Opiates are an American Health Crisis
Opiate, and opioid, addiction is one of the most serious health crises that Americans have faced in modern times. In 2017:1
More than 70,000 people in the United States died from a drug overdose
About 70% of these overdose deaths were opioid-related. From 2016 to 2017, this represented a 12% increase
From 2016 to 2017, overdose death rates that involved synthetic opioids increased more than 45%
What are Opiates?
Opiates are one of the oldest drugs available to man to manage moderate to severe pain and other medical conditions.2 Opium is a plant that contains high levels of both codeine and morphine.2 Opium also contains thebaine, which is used in many semi-synthetic opioid pain killing drugs.2 Opium poppy plants can be found in South Asia, Colombia and Mexico.3
The term “opiates” typically refers to naturally occurring substances. The term “opioids” refers to man-made drugs produced using opiates mixed with other chemicals or chemical imitations of opiates. For our purposes here, the words are sometimes used interchangeably.
Why Are Opiates Used for Pain Management?
The main reason opiates are so popular for pain management is that, unlike local anesthetic medicines that block all sensory channels, opiates selectively reduce pain without interrupting other important sensory functions such as touch, position sense, and temperature. Opiates reduce the perception of pain where some people report they still have the pain, but it doesn’t hurt. In short, opiates act on the nervous system to produce feelings of pleasure and to relieve pain.
Three Classes of Opioids
There are three classes of opioids: agonists, partial agonists and antagonists.4 They are grouped by the effects they produce at opioid receptors. Opioid receptors are sites inside the body that are activated by opioid and opiate substances.
Agonists bind with a receptor to produce a functional response (for example, pain relief after receiving morphine or euphoria after taking heroin)
Antagonists interact with a receptor but produce no response along with preventing an agonist from binding to that receptor (for example, naloxone to rescue a person in an opiate overdose situation)
Partial agonists bind to a receptor but induce just a partial functional response regardless of how much of the drug is taken (for example, buprenorphine used as a maintenance medication for opiate addiction recovery)
Names of Opioids
In 1847, morphine’s chemical formula was uncovered.4 Along with the invention of the hypodermic needle several years later, morphine became a widely used drug to treat pain.4 In the 20th century, manipulating the chemical formula of morphine led to a variety of semi-synthetic opioids being introduced, including naloxone, oxycodone, buprenorphine and fentanyl.4
In 2018, approximately 808,000 people ages 12 or older reported using heroin in the past 12 months.5 Heroin is an opioid drug derived from morphine. The changes made in the process to produce heroin make it much more powerful than morphine. That higher potency comes from the ability of heroin to pass the blood-brain barrier faster than morphine can.6
Codeine is a naturally occurring substance within the opium poppy plant. It is typically used for cough suppression, pain relief, as a sedative, and as a drug to block digestive system activity, such as in the case of diarrhea.7 Codeine is also used in the treatment of tuberculosis and sleeplessness from persistent coughing.7
What are the Street Names for Opiates and Opioids?
Various street names for opiates are:
Morphine: M, morph
Codeine cough syrup: Tuss
Warning Signs that Someone Took Opiates
There are warning signs that can alert you if someone is abusing opiates. In the early stages, mood changes start to become more obvious. There could be puzzling behaviors that are not easy to figure out. Or possibly you have a nagging, inner voice telling you that something is not right.
People experiencing opiate abuse may still work a job and handle other obligations. The appearance of stability may exist. Eventually, the facade will deteriorate because the opiate addiction will continue to make life worse.
Other signs to look for include:
Lack of total control over body movements
An unusual body smell
Sudden weight loss
Sudden change in sleep patterns
Excessive amount of injuries
Angry reactions when asked about injuries
Difficulty holding objects
Involuntary muscle movements or tremors
Poor personal hygiene
No explanation for how money was spent
Early refills on opiate or opioid prescriptions
Doctor shopping to obtain more pills
How to Recognize Opiates
Opiates can come in a variety of shapes, sizes and forms. Opiates can be in the following forms:
Injectable liquid by needle
Consumable liquid by mouth
Sublingual film (for placement under the tongue)
If you find a substance and you do not know what it is, you can look it up in a drug identifier site online. See if you can determine its nature using their database.
