How Concerned Should We Be About Opiates?

prescription opiates on table
Opiate substances (both natural and synthetic) are highly addictive.

Opiates are a group of drugs that manage pain by depressing the central nervous system (CNS). There are two different kinds of opiates: natural and synthetic. Natural opiates come from the dried “milk” of the poppy plant and include opium, morphine and codeine. Heroin, for example, is made from the sap-like opium of poppy plants. Once cultivated, the opium resin is refined to make morphine, then transformed into different forms of heroin.

Synthetic opiates, on the other hand, are man-made in a laboratory and are most often used to treat chronic or severe pain. Examples of synthetic opiates include Dilaudid, Demerol, Oxycodone, Vicodin, Fentanyl and Methadone.

Whether natural or synthetic, opiate substances are highly addictive.

How Do Opiates Work?

Special proteins known as opioid receptors are found in certain areas of the human body. Those areas include the brain, spinal cord and gastrointestinal tract. When opiate substances are introduced to the body, they attach to opioid receptors.

Once attached, opiates prevent your brain from receiving messages that indicate the presence of pain.

Side effects of opiate substances include euphoria, drowsiness and relaxation. Opiates also tend to lower resting heart rate, cause chronic constipation, create a widening of blood vessels, depress coughing and slow breathing reflexes severely.1

Pain Management Morphs into an Addiction Epidemic

Approximately two decades ago, adequate pain relief became a central issue. The resulting patient’s rights movement was meant to ensure the pain of each and every American patient was adequately treated.2

Unfortunately, thousands of those patients became opiate addicts in the process.


In the last about 10 years, there’s been a huge increase in the amount of opioid use and opioid abuse and dependence. In addition, there’s been a really stark increase in overdose deaths related to opioid abuse.
Dr. Chinazo Cunningham

“In the last about ten years, there’s been a huge increase in the amount of opioid use and opioid abuse and dependence.

In addition, there’s been a really stark increase in overdose deaths related to opioid abuse,” says Dr. Chinazo Cunningham, professor of family and social medicine at Albert Einstein College of Medicine and Montefiore Medical Center in New York.3

Addiction milestones have continued to mount over the years, indicating the growing opiate epidemic. For example, in 2008, the Centers for Disease Control and Prevention (CDC) announced that opiate pain relievers were involved in 14,800 overdose deaths – more than cocaine and heroin combined.4

In 2012, the CDC also revealed a 91% increase in poisoning deaths among teenagers between the ages of 15 and 19, with prescription drug overdoses being the main cause.5

Specific Opiate Examples

Some of the most commonly used/abused opiates are:

  • Codeine: Codeine is an opiate agonist—a sedative and narcotic painkiller—that relieves mild to moderate pain. It is also found in combination products meant to reduce coughing. For example, codeine and promethazine are combined to make a cough syrup. Because of the small concentration found in nature, most codeine in medical products is synthesized from morphine.6
  • Demerol: Demerol is a narcotic analgesic similar to morphine. It is used as a pain reliever and pre-operative medication. Side effects include confusion, convulsions, dizziness, drowsiness, low blood pressure and slow heartbeat.7
  • Heroin: Made from morphine, heroin is an extremely addictive opiate drug; its abuse is a serious and growing problem in the U.S. The drug can be injected, snorted or smoked. Abuse is associated with serious health conditions, including fatal overdose, collapsed veins and, particularly among IV users, infectious diseases that include HIV/AIDS and hepatitis.8
  • Hydrocodone: According to data from the International Narcotics Control Board, the United States consumes approximately 99% of the world’s hydrocodone.9 Found in combination products like Vicodin and Lorcet, hydrocodone is six times stronger than codeine and comparable to morphine in potency. Thanks to rampant abuse and physical dependency, the Drug Enforcement Administration (DEA) reclassified all hydrocodone combination products as Controlled Substance Schedule II, effective October 6, 2014.10
  • Morphine: This powerful analgesic is found primarily in opium, but is also naturally produced (in small quantities) by the human brain. When not used as directed for the treatment for chronic pain, morphine is highly addictive; physical and psychological dependency can develop quickly.1
  • Methadone: Due to a shortage of morphine during World War II, German scientists synthesized methadone for military troops. Although chemically unlike morphine or heroin, methadone is able to produce many of the same effects. The effects of methadone are long-lasting, working up to 24 hours per dose. It is used for heroin detoxification or as part of a maintenance program.11
  • OxyContin: Developed by Purdue Pharma in 1995, OxyContin addiction has since become a highly publicized epidemic. This time-released medication is designed to treat severe pain associated with cancer or severe injuries over a 12-hour period. However, when chewed, snorted or injected, the time-release mechanism is bypassed, producing a quick and powerful euphoric high that is similar to heroin. [12] In 2015, the state of Kentucky filed a $1 billion lawsuit against Purdue Pharma – the makers of OxyContin – accusing them of “misleading doctors by withholding information about the potential dangers of the drug and its relative ease to abuse.”13

Ignoring the Addiction Epidemic?

