The Opioid Epidemic: A Look at Opioid Creation, Addiction, Treatment and Rehabilitation
What are Opioids?
Opioids are a class of drugs that are specifically used in the medical field to manage and relieve pain. There are two kinds of opioids: semi-synthetic and synthetic. Semi-synthetic opioids are derived from the opium in poppies and chemically enhanced in a laboratory. Synthetic opioids are completely manufactured to be chemically similar to the compounds found in opium poppies. They are all produced in a laboratory through chemical synthesis.
Opioids can be taken correctly and legally, or can be taken incorrectly and illegally. The United States is in a state of crisis right now with an epidemic of opioid abuse resulting in addiction and death. It is a national emergency. The American Society of Addiction Medicine states that drug overdose is the leading cause of accidental death in the US. In 2015, there were 52,404 deaths from drugs. It is now the leading cause of death for those under age 50.
Opiates vs Opioids
Opiates are natural substances derived from opium. The name Opioids historically referred to semi and fully synthetic opiates, but is now used inclusively for all.
Opiates: Opium is the substance that the Poppy plant produces that all the opium drugs are made from, or mimicked in a lab. Opium Poppy plants are usually found in Southeast Asia, but can also be found in Central America, specifically Guatemala and Mexico. The opium sap contains over 25 alkaloids (nitrogenous organic compounds of plant origin that have a pronounced physiological action on humans). However only three of them, Morphine, Codeine and Thebaine (called opiates) are used as narcotic opiate analgesics (a narcotic is a drug affecting mood or behavior and an analgesic is a pain killer). All three of them are naturally occurring.
- Morphine and Codeine: cause relaxation and sedation.
- Thebaine: causes stimulation and, if too high a dose, can cause convulsions and resemble Strychnine poisoning. It is not used therapeutically alone, but combined in a few of the opioid compounds.
Semi-Synthetic Opioids: These drugs are derived from the naturally occurring opium alkaloids, Morphine and Thebaine in particular, and reconfigured in the lab.
- Hydrocodone (Vicodin)
- Oxycodone (Oxycontin)
- Naloxone (Narcan)
Synthetic Opioids: These opioids are fully synthetic and lab created, synthesized from other chemicals and molecules that do not come from the alkaloids that are found in opium.
- Meperidine (Demerol)
It should be noted that some specialists use the term Opioids universally to refer to naturally occurring opiates and semi-synthetic and synthetic opioids.
How Opioids Work in the Body
Opiates, the natural substances found in opium, and both semi-synthetic and totally synthetic opioids, react the same way in the human brain and body. They have similar molecular structure and respond similarly when taken.
The drug attaches to opioid receptors on nerves in the central nervous system that increase the amount of stimulation it takes to feel pain and reduces the perceived importance of pain. These receptors are found in the highest concentration in the brain, spinal cord, and the gastrointestinal tract.
In addition, opiates and opioids change the way in which the brain experiences pleasure. If you take these drugs, with no pain, you can experience strong feelings of relaxation or sleepiness, as well as euphoria and elation – feelings also produced by eating or sex.
Taking these drugs recreationally can also cause some serious side effects.
Psychological: Addiction, memory problems, paranoia, delusions, hallucinations.
Physical: Sedation, respiratory depression, muscle spasms, nausea/vomiting, sweating, itching, constipation, insomnia, exhaustion, seizures, coma, death.
Behavioral: Forging prescriptions, stealing, robbing, decreased performance, lying, withdrawing from activities, social isolation, preoccupation with obtaining, using and recovering from usage.
Mood: Mood swings, anxiety, irritability, depression, euphoric, suicidal ideation.
Opioid Tolerance, Dependence and Addiction
Tolerance, dependence and addiction are caused by brain changes resulting from chronic opioid use. The distinction between these terms can lead to a better understanding of the dangers of drug abuse.
