Opiates are generally prescribed for the treatment of mild to moderate pain, but they are regularly abused for their sedative properties. However, this may also happen unintentionally, with those doing so being at risk of developing an addiction that will require a comprehensive treatment programme to enable them to regain control of their lives.
Opioids, or opiates, are typically prescribed by doctors to treat severe or chronic pain associated with certain medical conditions or following a surgical procedure. When used temporarily for the treatment of pain, opioids can be effective medications; however, when taken for longer than prescribed, or when abused, they can cause severe harm.
The use of opiates for chronic pain is not usually recommended because it can lead to drug abuse and dependence developing and, in many cases, a crippling addiction that can be difficult to overcome.
In fact, opiate addiction is a growing problem around the world, particularly in the US, where it has been described as an epidemic. A report in the Guardian newspaper has described the opioid epidemic in the US as a ‘national crisis’, with almost 100 people a day dying from overdoses of opioid drugs. Nevertheless, it is not just a problem for people in the US or here in the UK. In Nigeria, millions of people are struggling with an addiction to the opioid drug tramadol.
What Are Opiates & Why Are They So Addictive?
Opiates are drugs that can relieve severe pain; they do so by depressing the central nervous system. Opiate drugs are derived from opium, the chemical that originates in the poppy plant.
Opioids work in the same way as brain chemicals known as endorphins and act on receptors within the brain. These receptors are found in the part of the brain that is responsible for pain and pleasure.
Natural endorphins are released to fight pain and to induce feelings of pleasure. Opioids mimic natural endorphins, thus relieving pain but also inducing pleasure.
What most people do not realise, however, is that opioids have been created to be much more powerful than natural endorphins. The feelings of pleasure associated with opiate drugs can be very intense. It is these intense feelings of pleasure that can hijack the reward centre in the brain of some people, making them want to take the drug again to replicate the experience.
Nonetheless, taking opioids repeatedly can result in a tolerance to the effects. So, rather than recreating the intense feelings of pleasure, many individuals find that the experience is far less enjoyable than it once was. As the body becomes tolerant to the opioids, more of them will be needed to get the desired effects.
This often leads to a cycle of abuse and a subsequent physical dependence on the drug. When this happens, you are likely to experience withdrawal symptoms when trying to quit or even cut back on your use. To avoid the unpleasant symptoms associated with opioid use, you may need to take higher doses of the drug, which can then lead to a situation where you are unable to function normally without the medication. At this point, you will continue to abuse opiates even though doing so could be having a negative impact on your life.
Opiate Intended Use
Opiates were initially created to treat moderate to severe pain. In fact, opium has been used to treat pain for centuries, so modern medicine has harnessed various drugs derived from the poppy plant that are highly effective. As opiates are fast-acting and have a high efficacy for treating pain, they are commonly used following surgical procedures.
Opiates are also useful as a pain reliever for patients with conditions such as cancer and often form a key part in palliative care associated with terminal forms of the illness. They may also be useful for treating patients with degenerative conditions like rheumatoid arthritis.
Although some doctors have prescribed opiates for treating chronic pain associated with other medical conditions that are not terminal, such as back pain, headaches and fibromyalgia, for example, there is always the risk of physical dependence with long-term use of these drugs. It has therefore been recommended that opiates only be used for chronic non-cancer pain when other medications have proved to be ineffective.
Understanding the Opioid Crisis
Taking a look at the situation in the US, prescriptions of opioid medications increased dramatically between 1996 and 2002. In 2002, opioid drugs were said to be responsible for 5,000 deaths. In 2016, more than 42,000 people died from overdosing on opioids.
Opioids were always considered one of the most effective treatments for pain, and from the late 1990s, healthcare professionals in the US began prescribing them for various conditions, despite the risks. But because of their sedative effects and the ability to induce intense feelings of pleasure, opioids quickly became popular for recreational purposes as well as medicinal ones.
Perilous for health
What many individuals taking opioids did not realise was that these drugs have a high potential for abuse and, when taken in high doses, can significantly raise the risk of overdose. When abused, opioids can severely depress the central nervous system, causing breathing problems, respiratory failure, and death.
