Opioids are analgesic prescription drugs often prescribed for the treatment of mild to severe pain. Opioids are either semi-synthetic or fully synthetic, which means that they are man-made, although some, like morphine and codeine, are derived from the opium poppy plant.
Opium and its derivatives date back to 3,400 B.C.when the opium poppy was first cultivated in lower Mesopotamia (Southwest Asia).
There are three main formulations of opioids, based on the way they are produced:
- natural opioids derived from the opium poppy plan like morphine, heroin, and codeine
- semi-synthetic opioids like oxycodone, hydrocodone, hydromorphone and oxymorphone
- fully synthetic opioids like methadone, buprenorphine, fentanyl and tramadol
Effects of Opioids
Opioids have medical value in their painkilling properties, but have become the flashpoint of the current opioid epidemic rattling neighborhoods throughout the country. The way opioids work is by reducing the negative emotional response in the brain. This analgesic property of heroin and morphine was largely discovered during the Civil War, which also exposed their addictive nature. Read more about the history of opium.
Opioids are effective in reducing the pain signals in the brain, but they are not intended for long-term use because opioids have several other negative effects and consequences with their prolonged use.
Some of the most common effects of opioids include:
- reduced heart rate
- shallow breathing
- nausea and vomiting
- dry mouth
Long-term use of opioid painkillers leads to dependence and addiction, both of which are significant risks.
Since most opioids produce feelings of euphoria and well-being in users, their abuse potential is extremely high, as evidenced by their DEA listings as Schedule II and III drugs under the Controlled Substances Act.
Opioid Abuse and Dependence
Opioid abuse over a sustained time leads to increased tolerance, which means more opioids are necessary to achieve the same effect. Another negative effect of long-term opioid abuse, reported by the CDC (Center for Disease Control and Prevention) is increased sensitivity to pain, meaning that an individual can feel more pain while needing to take more opioids to account for growing tolerance.
High tolerance to opioids is more than the inconvenience of needing more drugs to achieve the same effect. High tolerance to opioids also increases the likelihood of a fatal overdose. Fatal opioid overdoses occur when respiratory depression and low heart rate become so severe, that the user stops breathing, at which time he or she may slip into a coma or die.
Some signs of excessive doses of opioids and overdose can include the following:
- dangerously low blood pressure
- significantly reduced heart rate
- constricted (pinpoint) pupils, especially in dim light
- slurred speech
- extreme lethargy
- slurred speech
- nodding out (intermittent periods of sleep and wakefulness)
- pale, clammy skin
- difficulty maintaining balance
- blue or purple fingertips or lips
Although overdose is a serious and well-known risk for any person who abuses opioids, most overdoses are inadvertent. However, there are certain factors that significantly increase the chances of a fatal overdose.
- History of drug or alcohol abuse
- Current or past mental illness
- Drug Seeking Behaviors such as:
- obtaining overlapping prescriptions from multiple providers
- taking more opioids than directed
- using other drugs to enhance the effects of opioids
- using inappropriate methods of administration like crushing and snorting pills, diluting and injecting pills
One of the most dangerous effects of opioid abuse is dependence which causes people to experience intense and painful withdrawal symptoms without opioids. While it is not life-threatening, opioid withdrawal is painful and includes the following symptoms:
- runny nose
- high blood pressure
- increased heart rate
- high fever
- abdominal pain
- body and muscle pain
- increased anxiety
- cold sweats
- intense cravings
Opioid withdrawal symptoms can be so unpleasant that dependent people will take extreme measures to get more opioids and avoid worsening withdrawal symptoms, referred to as getting well by many addicts.
Attempts to get well can be virtually anything, depending on how desperate the addict is. Some examples of behaviors that push addicts to their limits include the following:
- resorting to intravenous use for the first time
- robbing or stealing from another person, even if that person is dear to the addict
- sharing a needle if that is the only available means of using opioids
- taking unknown strengths or forms of opioids, such a fentanyl or heroin
- intentionally causing injury to oneself to get prescription opioids
The most glaring indicator of the damage done by opioid abuse is in the CDC report that nearly 75% of new heroin users reported misusing prescription opioids prior to heroin.
Opioid dependence is an inevitable result of prolonged abuse and dependence can develop in as little as two weeks, depending on personal circumstances and the severity of abuse.
When is Treatment Needed For Opioid Addiction?
Opioid addiction is a serious mental health condition that is chronic and continues to get worse without effective treatment and recovery efforts. Although there are clear indicators of opioid abuse, like any non-medical use of any opioid, it doesn’t necessarily warrant addiction treatment. Opioid abuse always carries risks like overdose, but when is it time to get professional help?
The reality is that addiction treatment is necessary at the time when life becomes unmanageable in any way, as a result of opioid abuse. Someone does not need to hit rock bottom to get help for opioid abuse, and the following are some examples of the unmanageability that warrants addiction treatment:
- new or worsening legal troubles related to obtaining or being under the influence of opioids
- relationship troubles over opioid use
- continued use despite negative consequences
- accidental injury due to opioid use
- financial troubles resulting from buying opioids
- reduction or loss of work because of opioid abuse
- increasing preoccupation with opioids over responsibilities to family, work, and relationships
- reduction or inability to care for oneself and dependent loved ones
All of the above examples are valid concerns about opioid abuse and enough cause to seek addiction treatment. Of course, if everyone were able to recognize the early signs and get preemptive help, the United States would not be in the grips of an opioid epidemic.