Please remember to dispose of any medications responsibly (no flushing down the toilet or no household trash disposal) but through a drug collection program. Ask your doctor or pharmacist about drug collection programs where you live. Using a collection program helps keep medications out of our water supply and the ground.
What are the Effects of Opiates?
Opiates have a range of short-term effects besides pain relief. These include:8
Inhibits gastrointestinal activity
Glandular and hormone effects
Long-Term Effects of Opiates
People who take opiates for extended periods of time can develop three serious conditions: tolerance, dependence and withdrawal syndrome.9
The need to take higher doses of a drug to maintain the same previous effects. Tolerance can develop in as little as a period of days to just a few weeks.
Taking opiates or opioids over long durations produces dependence. When someone stops taking the drug, he or she experiences physical and psychological symptoms of withdrawal. This is different from addiction.
Symptoms of withdrawal occur when someone with a drug dependence reduces or stops taking the drug.
Symptoms of withdrawal occur when someone with a drug dependence reduces or stops taking the drug.
People who take opiates or opioids for long periods will become dependent, and out of these people, some will also experience the compulsive, persistent need for the drug that defines addiction.
Brain Side Effects
Opiates can cause brain side effects.9 Opiate-related slowed breathing can deprive the brain of necessary oxygen.9 Oxygen deprivation can be harmful to mental health and nervous systems, can cause coma, as well as cause permanent brain damage. Opiates can also deteriorate brain tissues and nerve fibers, leading to problems with decision-making, behavioral control and can cause abnormal reactions under stressful conditions.9
Additional Complications from Long-Term Opiate Use
- Heart infections
- Skin infections
- Collapsed veins
- Lung damage
- Lung disease and complications
- Kidney damage
- Liver damage
- Death from overdose
Opiate addiction can cause life-threatening medical issues, including the risk of overdose. An opiate overdose happens when high doses of the drugs cause slowed or stopped breathing. Loss of consciousness and death can happen if the overdose is not treated right away. Legal and illicit opiates can cause an overdose if someone takes too much of the drug, or if opiates are combined with other drugs (especially with the tranquilizers classified as benzodiazepines).
Opiate Withdrawal Symptoms
Once someone develops a drug tolerance and then reduces the dose or stops taking it, withdrawal symptoms can occur. The appearance and intensity of withdrawal symptoms will vary from person to person. Symptoms will depend on the amounts and how long opiates were used.
Generally, the opiate withdrawal symptoms that can develop within the first 24 hours after the last dose include:
Once 24 hours has passed, more intense symptoms can develop, including:
- Stomach cramps
- Skin goosebumps
- Eye pupil dilation
- Blurry vision
- Raised blood pressure
- Elevated heartbeat
Opiate detoxification is a medically supervised process that gradually reduces the amount of opiates in the body and brain. This process helps safely and quickly eliminate or reduce withdrawal symptoms. Prescription medications are given to alleviate the distress and discomfort that withdrawal causes.
Detox can be given on an inpatient or outpatient basis. People with high levels of opiate use for extended periods may have more success with an inpatient detox.
In the early stages of the process, detoxification can span several days to about a week to help the person avoid the most severe withdrawal symptoms. Then a long-term detox plan is put into place.
A long-term opiate detox typically involves dispensing opiate substitute medications that are partial agonists and/or antagonists, such as methadone or buprenorphine. The detox can last anywhere from days to months, depending on the medications used. There are opiate replacement detoxes that last a week to 3 weeks. There are other detox methods using a slower taper that can last for 6 months or longer.
Opiate Antagonist Drugs During Detox
Naltrexone and naloxone are opiate antagonist drugs that can help speed up the detoxification. Called an ultra-rapid or rapid detox, this type of detox floods the brain with the antagonist drug to eliminate all opiates. Also, antagonist drugs fill the opioid receptors, effectively blocking the receptors. Antagonist drugs such as naltrexone and naloxone are given to people in emergency overdose situations to prevent fatalities.
