Opiates

In 2018, it was found that a total of 128 daily deaths were recorded in the United States daily due to opioid abuse. Considered a health crisis or epidemic, opioid addiction can cause serious dangers to a person’s health, social, and financial problems. The class of drugs are typically prescribed in the healthcare setting to treat pain, but their strong potential for abuse has become a major problem worldwide.

Today, it’s estimated that 15 million people are addicted to opiates, and in the United States, the problem is costing $78.5 billion annually to cover the cost of healthcare, productivity losses, criminal justice, and abuse treatment.

Opium first arrived in the United States in 1775, but it wasn’t until close to a century later that it found a purpose within the country. The drugs were given to soldiers serving in the civil war which resulted to widespread abuse throughout the military. Later in the 1800s, opioids were made available as over-the-counter medications, with even some pharmaceutical companies incorporating heroin into pain relief and cough medications.

By 1910, the recreational use of opioids became rampant. Pills were typically crushed and then snorted to provide a feeling of pleasure and pain relief. So, by the years 1914, opioids were tagged prescription medications in order to restrict their availability to those who abused them.

Between 1920 to 1950, it was mandated that opioids could only be provided to individuals who were dying, as opposed to those who needed them for chronic pain. This was an attempt to curb addiction and dependence, however with the approval of Vicodin and the soaring popularity of Oxycontin, it became difficult to prevent abuse.

In 2002, prescriptions for the entire range of opiate medications increased significantly, with Oxycodone leading the way with a record increase of 402%. It was also reported during this time that opiate abuse was becoming more and more common among teens as they gained access to the drugs through their parents’ prescriptions.

And while doctors attempted to relieve the need to prescribe pain medication through nerve blocking surgeries and other non-pharmaceutical methods, more and more people started transitioning to heroin abuse.

• In 2012, 259 million prescriptions for opioids were provided, which is more than enough to give each individual American adult their own bottle of pills
• 2017, 1.7 million people in the United States suffered from opioid abuse
• In the same year, 652,000 people were reported to suffer from heroin use disorder
• Close to 30% of people who are prescribed opioids for valid health reasons abuse the medication
• Up to 12% of those prescribed with opioids develop a substance use disorder
• Up to 6% of those who use opioids will transition to heroin use
• 80% of heroin users report having used opioids first

Opiates are a class of drugs that are usually prescribed to treat pain or as anaesthetics. These include medications like:

• Codeine
• Oxycodone
• Hydrocodone
• Tramadol
• Morphine
• Hydromorphone
• Carfentanil
• Fentanyl

Many of these medications are synthesized from the extracts of the opium poppy plant. Opium itself – which is derived directly from the plant – does have some benefits, but isn’t typically abused in the United States. However, the illegal drug trade has found a way to make use of opium’s effects.

Synthesized from the extracts of the opium poppy plant, heroin is an illegal Schedule I drug. This means that it doesn’t have medical benefits, and it poses a significant tendency for abuse. It appears like a brown or white powder or as a black tar like substance.

As the government attempt so put a lid on the use of prescription opiates, heroin is fast becoming a cheap alternative for those who have developed an addiction. During use, the illicit drug induces feelings of relaxation, sedation, and cognitive clouding, cycling its user between states of wakefulness and unconsciousness.

Although there are a variety of opiate medications, many of these drugs work to produce the same effects. Some of the short term effects of opioids may include:

• Drowsiness
• Coma
• Decreased respiration
• Nausea
• Unconsciousness
• Constipation
• Sedation
• Pain relief

The feeling of calm and numbness that results from the use of opioids may give a person a sense of a ‘rush’. This initial high can be described as pleasant, while the subsequent crash might make a person feel sick and unwell. This stark contrast between the feelings of being on opioids and off of them is what ultimately drives individuals to keep taking the drug.

In the long run, opioids can cause some if not all of the following long-term effects:

• Restlessness
• Insomnia
• Pain
• Cold flashes
• Psychosis
• Paranoia
• Increased tolerance
• Diarrhea
• Anxiety

Note that this is not an all-inclusive list and that some people might react differently to the long-term use of opioids. What’s common however is an increased tolerance for the substance. With frequent use of opioids, the body becomes accustomed to the presence of the drug.

