Opiate drugs are used in medical treatment of pain. Opiates are also often used illegally for recreational purposes of generating a sense of euphoria or elevated sense of well-being. The drugs are highly addictive. In fact, opiate abuse in the United States is at an epidemic level and now presents serious difficulties for many families, employers and communities.
In the 1990s, doctors began over-prescribing powerful opioid medications for pain relief. Opioids soon became the most prescribed drugs in the U.S., even outnumbering antibiotics. Up to 30 percent of patients who receive prescriptions for opioids in treatment for chronic pain misuse the prescribed drug. Drug overdose is the leading cause of accidental death in the U.S., outnumbering the combined total of deaths due to gun and car accidents. There were over 64,000 deaths from drug overdose in 2016, most of which were due to opioid overdose. The problem has become so widespread that the Department of Transportation has recently updated their DOT drug testing panel to include additional opiates.
Cases regarding legally prescribed opiate pain medications have been filling up the civil courts in some counties and states. And, drug-related crimes fill many criminal courts. Drug-related workplace injuries have made worker safety efforts more complicated and have increased insurance costs. Opiate drug use has also resulted in significant losses of productivity and income for families and employers.
What are opiates?
Opiates are drugs derived from opium, which is extracted from the poppy plant. They drugs are made from either natural or partially altered constituents of opium. Opioid is a term that was for some time used to refer only to synthetic opiates, which are drugs designed to mimic the effects of opium, though their chemical content was different. These days, the term opioid is often used to refer to all opiates and opioids, whether they’re natural, synthetic or semi-synthetic. (Narcotics refers to opiates or any other drugs that induce sleep and have properties of altering mental processes.)
How do opiates work?
The opiate group of drugs are narcotics that act on the opioid receptors located on the cell membranes of neurons. Opiates act presynaptically to inhibit the release of neurotransmitters in the nervous system. Opioid receptors are involved in response to natural and artificial stimuli of reward sensation. Receptors become modified as drug tolerance and addiction develops. The effects of the drugs have made them useful for medical treatment of pain, and have made them appealing for illegal use in producing “high”, or euphoric effects.
Common opiate drugs
The following are the most common forms of opiate drugs, used for both medically prescribed pain treatment and illegal recreational purposes:
- Morphine — For acute or moderate chronic pain. (Street Names: Monkey, Morph, Duramorph)
- Oxycodone — For moderate to severe pain. (Street Names: Tylox, Oxycontin, Hillbilly Heroin, Oxy, Ox, Cotton)
- Vicodin — Combined oxycodone and acetaminophen. For short-term pain relief. (Street Names: Vikes, Vikings, Hydros)
- Dilaudid — For moderate to severe pain. (Street Names: Dillies, Hospital Heroin, Dillies, D)
- Codeine — For mild to moderate pain and cough. (Street Names: When mixed with soda and codeine cough syrup, it is sometime called Lean, Purple Drank)
- Demerol (Meperedine) — For moderate to severe pain. (Street Names: Captain Cody, Cody, School Boy)
- Heroin — Illegal opiate in the U.S., used for euphoric effects. (Street Names: Poppy, Black Tar, Poppy, Brown Crystal)
- Fentanyl — For patients who have developed a tolerance for other pain medications, and combined with other drugs for anesthesia. It is 50-100 percent more potent than morphine. (Street Names: China Girl, Apache, China 8, Murder 8, Jackpot)
- Carfentanil — For pain prevention after surgery. It is 100 percent more potent than fentanyl, so it is 10,000 percent more potent than morphine. (Street Names: C50, Drop Dead, Serial Killer)
Physical and mental effects
In addition to the pain relief and mood enhancing effects of opiates, there are potential negative impacts to physical and mental functioning that can occur while under the influence of these powerful drugs. Instructions for opiate use include avoiding driving or operating equipment. Motor coordination and decision-making abilities can be affected during opiate use, resulting in:
- Impaired judgment
- Reduced attention span
- Impaired ability to focus on tasks
- Impaired short-term memory
- Slowed physical reaction time
- Loss of coordination
During medical use of opiates for pain relief, many people build up a tolerance for the prescribed drug and can become addicted. They need increasing amounts of it to experience the same level of effects. In this way, addiction to opiate drugs can develop.
