Why Are Prescription Opiates So Addictive?
Prescription opiates – such as Vicodin, Percocet, and OxyContin – are narcotic medications used for pain management. These drugs are often referred to as “opioids,” which are synthetic and semi-synthetic derivatives of the active “opiate” chemicals sourced from the opium poppy. The terms “opiates” and “opioids” are often used interchangeably as they are extremely similar.
Although they can be incredibly therapeutic for people who need them, opiates are the most abused of all prescription drugs, according to the National Institutes of Health (NIH).
The Rise of Prescription Opiate Abuse
Prescription opiate abuse has become one of the biggest health problems in the United States today. Consider the following statistics from the Substance Abuse and Mental Health Services Administration:
- In 2014, 1.6% of the U.S. population aged 12 or older reported current non-medical use of prescription pain relievers, though fortunately this number is lower than most previous years from 2002 on.
- In 2014, 1.9 million people met the criteria for prescription painkiller use disorder.
- In 2011, nearly 40% of all emergency department visits involving nonmedical use of pharmaceuticals involved prescription opiates.
Addictive Properties of Prescription Opiates
Prescription opiates affect the brain the same way morphine and heroin do. They attach to opioid receptors found throughout the brain, spinal cord, gastrointestinal tract, and other parts of the body. When prescription opiates attach to these receptors, they reduce the perception of pain, which provides relief. These drugs also produce euphoria and feelings of well-being as they act on the brain's reward systems. These feelings, which often accompany activities that promote survival, such as eating or having sex, produce a sense of motivation to repeat the behavior, even when doing so causes harm.
Repeated use of opiates can inhibit the production of the body's natural opioid neuropeptides, including endorphins, which are the body's "feel good" chemicals. “Endorphin” is a word adapted from the concept of “endogenous morphine” and, essentially, is the body's natural morphine. Over time, opiates desensitize the brain's natural opioid system, making it less responsive. This creates tolerance, so the person will no longer respond to the drug as strongly and will need a higher dose to achieve the desired effect. Tolerance fuels addiction because the addict will need to continue to increase his dosage in order to experience the desired high. Tolerance can also contribute to overdose, as dangers increase significantly with higher doses.
Video: The Deadly Truth About Opiates
Methods of Use and the Effects of Prescription Opiates
Those who abuse opiate painkillers typically begin by taking the drugs orally but may advance to snorting or injecting them at some point in order to amplify the “high” or desired effects. These methods, as well as combining the opiate with alcohol or other drugs, increase the potential for addiction and life-threatening effects. Individuals may misuse their prescription by taking the drug more often than directed or in larger doses than prescribed, which can also increase the risk of complications.
There are a myriad of effects that the user may experience in both the short term and over the course of time.
Abusing opiates can increase the individual’s risk of overdose. Signs of overdose include:
- Markedly constricted, or “pinpoint” pupils.
- Respiratory arrest.
- Profound obtundation.
- Loss of consciousness.
- Brief, euphoric sensation followed by apathy.
- Inattention to threatening environmental cues.
- Impaired judgment.
- Slurred speech.
- Memory and attention problems.
- Slow movements.
- Constricted pupils.
- Sexual dysfunction.
- Painful withdrawal syndrome.
- Opioid induced hyperalgesia – or lowered pain threshold.
- Increased risk of suicide attempts.
- Brain damage due to decreased oxygen flow.
- Perforated nasal septum.
- Irritation of nasal mucosa.
- Track lines.
- Puncture marks.
- Peripheral edema.
- Increased risk of infection (e.g., HIV and hepatitis).
Combining opiates with other drugs and alcohol may further increase the risks of addiction, medical complications, and overdose. This is especially true with other central nervous system (CNS) depressants such as alcohol and benzodiazepines.
What Does It Mean to Be Addicted to Prescription Opiates?
Prescription opiates are both psychologically and physiologically addictive.
Psychologically, the drugs are addictive because users will crave the high they achieved when they first used the drug and will use compulsively even as negative consequences build up. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists criteria for an opioid use disorder, and one of the main signs is continued use despite negative impact on physical and mental health, and social interpersonal problems.
Physiologically, dependence develops quickly as ever-increasing doses of drug are used in an attempt to counter the phenomenon of tolerance. Tolerance that has becomes more and more of an issue for the drug use is a strong indicator that serious physical withdrawal symptoms may result upon stopping use (see below). Physiological dependence can make it incredibly difficult to quit using even if the user genuinely wants to do so.
Withdrawal from Prescription Opiates
When addicted users go for some time after their last dose, or make attempts to stop taking prescription opiates, they often will experience withdrawal symptoms. The opiate withdrawal syndrome is frequently described as feeling like a bad flu for those experiencing it, and may include:
- Intense opiate cravings.
- Body aches.
- Involuntary muscle movements (e.g., leg jerks).
- Nausea and vomiting.
- Abdominal pain.
