What are Opioids and Opiates?
Opioids and opiates are used as painkillers and as recreational drugs. According to the National Institute on Drug Abuse (NIDA), opioids work by acting like endorphins in the brain. Endorphins are chemicals that are naturally produced by the body and are responsible for reducing pain, slowing down bodily functions like breathing and heart rate, and lifting mood. When a person takes an opiate, they will have pain relief, sedation and euphoria. Opioids include both prescription painkillers, and illicit drugs like heroin. The term opiate refers to drugs that are created from the opium poppy. Examples include heroin, opium, codeine, and morphine. The term opioids includes both opiates and man-made drugs that are designed to act like opiates. This article will use the terms interchangeably.
Examples of opioids include:
- Hydrocodone (Norco®)
- Oxycodone (OxyContin®)
- Hydromorphone (Dilaudid®)
And many others.
Most people start out using opioids by receiving a prescription for painkillers by a physician. Others start out taking someone else’s medications, or buy opioids off the street. Opioids are taken in a variety of ways. Pills can be taken whole or crushed. Opiates can be swallowed, snorted, inhaled/smoked, or injected intravenously using needles. Opiates are highly addictive. Frequent use can lead someone to feel physically dependent on opioids, which means they could have symptoms of withdrawal when they try to cut down or stop using.
Opioid Abuse and Addiction
According to the National Institute on Drug Addiction, 80% of Americans who have used heroin started out using prescription opiates. They may get these from their doctor to treat a sports injury, a broken bone, post-surgical pain or even chronic pain. Others start out taking someone else’s medications, including from parents, spouses or grandparents. To misuse or abuse opiates means to take them in a way other than prescribed. The following will give you more information on the signs and symptoms of opioid abuse and addiction, and is intended to be for your information only – not to diagnose or treat a condition.
Signs, symptoms and side effects of opioid use include:
- Euphoria: feeling very happy, or having an exaggerated sense of wellbeing
- Drowsiness or Tiredness
- Feeling heavy
- Warm flush of the skin
- Constricted pupils
- Changes in mental awareness: Confusion, nodding off, slurred speech, delirium, disorientation
- Slowing of bodily functions: constipation, slowing of breathing, slowing of heart rate,
- Intestinal spasms
- Dry mouth
As a person continues to use opioids, additional consequences of use can include:
- Mood disturbances like depression and anxiety
- Collapsed veins and/or abscesses if the drug is injected
- Damaged nasal tissue if the drug is snorted
- Problems with the liver, kidneys, heart, and/or lungs
- Sexual dysfunction
- Irregular menstrual cycles in women
Opioids can be dangerous. Problems happen when drugs are mixed, for instance alcohol and opiates, becoming a potentially lethal combination. The overdose rate in the United States has been increasing, largely due to highly potent and potentially lethal drugs such as fentanyl and carfentanyl being put into heroin and other opiate pills that don’t come directly from a pharmacy. According to the Centers for Disease Control and Prevention, the heroin overdose rate rose nearly 20% between 2015 and 2016, and it continues to rise. An overdose happens when the drug slows or stops a person’s breathing and heart rate, so much that the brain and body become starved of oxygen. Symptoms of an overdose include very weak or no breathing, weak or no pulse, and discoloration (bluish) of the tongue, fingernails and toes. It is cause of for concern if someone has completely lost consciousness, or is having trouble staying awake. If you suspect someone is having a medical emergency, please call 9-1-1. Many times, the medication naloxone (Narcan®, Evzio®) can be used to treat or reverse an opioid or heroin overdose.
Like any drug, opioids can become a problem when people take more than intended, or use for longer periods of time. As a person continues to take opioids, they will need more of the drug for the same effect – called tolerance. And if they stop, symptoms of withdrawal could set in as the body craves more. An addicted person may wish to take more and more of the drug, or find a stronger opiate. If a doctor will not prescribe a stronger drug or give a refill, a person with an opiate addiction might engage in “doctor shopping” to find a physician who will give them what they want, or go to the emergency room. Other signs of opiate addiction include spending a significant amount of time using, and ultimately even giving up important activities to spend more time with the drug. Usually people who have an opiates addiction will use it despite the negative consequences of the drugs, including its effects to health, wellbeing, relationships, employment, etc. Their self-care could suffer, and they could also put themselves in dangerous situations (i.e. using while driving, or mixing with alcohol). Most people with an opioid addiction also have intense craving or desire to use the drug, and spend much of the time preoccupied with thoughts about obtaining, using and/or recovering from use. Additionally, people with opiate addiction try unsuccessfully to control, cut down, or taper their use without professional help.
