According to the National Institute on Drug Abuse, or NIDA the number of people in the United States who have died from opioid overdose increased 500 percent between 1999 and 2016. In 2017, opioid abuse killed 47,000 Americans which is more than people killed in car crashes or by firearms. The reasons for this are various and include the overprescription of these pain-killing drugs for chronic or post-operative pain. The problem with this is that opioids are uniquely designed to lead to chemical dependency. The human central nervous system actually contain sites called mu receptors into which opioids fit like keys into the locks made specifically for them.
Opioids or Opiates?
Both opioids and opiates are derived from the opium poppy. Opiates are natural drugs such as morphine while opioids can be both synthetic and natural. Heroin, for example, is an opioid because it is synthetic. It was created in England in the late 19th century and is derived from morphine. Made popular by Germany’s Bayer company, for a while heroin could be bought over the counter at the pharmacy. It was given its name because it made the user feel heroic. It is now a Schedule I drug in the United States, which means it is not only illegal and addictive but has no medicinal use. Yet, according to NIDA, most patients who use heroin used prescription opioids as their first drug of abuse.
Other opioids do have medicinal uses but can only be prescribed by a physician. They include fentanyl, an opioid that is 50 to 100 times more potent than heroin and used to ease the pain of terminally ill cancer patients. Yet, one of the reasons that death from opioid overdose is so high in many places in the country is that other drugs are “cut” with fentanyl, unknown to the user. Because it is so powerful, death can come before the person can be treated for overdose.
Carfentanil is an opioid that is even more powerful than fentanyl. It is used as an elephant tranquilizer and to ease the pain of end-stage cancer. It is so potent that there are apocryphal stories of people experiencing overdose symptoms simply from handling it.
Hydrocodone and oxycodone are opioids that are taken to ease severe pain. Sometimes they are added to aspirin. Codeine, another opiate, is used in cough syrups.
Morphine, which gets its name from Morpheus, the Greek god of sleep, is a natural derivative of the opioid poppy.
There is a class of opioids that is used to help patients withdraw from other opioids. Called opioid antagonists, these drugs are Naloxone, buprenorphine and methadone. They block the other opioids from locking into the opioid receptors in the person’s central nervous system. This both dulls the worst symptoms of withdrawal and stops the cravings that can lead patients to relapse.
These opioids are taken orally, either as a pill, as a film placed under the tongue, or via injection. The first two are sold under the names Suboxone and Subutex, and the third is sold under the name Vivitrol. The oral medications are taken daily while Vivitrol is injected once a month. Naloxone is now available as an overdose reversal drug and has contributed to a drop in overdose deaths in places where it is carried either by first responders or by patients.
How Are They Taken?
Opioids can be taken in several ways. They can be injected, smoked, or ingested as tablets or capsules. They come as powders, in liquid form, as syrups, skin patches or suppositories. Opioids in the form of lollipops are sometimes given to children to ease pain.
Opioids are subject to abuse because many bring euphoria as well as pain relief. Other effects of opioid use include drowsiness and apathy. Because opioids depress the central nervous system, patients can also experience a slower heart rate and breathing as well as other side effects such as constipation, pinpoint pupils, nausea and vomiting. Overdose happens when the person takes so much of the drug that their breathing and heart rate become dangerously slow or stop altogether. Other signs of overdose are cold and clammy skin, convulsions, confusion and stupor. The cold and clammy skin gives unmedicated opioid withdrawal the name “cold turkey,” for the skin resembles the flesh of a raw turkey.
Some people continue to take opioids long after their original problem has been resolved because of the way it makes them feel psychologically. Eventually, the person develops a tolerance to the drug that forces them to take more of it to get the same feeling. Physical dependency occurs when they must take the drug to avoid withdrawal symptoms.
Withdrawal symptoms begin about 24 hours after the last dosage of opioid. The intensity of the symptoms depend on the type of drug, how much the patient used, how long the patient had been abusing the drug, how much time usually passed between dosages and the health of the user.
Early symptoms of withdrawal are incessant yawning, sweating, a runny nose and watery eyes. If the person doesn’t take another dose of the drug, they experience irritability, nausea and vomiting, abdominal cramps, insomnia, tremors, chills that alternate with flushing and sweating and a deep depression. Their heart rate and blood pressure also increase. These symptoms can last for a few days.
Unpleasant as it is, opioid withdrawal is not life threatening. Still, more and more drug rehab facilities are treating patients with MAT, or medication-assisted treatment as they go through withdrawal to lessen their discomfort. The medications given to the patient traditionally include methadone and have started to include buprenorphine.
MAT helps patients withdraw under some kind of supervision by a health specialist. Depending on the patient’s needs, they can take the medication home with them during their withdrawal period or withdraw as an inpatient. Some patients opt for what’s called rapid detox, even though this is controversial. During rapid detox the patient is placed under general anesthesia while the drugs of abuse are purged from their body. This spares them the pain of withdrawal, but it does expose them to the risks of general anesthesia.
Treatment for Opioid Addiction
One piece of good news about the opioid epidemic is that availability of drug rehab centers around the country. Every state can be said to have at least one of these facilities, and several states have many. Most offer help in the form of programs such as outpatient, intensive outpatient, inpatient and partial hospitalization.
In outpatient programs, patients attend meetings and counseling sessions a few days a week for a period of time to help them recover from their addiction. With intensive outpatient programs, the patients come to the center more often. With inpatient, the patient actually lives at the center. Stays of 30, 60 or 90 days are common. With partial hospitalization, the patient spends all day at the center, then goes home or to a sober living facility at night.
While in these programs, patients are helped with therapies that can range from cognitive behavioral therapy to relapse prevention to art or music therapy and even equine therapy. Equine and other animal or outdoor therapies are especially popular in more rural areas.
Get in Touch With Our Counselors for Help
If you or our loved one are struggling with an opioid addiction, don’t hesitate to call our counselors at Om to Home by Central FL Recovery Centers in Apopka, Florida. Call for a consultation at (407) 370-5357.