- Cold chills and goose bumps.
- Dilated pupils.
- Hypertension (high blood pressure).
- Tachycardia (rapid heart rate).
- Lack of ability to experience pleasure (anhedonia).
Many of the severe symptoms subside within a few days, although the full spectrum of opiate withdrawal can last anywhere from hours to days to even several weeks, depending on how long and how much the person was using. It is not unheard of for cravings and other, mild forms of physical and mental discomfort to persist for months after successfully quitting opiates. While not usually life-threatening, the withdrawal period can be very uncomfortable. Many people will do almost anything to avoid it, which contributes to the high rate of relapse.
How to Get Help for Prescription Opiate Addiction
Detox and Medication-Assisted Treatment
Medications can help with detoxification by easing withdrawal symptoms and cravings, which can help prevent relapse. Medications can also be an essential component of ongoing treatment.
There are three classes of medications commonly used in the treatment of opiate addiction:
- Agonists (i.e. methadone), which fully activate opioid receptors. These drugs have long half lives (they stay in the body between 24 and 60 hours) so they provide some of the feelings associated with prescription opiates but without the dangerous highs and lows, when taken as prescribed.
- Partial agonists (i.e. buprenorphine), which activate opioid receptors but not to the same extent as full agonists, meaning effects stop after reaching a certain plateau.
- Antagonists (i.e. naltrexone), which block receptors and interfere with the rewarding effects of opiates.
These medications treat prescription opiate addiction by working on receptors in a way that is less likely to cause harm. Scientific research has shown that when administered as part of a comprehensive treatment program, these drugs can:
- Help eliminate withdrawal symptoms.
- Sustain abstinence.
- Prevent relapse.
- Decrease opiate-related overdose.
- Minimize the spread of infectious disease.
- Reduce the risk of harmful behavior and criminal activity associated with opiate addiction.
Physicians will select which option is best for patients depending on their specific medical needs. Medication works best when combined with behavioral intervention as well as screening and treatment for comorbid psychiatric disorders and infectious diseases.
The need for maintenance treatment after initial detox is common, as the risk of relapse is high for those who undergo only detox and short-term counseling. Studies have shown that long-term maintenance treatment with drugs such as methadone and buprenorphine can greatly improve an opiate addict’s chance of beating the addiction. Some people can taper off maintenance medication after months, whereas others have a high rate of relapse and may remain on maintenance drugs for many years.
It’s important to note that medication is not the only part of addiction treatment. In fact, for some individuals, treatment does not need to include medication-assisted therapy at all. Long-term treatment that incorporates therapy, group counseling, skills training, and aftercare planning will raise the likelihood of success in recovery. Learn more below.
Upon the completion of detox, ongoing addiction treatment continues. Recovering addicts have a choice between inpatient and outpatient rehabilitation programs. Both typically offer some combination of medically-monitored detoxification, maintenance therapy, relapse prevention education, counseling, and support groups. Many also provide life skills training, art and recreational therapies, yoga, and meditation.
- Inpatient rehabilitation programs require the patient to live in the treatment facility 24 hours a day for a designated amount of time (typically between 30 and 90 days). There are also long-term care facilities that provide therapeutic treatment for 6 months or longer and work towards transitioning the recovering individual back into society. Inpatient treatment is a great option for those who want to focus on sobriety without distractions, while minimizing exposure to temptations and relapse triggers. Inpatient programs are often recommended for those with severe addictions and/or a high incidence of relapse.
- Outpatient rehabilitation uses many of the same treatment methodologies as inpatient treatment centers, but the patient visits at regular intervals instead of living in the facility. Outpatient treatment may be right for those who wish to live at home, remain close to friends and family, and continue working and/or going to school. Outpatient programs allow those in recovery to develop the skills to live a sober life in their natural environment.
Therapy and counseling are crucial aspects of the treatment process. Therapy and counseling for prescription opiate addiction may consist of:
- Cognitive Behavioral Therapy (CBT), which helps the patient cope with cravings and triggers associated with drug use by exploring the thoughts, feelings, and behaviors of the client.
- Family and couples therapy/counseling, which improves the likelihood of success by integrating the support of family and loved ones.
- Motivational interviewing, which helps the patient prepare for and sustain behavioral change needed for recovery. Motivational interviewing supports clients in coming to their own conclusions without outside pressure.
Support groups are another element of the recovery process that many find crucial in preventing relapse. The most common support groups fall under the Narcotics Anonymous (NA) approach. NA is a global network of community-based meetings and support groups for those recovering from narcotic addictions. These support groups use Alcoholics Anonymous' 12-step program, which suggests a specific, linear process for recovery. Because NA is an abstinence-based program, it does not support the use of maintenance drugs. However, other programs such as Methadone Anonymous provide an alternative 12-step model that acknowledges the value of methadone and related drugs for the recovery of opiate addiction.
The most successful programs incorporate many facets of treatment tailored to the individual.
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