So much so, that it becomes difficult to function without a dose. While the high might make a person feel relieved and comfortable, the absence of the drug is the exact opposite, fueling the urge to restore the pleasant experience with another dose.

But as with most addictive substances, opioids become less effective over time. As your body adjusts to your usual intake, the feelings of relief are no longer as pronounced. This forces many abusers to heighten their dose in an attempt to chase the potency of those first few doses. With time, constant increases may lead to an overdose.

Majority of those who abuse opioids will be so fixated on securing their next dose that they fail to fulfill many of their everyday responsibilities and work. As though fueled by their need for a fix, many will even delve into illegal activities like theft and fraud in order to guarantee their next dose.

The human brain has what’s called a reward pathway, in which the neurotransmitter dopamine plays a significant role. This neurotransmitter is associated with good, pleasurable feelings and is released when we experience pleasant stimulation. When using opioids, the substance interferes with this reward system, allowing copious amounts of dopamine to ‘soak’ the neurons and thus increase the feelings of pleasure.

But over time, the need to satisfy opiate addiction relies on more than just a desire for this pleasure response. Over time, the brain’s opioid receptors become less and less sensitive to stimulation when they’re far too often exposed to the drug. This in turn, develops a tolerance. Simply put, this means that the brain needs greater doses of opioids in order to stimulate the receptors.

Once a tolerance is established, then comes the dependence. This is an attempt to avoid the symptoms of withdrawal by taking repeated doses of the substance. When opioids are often present in the brain, they bind to noradrenaline which is a neurotransmitter responsible for wakefulness, breathing, alertness, and blood pressure, among other things.

By linking with these neurotransmitters, opioids dull down their function and thus create a feeling of drowsiness and sedation. Because of this, the brain is prompted to produce more noradrenaline in order to combat the effects of opioids. However as long as the drug is present, its effects remain supreme.

But when the opioids are removed from the system, noradrenaline production doesn’t return to normal. So, users experience heightened respiratory rate, alertness, and blood pressure which tend to create a negative response. All of these heightened functions are associated with pain, anxiety, and stress, which in turn pushes the abuser to take opioids to avoid the symptoms.

The treatment for opioid abuse is twofold: counseling and withdrawal management. The first focuses on the social, mental, and emotional aspects of the addiction while the second works to ease the system into a drug-free state.

Counseling typically involves:

• Looking into the factors that led to the use of opioids in the first place. Social factors like poor family dynamics or underlying mental health problems are typically associated with prescription medication abuse
• Providing skills that can help individuals identify situations that trigger cravings, and how to handle them
• Teaching strategies that can help individuals establish stronger relationships with friends, family, and other support groups
• Assisting in the adaptation of healthier habits like exercise, diet, and hobbies that help to divert the mind from the use of drugs
• Giving pointers on practical steps that the individual can take in case of a relapse

On the other hand, withdrawal management may include some of the following strategies:

• Detoxification by slowly reducing the dosage of the drug until it is no longer needed. For opioid addiction, quitting cold turkey may be lethal especially if the abuse is far too advanced.
• Providing other medications like Clonidine, a blood pressure management med that has been found to help with opioid abuse treatment. Under closely monitored conditions, some patients may be provided Buprenorphine.

Opiate abuse relapse rates are higher than any other addiction by 40% to 60%. But this doesn’t mean that treatment fails. It’s important to remember that opiate abuse is a chronic condition that leaves lasting changes in brain chemistry, so relapse isn’t only likely but is typically expected. In fact, majority of those who successfully complete treatment will relapse within one year.

Some studies have found that individuals with the following risk factors are more likely to relapse:

• Single
• Unemployment
• Low socioeconomic status
• With a previous criminal record

Many of those who relapse also report that their reason for doing so was the desire for a positive mood. Fortunately, drug abuse treatment and rehabilitation programs are prepared to address relapse by using follow-ups with discharged patients and by maintaining contact through regular monitoring.

Although opiate dependence remains an epidemic in the United States, many have recovered from the condition. With proper treatment, a strong network of family and friends, and a positive, proactive mental state, even those with the most severe addictions have a chance at living drug free.