Opioid painkillers are among the most prescribed medications in the nation. They’re also dangerously addictive and deadly. In 2016, an estimated 11.5 million Americans misused prescription painkillers, and 42,000 people died from an opioid overdose. Addiction to opioid medications may cause people to abuse heroin, an illicit opioid.
Opioid addiction doesn’t discriminate. A November 2017 presidential commission report examining the country’s opioid crisis found that opioid addiction affects young and old, the finally well-off and economically disadvantaged, and a wide range of people from all ethnic and racial backgrounds.
In 2016, more than one-third of adults in the United States — some 91 million Americans — used prescription opioids. Nearly 2 million adults reported abusing or being addicted to opioids such as prescription painkillers and heroin in 2016, accordin to the National Survey on Drug Use and Health.
Opioid addiction is dangerous, and it can be deadly. On average, 115 Americans die from an opioid overdose every day.
Opioids are a class of drugs that include the illegal street drug heroin and powerful prescription painkillers such as oxycodone, hydrocodone and morphine.
Doctors commonly prescribe opioid medications to treat many types of pain, including post-surgical pain and cancer pain. Over the past few decades, they have increasingly prescribed opioids to manage chronic pain. Various opioid medications are also used to suppress coughs, treat diarrhea and manage opioid addiction during rehab treatment.
You may also have heard the term opiate and wondered about the differences between opiates and opioids. While the media often uses the terms interchangeably, there are some subtle distinctions.
Opiates are drugs such as morphine, codeine and heroin that come directly from the opium poppy plant. Oxycodone and hydrocodone, however, are not considered opiates because they’ve been chemically created in a lab using natural opiates. These medications are known as semi-synthetic opioids.
Completely synthetic opioids also exist, including fentanyl, a potent man-made opioid 50 to 100 times more powerful than morphine that has been implicated in the recent spike of opioid overdose deaths.
The term opioid can be used to refer to a group of drugs that includes natural opiates, semi-synthetic opioids and synthetic opioids. In addition, it’s not uncommon for media outlets to use the term opioid when referring to prescription opioids used to treat pain.
The potency or strength of opioids can vary widely. The strength of these drugs is often measured as a comparison to morphine, which has been used medically for more than 200 years.
Common prescription opioids include codeine, morphine, hydrocodone, oxycodone and fentanyl. Heroin, which is processed from morphine, is an illegal opioid with no medical use.
Derived directly from the opium poppy plant, morphine has been used since the Civil War to relieve acute pain. Morphine comes in both injectable and tablet form, and it is highly addictive.
Since the 19th century, doctors have used codeine to treat medical issues ranging from coughs to diarrhea to pain. While codeine is substantially weaker than morphine, it still has a high potential for abuse and addiction.
Oxycodone is one of the most commonly prescribed painkillers in the world. An extended-release version of the drug, OxyContin, became popular in the 1990s among drug users who would snort and inject the medication.
This semi-synthetic opioid is used to treat moderate to severe pain following surgery or an injury. Hydrocodone is the most prescribed pain medication United States, and Vicodin addiction is widespread.
This powerful narcotic pain reliever is available in both pill and IV form. As a Schedule II narcotic, Dilaudid has a high potential for abuse and addiction.
Meperidine is a short-acting synthetic opioid about one-tenth as potent as heroin. Once widely used in hospitals, the injectable painkiller is less used today because it carries a risk of seizures. Like other opioids, misuse of meperidine or its brand-name version Demerol can result in addiction.
Fentanyl is the most potent prescription opioid in popular use today. It is only intended for patients with severe pain who have previously been taking opioids daily. That’s because the drug is so strong that it could kill a person who hasn’t developed a tolerance to opioids.
Fentanyl is available many forms, including an injectable liquid, a transdermal patch, a pill, a nasal spray and a spray for under the tongue. More recently, fentanyl has crept into the nation’s heroin supply, causing a spike in opioid overdose deaths.
Once on the decline, heroin use and heroin addiction is rising again in the United States. In fact, heroin overdose deaths increased fourfold between 2010 and 2015, according to the President’s Commission on Combating Drug Addiction and the Opioid Crisis.
One theory behind the heroin resurgence is that people who develop an addiction to prescription opioids frequently turn to heroin when they are unable to access or afford prescription painkillers.