Overdose occurs by taking too much of the drug, in attempt to get the same euphoric effect. Overdose of an opiate can be counteracted with emergency intravenous injection of naltrexone.
Signs and symptoms of addiction
If three or more of the following conditions apply, then opiate addiction is likely and an evaluation for addiction treatment is necessary:
- Increasing use of the drug over time.
- Using more of the drug than prescribed.
- Continuing to use the drug despite negative consequences of using it.
- Putting off work or recreational activities in order to obtain and use the drug.
- Obsessively thinking about and taking actions to get or use the drug.
- Unsuccessful efforts to reduce use of the drug.
- Experiencing withdrawal symptoms when trying to stop using the drug.
Withdrawal from opiates can be very difficult. There is ongoing debate about whether or not opiate withdrawal can be life-threatening when the withdrawal is from an opioid alone. However, it is generally understood that withdrawal from combined alcohol and an opiate (such as benzodiazepine) can be dangerous. Symptoms of opiate withdrawal include:
- Anxiety, irritability
- Low energy
- Muscle pain and aching
- Abdominal cramps, diarrhea
- Nausea, vomiting
- Eyes tearing, nose runny
- Hot and cold sweating, chills
- Frequent yawning
Stages of Opioid Withdrawal — The length of time it may take for symptoms of opiate withdrawal to disappear can vary widely from one case of addiction to another. Further, timeframes for withdrawal symptoms vary between the two stages of opiate withdrawal.
- Acute Withdrawal —The first phase of opiate withdrawal typically begins within about 12 hours after the last use of the drug. Acute withdrawal usually peaks at some point between 3-5 days after the last use of the drug, and this withdrawal phase takes between 1-4 weeks to complete. During the acute stage, the addict experiences mostly physical symptoms.
- Post-Acute Withdrawal — The second phase of opiate withdrawal can take as long as two years to complete. Symptoms during this period typically include anxiety, mood swings, lack of enthusiasm, variations in energy levels, irregularities in concentration, and sleep issues. During the post-acute stage, the recovering addict experiences mostly emotional symptoms.
Drugs used in withdrawal treatment
These are some of the most common drugs used in treatment of opiate addiction symptoms during detoxification and recovery:
- Methadone — Used to helps relieve symptoms of withdrawal during detoxification.
- Revia (naltrexone) — Used to reduce cravings for opioids and to prevent “high” effects of opioids.
- Suboxone — A mix of buprenorphine and naloxone. Suboxone reverses the opiate effects, if administered intravenously. Suboxene use can lead to addiction.
- Subutex — Used in treatment of opioid addiction. Subutex can be addictive.
- Buprenorphine — A partial opioid agonist, which means may produce a mild high as its maximum effect. Buprenorphine is used in some cases to help in recovery from addiction to opiates such as heroin or oxycodone.
- Naloxone — Used for emergency treatment in cases of opioid overdose. Naloxone is an opioid antagonist, which means it binds with opioid receptors more strongly than prescription opioids or heroin. It does not produce either the euphoric or dangerous effects of opioids. It can be administered either intravenously or by nasal spray.
Opioid treatment and recovery
Treatment for drug addiction should be administered by trained professionals, upon referral from a medical doctor. Recommendations for those seeking and undergoing opiate addiction treatment include:
- Reach out and ask for professional help.
- Work on sharing your feelings openly and honestly.
- Use your personal support system (family and friends).
- Avoid placing yourself in high-risk situations.
- Learn strategies for preventing relapse.
- Keep perspective that recovery is a daily process.