Tolerance: The need to take higher and higher dosages of the drugs to achieve and maintain the same effect. Tolerance occurs when the brain cells become less responsive to the opioid stimulation because of continuous and excessive use.
Dependence: The need to keep taking drugs to avoid the severe symptoms of withdrawal.
Addiction: Intense drug craving and compulsive use. Continued abuse of these drugs leads to changes in the brain that makes it impossible to stop using the drugs, and forces one to continuously, desperately need the next fix.
Withdrawal: Withdrawal is unpleasant, painful, frightening, and can be medically dangerous. It is best done under the supervision of medical personnel. Some of the symptoms that can be experienced are nausea/vomiting, diarrhea, anxiety, dilated pupils, irritation, agitation, seizures, fevers, suicidal thoughts, bone and muscle pain, severe chills, coma, death.
The effects of opioid abuse are life-altering and can be fatal, and devastate not only the drug abuser, but also those around them.
Some of the most common medical effects of opioid drug abuse are:
- Liver Damage
- Bleeding Ulcers
- Kidney Damage
- Damage to Major Organs
- Brain Damage
Some of the most common life effects of opioid drug abuse are:
- Chronic illness
- Job Loss
- Domestic Abuse
- Child Abuse
- Financial Ruin
Intervention and Treatment
Seeking treatment is key, whether by yourself or having a loved one arrange and assist. There are inpatient as well as outpatient centers for assistance. Some professionals believe that detox, withdrawal and rehab are safest when done under the watchful eyes of professionals in a professional setting, unless your medical doctor is confident of the safety in an outpatient setting.
The Steps for Rehabilitation:
Intake: This is the process of deciding what you need, if a facility can help you, and if it is the best fit for you. They will assess your background and meds, your medical and psychological history, your previous and current drug use, your family support and your risks.
Detox: Most alcohol and drug addictions need the step of detoxification before beginning the actual rehabilitation process. This beginning step is to remove all alcohol or drugs from your system. Since detox for certain people and from certain substances can be potentially very hard and, in some cases life threatening, it is not advisable for some people to detox on their own at home. There are some cases, decided by professionals, that are safe to detox in an outpatient, clinic setting. Others should be in an inpatient setting to be medically monitored.
Rehab: Rehab provides an atmosphere of understanding, support, education and self-awareness in order to get to the underlying reason behind their addiction. Individual and group therapy give patients the tools and strategies to move on with their lives.
Recovery: This is a lifetime endeavor for both the patient and their families.
There are pharmacological interventions as well to assist with this process. To name a few of the most recognized, Methadone, a long acting opioid medication lasts for days in the body. It can cause dependence, but it has a steadier influence on the receptors in your brain, producing minimal tolerance and alleviating craving and compulsive drug use. Methadone also tends to normalize some aspects of the hormonal disruptions found in addicts. Buprenorphine is also frequently used to help taper drug usage and does not create a “high.” Suboxone is a combination of Buprenorphine and Naloxone. It is an opioid medication, but helps with withdrawal symptoms, and the Naloxone blocks the effects of pain relief and euphoria, so no “high.”
We need to be aware of the dangers of these medications. If needed for a serious medical problem, they need to be taken with caution and the knowledge of the strength of these drugs and the potential strength of their addictive qualities. All medical professionals are now under strong scrutiny to prescribe safely and cautiously, but it is still important for all to be aware and educated. It is crucial to use only under the supervision of a doctor and when finished with the prescription, these drugs need to disposed of correctly.
It is appropriate to refer to opioid abuse as a “chronic medical disorder”. A cure is not guaranteed, but a lifetime commitment to treatment and recovery will limit the disease’s serious adverse effects. It will improve the patient’s quality of life and allow for optimal day to day functioning.
It is important to remember that an opioid addict is a person, struggling with a disease that many times places them in a spotlight of contempt and dismissal from lack of understanding or knowledge. It is a widespread problem in this country, and we need to collectively understand and educate ourselves in order to be better informed and able to help where we can.