In addition to opiates already on the market, a number of pharmaceutical companies are in the process of launching new versions of these narcotic painkillers. One of those drugs hit the market last year, despite a wealth of public controversy.

Zogenix pharmaceutical company introduced its newest narcotic creation, Zohydro, amidst a flurry of public concern. Despite containing a pure form of time-released hydrocodone (that can easily be crushed and abused), the drug was approved by the US Food and Drug Administration (FDA).14

Dr. Andrew Kolodny, president of the advocacy group Physicians for Responsible Opioid Prescribing, believes “it will kill people as soon as it’s released. It’s a whopping dose of hydrocodone packed in an easy-to-crush capsule.”15


[Zohydro] will kill people as soon as it’s released. It’s a whopping dose of hydrocodone packed in an easy-to-crush capsule.
Dr. Andrew Kolodny

In a letter addressed to the FDA Commissioner, a coalition of more than 40 health care, consumer and addiction treatment groups voiced their concerns about Zohydro.

The letter, in part, read: “In the midst of a severe drug epidemic fueled by overprescribing of opioids, the very last thing the country needs is a new, dangerous, high-dose opioid. Too many people have already become addicted to similar opioid medications, and too many lives have been lost.”16

Despite the growing addiction epidemic and record-breaking number of overdose fatalities, pharmaceutical companies are clamoring to get into the $10 billion-a-year opioid narcotics market.

Concern for the Future Is Justified

Critics warn that new narcotic painkillers can lead to a spike in murders, pharmacy robberies and millions of dollars spent treating overdose victims.

Thousands of legitimate pain patients are becoming addicted to these powerful prescription painkillers, in addition to the thousands more who abuse them illegally. Troublesome statistics include:

  • Every day, on average, 2,500 teens use prescription drugs to get high for the first time.
  • 1 in 7 teens admit to abusing prescription drugs to get high in the past year.
  • 60% of teens who abused prescription pain relievers did so before the age of 15.
  • About 7 million people age 12 years and older used a prescription drug non-medically in 2009, according to the most recent National Survey on Drug Use and Health. That was a 13% increase over the previous year.
  • 56% percent of teens believe that prescription drugs are easier to get than illicit drugs.
  • More than 50 million Americans—about 1 in 6—have admitted to abusing prescription drugs.17

The Need for Treatment Is Rising


…practitioners have at their disposal more tools than ever to treat opioid dependence. Yet these tools are not being used to their greatest potential in the United States or Canada.
Dr. Bohdan Nosyk

Millions of Americans suffer from addiction to opioids like heroin or OxyContin, but according to research, many of them aren’t getting the help they need.

In an article published to the journal Health Affairs, Dr. Bohdan Nosyk and seven other experts in the field say the gap between current treatment options and evidence-based practices is more than troublesome.

“45 years after the introduction of opioid substitution treatment, practitioners have at their disposal more tools than ever to treat opioid dependence,” the researchers write. “Yet these tools are not being used to their greatest potential in the United States or Canada.”18

Sources

  1. National Institute on Drug Abuse. (2014). Prescription Drug Abuse: How do opioids affect the brain and body?
  2. The Joint Commission. (2016). Facts about Pain Management.
  3. CBS News. (2014). #14Days: Dying for pain relief in the opioid epidemic.
  4. Centers for Disease Control and Prevention. (2011). Vital Signs: Overdoses of Prescription Opioid Pain Relievers – United States, 1999-2008.
  5. Centers for Disease Control and Prevention. (2012). Death rates from unintentional injury among children dropped by nearly 30 percent in 10 years.
  6. National Institute on Drug Abuse. (2014). DrugFacts: Cough and Cold Medicine Abuse.
  7. Medline Plus. (2010). Meperidine.
  8. National Institute on Drug Abuse. (2014). DrugFacts: Heroin.
  9. National Institute on Drug Abuse. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
  10. Drug Enforcement Administration. (2014). Schedules of Controlled Substances: Rescheduling of Hydrocodone Combination Products From Schedule III to Schedule II.
  11. Center for Substance Abuse Research. (2016). Methadone.
  12. U.S. Food and Drug Administration. (2010). OxyContin – Questions and Answers.
  13. Rehabs.com. (2014). OxyContin Maker Slapped with Billion-Dollar Lawsuit.
  14. U.S. Food and Drug Administration. (2013). FDA approves extended-release, single-entity hydrocodone product.
  15. The New Yorker. (2014). Who’s Afraid of Zohydro?
  16. The FED Up! Coalition Steering Committee. (2014). New Drug Application NDA 202880, Zohydro ER.
  17. American Society of Intervention Pain Physicians. (2011). Overview of Prescription Drug Abuse.
  18. Bohdan, N., Anglin, M.D., Brissette, S., Kerr, T., Marsh, D.C., Schackman, B.R., Wood, E., Montaner, J.S.G. (2013). A Call for Evidence-Based Medical Treatment Of Opioid Dependence In The United States And Canada. Health Affairs, 32(8), 1462-1469.