In recent years, many government and other health agencies and organizations have been sounding an alarm on the level of abuse of and addiction to opiate drugs in the US. Just one example is a report from the National Institute on Drug Abuse (NIDA). This reports shows opiates are abused by up to 36 million people worldwide, with about 2.5 million in the US struggling with substance use disorders related to opiate drugs.
While illicit substances such as heroin make up a large part of this struggle, abuse of prescription opiate drugs has been on the rise as well. In fact,
use of prescription opiates accounts for about 1.9 million of the people in the US dealing with these disorders.
Gaining more understanding about what opiates are, how people become addicted to them, and what options exist for treating opiate use disorders can help us stem the tide of this mental health epidemic.
Opiates are drugs based on a psychoactive substance obtained from the seeds of the opium poppy, and these drugs can be found in natural, synthetic, and semi-synthetic forms.
Opiates bond with receptors in the brain and nervous system that control a person’s sensory perceptions, helping to reduce pain levels.
Because of this, opiates have been used for thousands of years in treating pain in various forms. They can also be used to treat conditions like severe coughs and diarrhea.
NIDA lists some of the more well-known types of opiates, including:
- Hydrocodone (Vicodin): often used for dental or injury-related pain
- Oxycodone (OxyContin, Percocet): long-term, round-the-clock pain treatment
- Morphine: used for pre- and post-surgical pain relief
- Codeine: used for mild pain relief as well as cough relief
More recent versions of these drugs include fentanyl and Opana (oxymorphone), which have contributed to recent spikes in opiate abuse problems.
Opiate drugs have also been used historically for recreational purposes. Use of these drugs by snorting, injecting, or smoking them can create an immediate and overpowering sense of relaxation and a hypnotic effect, along with a euphoric state caused by the drugs’ effects on the brain’s reward and pleasure systems. Through these systems, opiate drugs are also quickly addictive and can cause detrimental health effects with long-term use. Heroin, a potent, illicit opiate drug, is well-known for these effects, yet is still a major contributor to the drug abuse problems in the US.
For many people, opiate abuse begins with prescription painkillers.
This generally occurs through misuse of the drugs, either through irresponsible prescribing practices or through misuse of the drugs by the individual, including taking higher doses than prescribed or taking them more often than needed.
As described by WebMD, this is often done either to experience the drug’s pleasurable effects or to self-medicate for anxiety.
For others, exposure to illicit substances like heroin may lead to this type of abuse. This can happen through social pressure or experimentation at a young age, and it may more likely for some due to several risk factors. In addition, those who start out abusing pain medications sometimes turn to heroin to continue the abuse.
When used on a long-term basis, these drugs can cause certain physical and psychological reactions that lead a person to become dependent on the drug to feel good or tolerant of its effects, meaning that, over time, higher or more frequent doses are needed to achieve the same effects. This feedback cycle results in further neurological and biochemical changes in the person, affecting multiple body systems.
As a result, as demonstrated by an article in Neuron, people who misuse or abuse opiate drugs can develop both physical and psychological dependence on the drugs. When this dependence results in behavioral changes based on the person’s perceived need for the drug, the person can be said to have developed an addiction to opiates.
Risk Factors for Opiate Addiction
According to the Centers for Disease Control and Prevention, risk factors for opiate abuse and addiction include:
- Obtaining multiple prescriptions from different pharmacies
- High or frequent doses of pain medications, beyond prescribed amounts
- Family or personal history of substance abuse or mental illness
- Residence in rural or high-risk areas
- Poverty, or low economic or social class
Other risk factors for substance abuse may include:
- Social awkwardness or being in a high-risk social group
- Perception that substance use is safe or okay
- Abuse, neglect, or otherwise chaotic upbringing
- High levels of stress at work, school, or in family and other relationships
Health Risks of Opiate Abuse and Addiction
Along with the risk of addiction as described above, long-term use and abuse of opiate drugs can result in physical and psychological health issues. A study from The Primary Care Companion for CNS Disorders shows that long-term opiate use can result in issues with multiple organ systems, including:
- Breathing problems, such as slow and stopped breathing
- Heart arrhythmia and circulatory issues
- Digestive dysfunction and intestinal blockages
- Muscle weakness and potential bone fractures
- Weakened immunity and susceptibility to disease
- Psychological issues and cognitive disruption
These issues can simply occur with long-term prescription use. Abuse can make these problems worse, and also risks overdose, which can lead to death, along with:
- Collapsed veins or disease risk in the case of injection use
- Increased anxiety, insomnia, and fatigue
- Heart attack or heart failure
- Hypoxia: a condition of decreased oxygen to the brain that can result in brain damage
For these reasons, if opiate abuse or addiction is suspected, it can be vital to get help as soon as possible to treat the condition and prevent these health issues from developing.
Signs of Opiate Abuse
According to information from the American Psychiatric Association, the general signs of abuse of or addiction to prescription painkillers include:
- Not following the prescription instructions
- Missing pills, or running out of pills early
- Heavy focus on obtaining and using the drug
- Relationship issues based on substance use
- Inability to keep up with daily responsibilities
- Continuing to use the drugs even when negative consequences occur
As with many opiates, physical and psychological symptoms of abuse include:
- Digestive upset and changes in eating patterns
- Slowed respiration
- Fatigue, sleepiness, and changes in sleep cycles
- Confusion and inability to focus
- Withdrawal symptoms, such as anxiety, nausea, and sweating
As explained in a study from Addiction Science & Clinical Practice, the physical symptoms of opiate use can resolve fairly quickly through stopping use of the drugs, within a matter of days or weeks. However, many of the psychological effects, including the symptoms of addiction itself, are pervasive and chronic, requiring continual management in order to achieve long-term recovery.
For this reason, while short-term treatment for opiate abuse is possible and available through a wide range of treatment types, a person is more likely to be able to achieve recovery through a long-term, comprehensive, research-based rehab program. The elements of this type of program considered most likely to result in positive outcomes include:
- Medically assisted detox and withdrawal to minimize discomfort and relapse potential
- Sometimes, medications to control cravings while treatment is ongoing
- Cognitive Behavioral Therapy to help the person learn to manage triggers and responses
- Family therapy to build the support needed to maintain abstinence
- Peer-support group involvement and motivational therapies
- Other aftercare services to support transition out of rehab and minimize future relapse risk
The Substance Abuse and Mental Health Services Administration demonstrates that these services, provided through an integrated continuum of care that is personalized for the individual’s specific needs, increases the probability that the person struggling with opiate abuse can emerge from rehab equipped to maintain abstinence from opiate use.