Detox is not a standalone treatment. Starting with detox and going forward, other therapies to address drug misuse and abuse are needed. After detox, it’s time for the next treatment stage to avoid relapse and continue the healing process. Research shows that people who left detox without further treatment:10
- 27% Relapse the day they were discharged 27% 27%
- 65% Relapsed within a month of their discharge 65% 65%
- 90% Relapsed within a year of discharge 90% 90%
Detox simply prepares the person for the next step, which is formal treatment. Continued treatment is needed after an initial detox because of these extremely high chances of relapse.
Medication-assisted therapy is one evidence-based treatment method for opiate abuse that has been successful.
Medication-Assisted Therapy (MAT)
MAT uses FDA-approved medications, substance abuse counseling, and social support to treat opiate misuse and abuse.11 A common misconception about MAT is that it simply substitutes one addictive drug for another. While someone in MAT may take the substitute medications for long periods, they do so because these prescribed medications relieve withdrawal discomfort and mental urges that can cause a relapse.
MAT provides controlled levels of medication to safely overcome opiate abuse. When replacement medications are dispensed at proper doses, these drugs have no harmful effects on intelligence levels, mental capabilities, physical functions, or employment potentials.11
There are several medications used in the treatment of opiate dependency and addiction. Buprenorphine, methadone and naltrexone are used to treat dependence and addiction to short-acting drugs such as morphine, codeine, and heroin. MAT also treats dependency and addiction issues regarding semi-synthetic opioids, such as hydrocodone and oxycodone. Medications used in MAT can be safely taken for weeks, months, years, or life if necessary. To stop a medication, it must always be first discussed with a doctor.
Buprenorphine holds back and/or reduces cravings for opiates. Buprenorphine can be swallowed in pill form or be given by a dissolving film placed under the tongue.
Similar to buprenorphine, methadone makes the brain think it’s still getting the opiates that were being taken before MAT. In truth, the person isn’t experiencing a euphoric high from the substitution. He or she is free from withdrawal symptoms.
The antagonist drug called naltrexone is different from buprenorphine or methadone. If someone taking naltrexone relapses and then takes an illicit drug, the result is that naltrexone blocks the euphoria and sedative effects of the illicit drug.
How MAT Works Within Treatment
Once detox is over, the next step is to continue treatment in a residential or outpatient program. Medication-assisted treatment as part of either rehab program helps get successful recovery results. MAT helps stabilize and maintain a commitment to abstinence to reach the later stages of treatment. The MAT process generally happens in a few steps:
This phase helps determine an effective medication dose. Daily checks are made to ensure no overmedication or undermedication is going on. Adjustments are made when needed.12
This phase is when the healthcare professional decides what minimum dosage (the very least) can be taken without withdrawal symptoms developing. Mental health and behavioral therapies are going on at the same time.12
This withdrawal phase from the medication can happen in one or more phases. There are those individuals that can stay in the maintenance phase for many years or a lifetime.12
Inpatient and Outpatient Therapies
In addition to MAT, individual and group therapy sessions will be ongoing during the treatment. Some people enter inpatient treatment right after detox. Others enter outpatient treatment initially, but if the risk of relapse becomes too great, they may decide to switch to residential rehab. In both types of rehab programs, both individual and group therapies are given. Also, holistic therapy is very common.
Counselors may deploy various types of therapies, including behavioral and mental health services. These sessions are personalized according to the individual’s needs. Therapy sessions can include stress management, anger management, family therapy, or treating underlying mental health issues.
Group therapy sessions help reduce the feeling of being alone in recovery. It also helps people in the group be part of something bigger. Interacting with peers who understand the ins and outs of recovery offers support and motivation. Many solid friendships are found and built from group therapy sessions.
Alternative or complementary therapies help teach natural, healthy ways on how to handle life without drugs. These types of therapies can include yoga and meditation, art and music therapy, and physical exercise classes.
Finding the Right Help for Addiction
If you believe that you or someone you know has an opiate addiction, help is needed to stop. Opiate drug withdrawal without professional help can be dangerous. A formal treatment program that includes a detox, maintenance medications, therapies and support is needed for the best chances of a successful recovery. Talk with your doctor, therapist or a treatment center for advice on what your next step should be.