If you are concerned you or a loved one may be addicted to opioids, it is important to seek professional advice. Often residential detox and rehab are highly recommended.
Detox and Withdrawal from Opioids
After continued use, the body can become physically dependent on opioids and a person can start to have symptoms of withdrawal. What happens is that the brain and body get used to taking in the drug, and then a person can start to feel sick without it. Some people describe this withdrawal period as feeling that their body “needs” the drug. Others might not even realize they are withdrawing, but think they have the flu instead.
Withdrawal from opioids typically follows a timeline. Some opiates stay in the body for a long time, and others are more fast-acting. The longer the drug stays in a person’s system, the longer it will take for withdrawal symptoms to set in and the longer these symptoms will last. An example of a fast-acting opioid is heroin, while buprenorphine (Suboxone®) tends to be a more slow-acting drug. The intensity of withdrawal symptoms will depend on what kind of opioid a person was using, how much, how long, and individual differences like health and age.
Initial withdrawal symptoms include:
- Aching muscles
- Sweating (Hot/cold sweats)
- Yawning, tearing up
After the first day or so, additional symptoms can kick in:
- Diarrhea and abdominal cramping
- Nausea and vomiting
- Increased heart rate
- Increased blood pressure
- Dilated pupils
- Goose bumps
- Intense craving or desire to use
There can be some significant complications from attempting to self-detox. For instance, it can stress the body’s heart and circulatory system, and diarrhea and vomiting can lead to dehydration. Even without medical complications, it can be extremely uncomfortable both physically and emotionally.
There are things that can be done to make opioid withdrawal safer, and more comfortable. A medically assisted detox involves a taper. This means an opiate medication such as Buprenorphine (i.e. Suboxone®) is taken in smaller and smaller amounts, allowing the body to gradually get used to being without opioids. Other medications can be taken to reduce blood pressure/heart rate, decrease nausea, and target certain other symptoms. Medications that can help with these include Clonidine for blood pressure and Promethazine for nausea. Detox symptoms will still be experienced, but they will be much more manageable. Most people find they benefit from other natural remedies while in treatment, including staying warm by taking a hot shower or using heating pad to help with muscle aches.
Recovery from an Opioid Addiction
There are many options for recovery from opioid addiction, and it’s important to discuss these options with a professional so that you can choose the one that is right for you or your loved one. Options for recovery from an opioid addiction include:
Detox helps people with opiates addiction to withdraw safely. Comfort detox medications like buprenorphine and clonidine are frequently used. While a detox is never symptom-free, a medically assisted detox significantly increases the chances of success.
Residential treatment is more than just detox. It allows a person to get away from the triggers in their home environment, and take some time to heal. A good residential treatment program will get people started on the road to recovery, help them to identify some of the underlying issues, educate people on addiction, give coping skills, and help people with opiate addiction to begin to develop a long term recovery plan.
Medically Assisted Treatment
This has shown to be an effective option for people recovering from opioid addiction, in particular to strong opioids such as heroin. People who choose to enter a maintenance program will take a drug such as buprenorphine (including Suboxone®) or methadone. Methadone is a longer-lasting opioid drug. Buprenorphine (Suboxone) works by partially binding to the opiate receptors in the brain. This allows the brain to feel satisfied, without allowing for a full intoxicating effect. If a person then takes another opioid – like heroin or painkillers – they also won’t have any additional euphoric effects. Maintenance allows many people recovering from opiate addiction to live a normal life while fighting cravings.
Another form of medically assisted treatment is taking anti-craving medications, which basically fight cravings without any opiate-like effects. In particular, Naltrexone® is recommended as a pill that can be taken once daily to reduce cravings. Naltrexone® also takes away the euphoric effects of using opioids. For people who do not wish to take a pill every day, this medication can also be administered as an injection that is effective for 30 days. This injection is called Vivitrol®.
Long term recovery
Long term recovery plans include options like spending time at a sober living, outpatient therapy, intensive outpatient programs with group therapy, and community meetings. It is important for someone with an opiates addiction to work with a professional to come up with a solid long term recovery plan. A solid plan will help a person recovering from an opiate addiction to stay motivated, cope with stress and triggers, and protect themselves and their sobriety.