loss or problems on the job 
  • Increase in the amount of substance used 

Although not everyone who has any of these symptoms may be abusing opioids or another drug, the presence of any or all of these symptoms may indicate the presence of a problem, mainly if the individual has been prescribed opioids for a relatively recent injury.

Those who used to be addicted to prescription opioids would visit multiple doctors so that they could obtain prescriptions for their medications. However, the advent of computers and state and national databases have virtually eliminated this option, so those who are addicted may resort to more nefarious means to obtain their medications, including the black market and buying prescriptions from other patients. Sometimes, a person’s conversation may provide insight into their drug habits. Street names often used to refer to opioids include:

  • Black tar 
  • Chinese H 
  • China White 
  • Dragon 
  • Elephant 
  • Gear 
  • Hammer 
  • Horse 
  • Nose drops 
  • Rock 
  • Skag 
  • Smack 
  • White 
  • White dynamite 

Opioids may be prescribed under the following names:

  • Codeine 
  • Fentanyl 
  • Hydrocodone 
  • Hydromorphone 
  • Lortab 
  • Meperidine 
  • Morphine 
  • Oxycodone 
  • Oxycontin 
  • Percocet 
  • Vicodin 

Ramifications of Addiction

Addiction takes a toll on the physical body, and it will eventually be fatal unless the user seeks treatment. Common complications of addiction include:

  • Cardiovascular disease including heart attack 
  • Constipation, diarrhea, abdominal pain 
  • Liver or kidney damage 
  • Seizures or a stroke 
  • Loss of appetite 
  • HIV or hepatitis 
  • Pancreatitis 
  • Malnutrition 

Can’t They Stop?

Addiction is a disease just as alcoholism or cancer or leukemia are diseases. Although the individual might have more control over the initial development of alcohol or drug addiction than they do over their potential development of cancer or leukemia, addiction is a disease nevertheless and requires treatment. The physiology of addiction often disallows the option to “just say no,” and many people are addicted before they’re aware of it. Sudden withdrawal of the substance isn’t possible for them, and even if it were, it’s hazardous to withdraw from a substance to which you’re addicted abruptly. For a treatment regimen to be effective, it must be comprehensive and address behavioral changes as well as physical and physiological changes. 

If Addiction is Part of Your Life

If you are addicted to opioids, even if they were prescribed, your life is no longer your own. The addiction owns you, and you’ll do whatever is necessary to keep it satisfied — your addiction is the only thing that matters. Relationships suffer, your job performance suffers if you haven’t already lost your job, and both your physical and mental health suffer. You may fear the stigma that’s attached to addiction, but be unable to rectify the situation, so you’re in emotional turmoil. That feeling can be alleviated by feeding your addiction, but that exacerbates your emotional turmoil, so you’re in a Catch-22 situation with no apparent way out.

By the time you’ve reached this stage, you’re experiencing the neurological impact of addiction and should seek treatment without delay. Fear of stigma will be irrelevant if you succumb to the effects of your addiction, but the only way you can free yourself of your addiction is to enroll in a professional treatment center. By the time you’ve reached this stage, sudden withdrawal from the drug can be fatal, so your rehab treatment must be supervised by professional medical personnel.

If Addiction is Part of a Loved One’s Life

If your loved one has an addiction to opioids, you probably feel like you’ve been consigned to perdition and that you’re living with a person, you no longer know. Since opioids change how the brain and CNS functions, you’re entirely correct. The person you knew before the addiction is not the same person they are now.

You may be blaming yourself for the addiction or blaming them or the doctor or the stress of the job or anything else. However, it’s no one’s fault; it just is. Most people didn’t intend to become addicts when they began using their prescribed opioids; they just wanted relief from constant and severe pain. Often, when they started with the prescribed dosage, there was almost immediate relief, and it felt pleasant to be free of excruciating pain. Then, it began to be less effective at reducing anxiety, so they took a little more of the medication so that they could reproduce the positive impact of the opioid. Then they needed a little more, and before long and entirely without the intention to do so, they became addicted. By this time, your loved one had no control over their opioid use, and by now, they probably feel unable to quit even though they may want to.

A substance abuse disorder doesn’t need to become a permanent part of your life, and there are programs available, both inpatient and outpatient, that can help you or your loved one overcome the addiction. Just as you wouldn’t blame yourself or your loved one for catching the seasonal flu, you shouldn’t blame yourself or your loved one for developing a substance abuse disorder. Treatment is available, and many insurance plans provide for treatment in a detoxification facility. Prayer, meditation, and personal goal setting can help you get through this, whether you’re the addict or a loved one suffers from a substance abuse disorder. The important thing is to become free of the addiction and go on to live life to its fullest, without the destructive influence of opioids.

About the Reviewer: Chris Barnes

Chris BarnesChristopher Barnes has worked in health care for over thirty years. He is a graduate of Alabama State University where he earned a double Bachelor of Science Degree in Social Work and Psychology in 1982. Christopher Barnes is currently the Director of Clinical services at The Discovery House where he has been employed for the past five years. Because of his extensive experience in health care & substance abuse he has an excellent rapport with constituents, clients, and other professional organizations in the counseling/social service community.