According to the National Institute on Drug Abuse, nearly 80 percent of people who started abusing opioids in the 1960s and entered rehab for heroin addiction reported misusing prescription opioids before moving on to heroin.
All opioids work in the same general way, acting on the central nervous system to reduce the perception of pain.
Opioids are structurally similar to endorphins, naturally occurring pain-killing chemicals that our brain manufactures when we experience pain or stress. Like endorphins, opioids attach to specialized receptors in the brain and spinal cord called mu-opioid receptors, which interrupt pain signals and trigger euphoric sensations.
Opioids also flood the brain with dopamine, a chemical that triggers a surge of happiness and imprints a good memory of the experience. That imprint encourages us to repeatedly seek more of the same feeling — which is why people often continue to take opioids even when they don’t need them for pain.
Eventually, this compulsive use can lead to tolerance and dependence, the hallmarks of addiction.
Over time, the original dose of the opioid fails to create the same level of pleasure it once did, so people are driven to take a higher dose to experience the same euphoric high. With repeated exposure to the drug, the brain revs up nerve cells to counteract the drowsiness, low blood pressure and other slowing effects of the opioids.
These changes allow individuals to function in a relatively normal state when the drug is in their system, but it will cause uncomfortable withdrawal symptoms such as anxiety, muscles cramps and diarrhea if they suddenly stop taking opioids.
To avoid those painful withdrawal symptoms, people are driven to seek more of the drug, reinforcing their addiction.
While prescription opioids are highly effective at relieving some types of pain, the drugs have a high potential for addiction — even when used as directed.
Physical signs and symptoms of opioid abuse can include:
A 2018 study found that for every additional week that patients take prescription opioids such as codeine, oxycodone or hydrocodone, their likelihood of abusing the drugs increases by 20 percent. Each time a prescription was refilled, the chance of misuse rose by 44 percent. The patients included in the study did not have a history of opioid misuse or ongoing treatment with opioids.
Several signs and symptoms can help you determine if you’re addicted to prescription opioids. Risky behaviors include taking more pills than prescribed, seeking opioids from multiple doctors and stealing pills from friends or family members. You might also experience withdrawal symptoms, such as insomnia, muscle cramps, chills, nausea and diarrhea when you stop taking your pills.
Because opioids slow breathing, the drugs can be deadly. In 2016, more than 42,000 Americans died of an opioid overdose — a record number and a 28 percent increase over 2015 that was driven in large part by increasing use of synthetic opioids such fentanyl.
Those at highest risk of an opioid overdose include:
Individuals with an opioid use disorder are at an especially high risk of overdose following detox, after completing a drug rehab program or following release from jail or prison because of a reduced tolerance. Even a low dose of an opioid can be fatal after a short time of abstinence.
The three main signs of an opioid overdose are:
Death from an opioid overdose is often preventable. If administered in time, the drug naloxone, also known by the brand name Narcan, can reverse the effects of an opioid overdose.
Highly potent opioids such as fentanyl, however, may require multiple doses of the medication. It may take six or more shots of naloxone to reverse the effects of carfentanil, a synthetic opioid 10,000 times stronger than morphine that’s used to tranquilize elephants and other large animals. Waves of overdoses in multiple states have been linked to heroin batches that drug dealers laced with carfentanil.
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Opioid addiction is difficult to treat and characterized by frequent relapses. Treatment starts with detox to help people overcome their physical dependence to opioids.
During medically monitored detox, medications may be prescribed to help decrease the uncomfortable symptoms of opioid withdrawal.
After detox is complete, individuals are ready to begin the rest of the opioid rehab and treatment process. This usually includes a mix of individual and group counseling, education on opioid addiction and coping strategies to deal with cravings and other factors driving addiction. Treatment is available in inpatient and outpatient settings.
In conjunction with behavioral counseling, the treatment team may prescribe medications to help the brain recover from addiction. Suboxone (buprenorphine and naloxone), methadone and Vivitrol (naltrexone) are all approved by the Food and Drug Administration to ease cravings and withdrawal symptoms associated with opioid dependency.
According to the National Institute on Drug Abuse, these medications improve social functioning and increase the likelihood that people will complete treatment. One study reported that heroin overdose deaths plummeted by 37 percent after buprenorphine became available in Baltimore.
Because relapse is common, drug testing is an important component of many drug treatment programs. Most opioids remain in your system for several days to a week. However, hair tests may detect opioids for up to three months after last use.