Opioids are a class of drugs often prescribed to induce surgical anesthesia, relieve acute post-surgical pain, and to treat other moderate to severe acute pain. When opioids are taken short-term and as prescribed, they can be effective and relatively safe. However, when misused or taken illegally, they present a high risk of addiction and overdose.
The National Institute on Drug Abuse (NIDA) reported deaths involving opioids rose from 8,048 in 1999 to 47,600 in 2017. These deaths were linked to prescription opioids, heroin, and synthetic narcotics. The report found there were over 70,000 overdose deaths in 2017 from all illegal drugs and prescription opioids. The NIDA data showed, “In 2016, more than 42,000 people died from an opioid overdose, or approximately 115 people per day.”
What are opioids and How do they work?
The American Council on Science and Health explains that the term opioid “refers to any drug that acts on opioid receptors in the brain.” The drug produces a morphine-like, sedative effect, as well as euphoria. Opioids can be either naturally derived from the poppy plant or can be synthetically produced in a lab.
Opioids send signals to the brain, spinal cord, and other areas of the body to increase relaxation and dull pain perception. The drugs also interact with the pleasure and reward center of the brain to increase levels of dopamine and other chemicals; increasing feelings of pleasure, well-being, and euphoria. Although these same signals can be triggered naturally in the brain, opioids deliver the effects at a higher intensity, which can lead to addiction as users continually seek to repeat the effects. As opioid use is continued, the brain adapts to the dose and demands more of the drug to produce the desired effect, leading to tolerance and addiction.
The opioid crisis has cast much scrutiny on the frightening rise in opioid addiction and deaths in the last few decades. Consequently, physicians are becoming more cautious about prescribing opioids for conditions other than cancer pain, palliative care, and end-of-life comfort.
In 2016 the CDC issued a Guideline for Prescribing Opioids for Chronic Pain, providing recommendations for primary care physicians when prescribing opioids. “The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use.”
As it has become more difficult for patients to obtain opioid prescriptions, there has been a sharp increase in the use of heroin. The effects of heroin are similar to those of opioids, and it’s easier to get and less expensive than opioids. As deaths from opioid overdose have begun to slightly decline, heroin overdose deaths have increased. Data from the CDC “counted 10,574 heroin overdose deaths in 2014, which represents more than a fivefold increase of the heroin death rate from 2002 to 2014.” The CDC also states, “about 80 percent of people who used heroin first misused prescription opioids.”
Signs and Symptoms of Opioid Abuse
There are many physical, mental, and behavioral signs that may warn of opioid abuse or addiction. Common behavioral changes may include: taking higher doses than prescribed or more often than prescribed; stealing or forging prescriptions; requesting prescriptions from several different doctors (“doctor shopping”); reporting a prescription as lost and requesting a new one; or asking for early refills.
Fluctuations in mood and energy levels, including rapidly swinging from high to low levels, can be a sign of opioid abuse, as can sleep disorders and risky behavior, including unprotected sex or injecting drugs.
The Mayo Clinic warns that side effects from abuse of opioids can be severe and life threatening. Their list of the signs and symptoms of opioid abuse includes:
- Feeling high (euphoria)
- Slowed breathing rate
- Poor coordination
- Increased dose required for pain relief
- Worsening or increased sensitivity to pain with higher doses (hyperalgesia)
Older adults may be at a greater risk of adverse side effects from opioids, as they may take longer to metabolize drugs, may take multiple prescriptions, and may have other chronic diseases.
Opioids affect many areas of the brain, including the brain stem. The brain stem controls all basic life functions, like heart rate, breathing, and sleeping. The effects of opioids vary according to the dosage and frequency taken. While low doses might make the user feel relaxed and sleepy, high doses can slow breathing and heart rate to dangerously low levels, and can also cause irregular heart rate and low blood pressure. If breathing becomes dangerously slow and shallow, too little oxygen may be reaching the brain, causing a condition called hypoxia. Hypoxia can lead to coma, brain damage, and death.
According to a 2018 World Health Organization (WHO) fact sheet on opioid overdose, “Roughly 450,000 people died as a result of drug use in 2015. Of those deaths, about 160,000 were directly associated with drug use disorders and about 118,000 with opioid use disorders.” Many fatal overdoses show a combination of opioids, alcohol or other drugs present in system of the deceased.
Opioid overdose is a medical emergency. The WHO fact sheet points to the “opioid overdose triad” as the most common signs of an opioid overdose. Warning signs of an overdose often include pinpoint pupils, unconsciousness, and respiratory depression (slowed breathing). Other signs may include blue-tinged skin as a sign of poor circulation, an individual who is awake but unable to talk, the sounds of choking, an irregular pulse, and vomiting.
If you suspect an opioid overdose, contact emergency services immediately. If help arrives in time, a drug called naloxone can reverse the effects and prevent death. Most first responders now carry naloxone.
On April 19, 2019, the Food and Drug Administration (FDA) approved a generic form of naloxone, that could be administered by those without medical training.
Dr. Douglas Throckmorton, Deputy Center Director for Regulatory Programs in the FDA’s Center for Drug Evaluation and Research stated, “these efforts have the potential to put a vital tool for combating opioid overdose in the hands of those who need it most – friends and families of opioid users, as well as first responders and community-based organizations.”
Withdrawal from Opioids
When an opioid has been used long-term, illegally, or in a manner other than as prescribed, the body comes to rely on its presence. If an individual stops using the drug, they will experience symptoms of withdrawal, ranging from mild to severe. Milder symptoms may include anxiety, achiness, agitation, insomnia, sweating, and runny nose. More severe symptoms may include:
- Abdominal cramps
- Dilated pupils
These symptoms are similar to flu-like symptoms, and as with the flu, can be life-threatening. Diarrhea and vomiting cause serious fluid loss, and if those fluids are not replaced, an individual can die. Withdrawal should always be done under medical supervision.
On May 16, 2018, the NIDA announced approval by the FDA of the first medication specifically to treat symptoms of opioid withdrawal. The medication is lofexidine and will be marketed under the name Lucemyra.
Treatment for Opioid Addiction
At BlueCrest Recovery Center, our addiction specialists have decades of experience in helping people achieve long-term recovery from addictive behaviors. Using a holistic approach that treats the mind, body, and spirit, we facilitate the healing of the whole person.
Our staff is compassionate and empathetic and includes some who have also traveled the road to recovery from addiction. They have a special understanding of what it takes to heal. Our counselors work with those in recovery to address family and other relationship issues, parenting, work-related issues, legal issues, and more.
Our opioid rehab program is offered on an outpatient or intensive basis, allowing clients to continue working, going to school, and living at home while getting the support they need from a structured treatment program.
During outpatient treatment, clients attend individual, group, and family therapy sessions in a supportive environment. Our skilled counselors work with clients to understand the psychological factors that may be contributing to their opioid addiction and provide clients with the skills necessary to identify and prevent drug-seeking behaviors and lower their risk of relapse.
If you or a loved one is struggling with an addiction to prescription or illegal opioids, our treatment center can help. BlueCrest Recovery Center takes a whole-person approach to treatment, considering not only a person’s physical needs but, also, his or her emotional, psychological, and spiritual needs. Learn more about our approach to treatment and contact us today for help.