Opioid Abuse: Effects, Addiction & Treatment

Opioids are a category of drugs that include both prescription medications and illicit substances. These drugs are primarily used for pain management because they interact with opioid receptors in the brain to reduce the perception of pain. These are often prescribed after surgeries or for chronic pain conditions. However, opioids also include illegal drugs like heroin, which can be even more dangerous due to the lack of regulation and higher risk of overdose.

Prescription vs Illicit Opioids

Prescription opioids are classified as controlled substances due to their high potential for misuse and addiction. They are typically prescribed in specific dosages and durations to minimize the risk of dependency. However, the euphoric effects that accompany pain relief can lead to misuse, where individuals take higher doses than prescribed or use the drugs without a prescription.

Prescription opioids include medications like:

• Oxycodone 
• Hydrocodone 
• Morphine 
• Fentanyl 
• Codeine 
• Hydromorphone
• Oxymorphone

These medications are prescribed for managing moderate to severe pain but come with a high risk of dependency and misuse.

Illicit opioids, such as heroin, are not regulated and pose significant health risks. The lack of quality control can lead to contamination with other dangerous substances, increasing the risk of overdose. Moreover, synthetic opioids like fentanyl, which can be both prescribed and illicitly manufactured, are incredibly potent and have been linked to a surge in overdose deaths. 

Illicit opioids include:

• Heroin (a highly addictive drug derived from morphine)
• Illicit fentanyl (a synthetic opioid illegally manufactured in ​​clandestine labs that is much more potent than heroin or prescription fentanyl)
• Opium (the dried latex obtained from the opium poppy, which contains several active compounds including morphine)
• Street versions of prescription opioids (such as counterfeit oxycodone, hydrocodone, or other medications that are manufactured and sold illegally)

Understanding the distinction between these types of opioids and their intended uses can help in addressing and treating opioid addiction effectively.

Opioid misuse can quickly lead to addiction due to the way these drugs interact with the brain. When opioids are taken in higher doses or more frequently than prescribed, they can cause a powerful surge of euphoria. This reinforces the behavior and leads to repeated misuse. Over time, the brain becomes reliant on the presence of opioids to feel normal, which can develop into an opioid use disorder (OUD).

Opioid use disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a problematic pattern of opioid use leading to significant impairment or distress. This condition is characterized by an inability to control opioid use, a strong desire or urge to use opioids, and continued use despite adverse consequences. 

Dependence refers to the body’s physical adaptation to the drug. When someone is dependent on opioids, they experience withdrawal symptoms if they suddenly stop taking the drug. Addiction includes dependence but also entails a psychological need for the drug, leading to behaviors that seek out the substance at any cost.

The DSM-5 outlines specific criteria for diagnosing opioid use disorder. Some of the signs include:

• Taking larger amounts of opioids or using them over a longer period than intended.
• Persistent desire or unsuccessful efforts to cut down or control opioid use.
• Spending a lot of time obtaining, using, or recovering from the effects of opioids.
• Craving, or a strong desire to use opioids.
• Recurrent opioid use results in a failure to fulfill major role obligations at work, school, or home.
• Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
• Giving up or reducing important social, occupational, or recreational activities because of opioid use.
• Recurrent opioid use in situations where it is physically hazardous.
• Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by opioids.
• Tolerance—defined by a need for markedly increased amounts of opioids to achieve intoxication or desired effect, or markedly diminished effect with continued use of the same amount of an opioid.
• Withdrawal—manifested by either the characteristic opioid withdrawal syndrome or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

Recognizing these signs early can help in seeking appropriate help and treatment for opioid use disorder.

When someone becomes dependent or addicted to opioids, abruptly stopping use or significantly reducing the dosage can lead to withdrawal symptoms. These symptoms occur because the body has adapted to the presence of the drug, and without it, the body struggles to regain balance. Withdrawal can be extremely uncomfortable and, in some cases, dangerous, which often discourages individuals from quitting on their own.

Withdrawal symptoms can range from mild to severe and typically begin within hours to a few days after the last dose. Some common symptoms include:

• Muscle aches
• Restlessness
• Anxiety
• Insomnia
• Sweating
• Abdominal cramping
• Diarrhea
• Nausea and vomiting
• Rapid heart rate
• Runny nose

Managing these symptoms in a medical detox program is crucial for a successful recovery. 

Detox provides a medically supervised environment where individuals can safely withdraw from opioids. During opioid detox, medical professionals can administer Medications for Addiction Treatment (MAT) to help manage withdrawal symptoms, making the process more bearable. MAT can include drugs like methadone, buprenorphine, or naltrexone, which work by reducing cravings and withdrawal symptoms without producing the high associated with opioids.

Detox is often the first step in a comprehensive treatment plan for opioid addiction. It helps to stabilize individuals physically, which is essential for them to engage fully in subsequent opioid treatment phases, such as therapy and counseling. By easing the withdrawal process, opioid detox can set individuals up for lasting recovery, giving them a stronger foundation to build upon as they work toward sobriety and improved health.