Unfortunately, one of the characteristics of addiction is denial which causes users to gloss over the effects of their opioid abuse without recognizing its destructive patterns. It is for this reason that family and other loved ones can play an important role in getting someone help whose drug abuse places them at risk for developing addiction.
What Does Opioid Addiction Treatment Do?
Opioid addiction treatment provides important tools, skills, and therapies that empower people to better understand their addiction and live a fulfilling life in recovery.
The ability of any person to live in recovery is a personal decision and life-long commitment, and treatment provides the necessary tools to be successful.
Some of the tools addiction treatment provides include the following:
- discovering and addressing underlying traumas and issues that may have contributed to, or caused drug abuse
- mental health assessments and management if necessary
- stress management
- life skills
- addiction education
- understanding relapse triggers and how to avoid them
- learning healthy habits like diets, sober activities, and lucrative skills for career building
- anger management
- communication skills building
- family counseling
- resources for sober support after treatment
Recovery from opioid addiction is a life-long journey and it often includes relapses even after a treatment program, but research has shown that the most effective addiction treatment is long-term, lasting at least ninety days.
Many people think of long-term treatment as being locked in a treatment center for months at a time, but it can take many forms, depending on the individual and his or her needs.
Most long-term opioid addiction treatment programs are designed with the following steps:
- Detox at the treatment facility or another dedicated detoxification facility (typically five to ten days)
- Intensive inpatient or residential treatment between 28 and 45 days
- Transitional housing or sober living environment (SLE) starting at 30 days up to several months or a year
- Outpatient treatment indefinitely or as needed for someone to remain strong in recovery
The time someone may need to remain in any one of the above steps in a long-term treatment program can be adjusted to meet their individual needs. Understanding that addiction treatment is not cheap, and that addiction is a life-threatening condition, a personalized long-term treatment plan is the most effective path to recovery.
Treatments at Vogue Recovery
At Vogue Recovery campuses in Arizona and Las Vegas, opioid addiction treatment is highly personalized with comfort, therapies, and care plans designed to be most effective for the individual client.
The environment and level of care at Vogue Recovery Centers is an all-of-the-above philosophy, meaning clients receive care for a full life of health and recovery, including mind, body, and spirit. At Vogue, personal comfort and healing are at the center of each client’s individual care plan. Some of the amenities and therapies clients can expect at either Vogue campus include the following:
- chef-created gourmet meals
- 24-hour medical staff and assistance
- state-of-the-art exercise facilities
- personal massage
- music therapy
- weekly group outings
- experiential therapy
The highly trained staff at Vogue Recovery Centers work with each person to determine the most effective steps and levels of care, from detox through treatment, and aftercare support.
The History of Opium in The United States
As opium trading routes spread through Europe and Asia, opium use increased worldwide and eventually made its way to the United States through Chinese migration to work on the railroads and the 1849 gold rush.
In America, opium dens became popular in San Francisco and spread west to New York. Areas known as Chinatowns were populated with opium dens, where the drug could be bought, sold, and smoked. 1,2
During the Civil War, morphine use was widespread among injured soldiers between 1861 and 1865. Morphine is the narcotic ingredient in opium which is ten times stronger in its pure form. Morphine was first isolated from opium in 1803, by a German scientist, Friedrich Sertürner.
As nearly 400,000 morphine-addicted soldiers returned home from the Civil War, an effort to find a less addictive painkiller lead to the 1874 development of heroin, which was branded and marketed by Bayer Pharmaceuticals in the late 1890s.
Despite their analgesic benefits, the addictive dangers of heroin and morphine became a health and social concern by the end of the century. By then, federal legislation was introduced to curb the addiction epidemic of the time.
- Chinese Exclusion Act of 1882
Signed into law on May 6, prohibited all immigration of Chinese laborers
- Harrison Narcotics Tax Act of 1914
Signed into law on December 17, effectually outlawed the recreational use of narcotics including cocaine by requiring registration and taxation of all transactions including importation.
Although the Harrison Narcotics Act seemed to reduce opium and heroin use in the country, the threat never really went away.
During the 1900s, synthetic and semi-synthetic opioids were developed and approved by the FDA (Food and Drug Administration) beginning in the 1910s.
Federal laws were introduced to attempt regulation and safe marketing of prescription medications. The Pure Food and Drug Act required drugs containing morphine to indicate the quantity of the narcotic drug on the label. A supplementmal law to the Pure Food and Drug Act was the 1938 Food and Drug Cosmetic Act (FDCA) which required manufacturers to test their products for safety in patient trials. 3
Percoset, a short-acting combination of oxycodone and acetaminophen had been introduced by 1976, followed by long-acting formulations of morphine, such as MS-Contin in 1985. After that, 1995 marked the beginning of what is the current opioid epidemic with the introduction of OxyContin;®.
From the 1800s through today, the addictive and dangerous nature of opiates has been demonstrated, attempted to be reduced, and been at the center of health and societal crises in the United States.
1.Drug Enforcement Administration Museum Origins of Opium
2. History.com Heroin, Morphine, and Opiates
3. National Center for Biotechnology Information, National Institutes of Health Opioid Approval and Monitoring By the U.S. Food and Drug Administration
Therapeutic Research Center PL Detail-Document, Equianalgesic Dosing of Opioids for Pain Management.
Pharmacist’s Letter/Prescriber’s Letter. August 2012
National Institute on Drug Abuse Opioid Overdose Crisis
Centers For Disease Control and Prevention (CDC)