Deaths related to drug use and abuse in the US reached crisis levels by 2015 and are now the leading cause of deaths in Americans under the age of fifty. In fact, opioid overdose causes more deaths in America than guns or car accidents. Over two-thirds of all drug overdose deaths are attributed to opioids.
Cause of Opiate Addiction
Although opiate drugs have a high potential for abuse due to the sedative effects and the intense feelings of pleasure they induce, not everyone who uses them will become addicted. So why are some people affected while others are not?
For most, abuse of prescription drugs such as opioids occurs unintentionally. It is usually caused by an increased tolerance to the effects of the medication. When this happens, the opioid tends to become less effective than it once was, with many people responding by increasing their dose, not realising that this is classed as prescription drug abuse.
As the cycle of tolerance and abuse continue, physical dependence usually occurs, which is often a precursor for addiction. Countless individuals become hooked on their opioid medication without even realising what is happening. It is only when they try to quit that they find they are unable to function without the medication.
It must also be mentioned at this point that not everyone who develops an addiction to opiates has unwittingly abused the drug. There are some who deliberately abuse opiates for recreational purposes or to escape the pain and trauma associated with daily life. It is worth noting that although there is no single cause for opiate addiction, there are several factors that can make it more likely.
For example, those with a family history of addiction have a higher risk for addiction themselves than those who do not have such a family history. Furthermore, the environment in which one grew up can influence his or her risk for addiction. It may be the case of living in a stressful home environment or having difficult relationships with family members or friends. Opioids might be used as a means of escape.
The risk will also increase if the user has a history of mental health problems. Substance abuse is a common side effect of mental health disorders, with many people choosing to use mood-altering substances to try to relieve the symptoms associated with their disorder.
How to Cure Opiate Addiction?
Although there is currently no cure for addiction, it is possible to overcome an addiction to opiates. With the right programme of treatment, you can quit opiates and learn how to live without them going forward.
Opiate addiction is typically treated with a comprehensive programme of recovery that includes a detoxification in the first instance, followed by a programme of rehabilitation. This should then be concluded with aftercare support.
A detox programme is a process that will help you to quit opioids. When you stop taking the medication, your body will naturally begin the healing process as it eliminates any remaining chemicals that may have accumulated in your system.
Rehabilitation is designed to address any underlying issues that may have caused the addiction or that may have developed as a result of it. These issues usually require psychotherapeutic therapy and counselling as well as holistic therapies to improve overall mental, physical, and spiritual well-being.
Once detox and rehab are complete, follow-up care and support are necessary for ongoing sobriety maintenance. As addiction cannot be cured, it is necessary to learn what triggers your addictive behaviour and to have strategies in place that will help you to avoid a relapse at a later date.
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Different Types of Opiates & Opioids
There are many different types of opiates and opioids, with some being more powerful than others. Below are some of the most common:
Codeine – Codeine is perhaps one of the least powerful opioids on the market. It is available on prescription but in low doses may be available over-the-counter. It is specifically designed to treat mild to moderate pain.
Morphine – Morphine is a powerful opioid that is commonly used in hospitals to treat severe pain. It is typically administered in liquid form by injection into a vein or muscle.
Fentanyl – Fentanyl is an extremely powerful opioid drug that is around fifty to one hundred times more potent than morphine. It is used to treat severe pain, typically in patients who have had surgery. It may also be used to treat patients with severe chronic pain who have built up a tolerance to other opiates.
Methadone – Methadone is a synthetic opioid that is commonly used as a substitute drug for heroin. It is administered to patients trying to break free from heroin because it produces similar effects but without the same intense high.
Oxycodone – Oxycodone is one of the opioid drugs that is said to have contributed to the opioid epidemic in the US. Its intended use is for the treatment of severe pain following injury or surgery, but it was regularly prescribed for the treatment of moderate pain in patients. Because of its sedative effects, it has a high potential for abuse, with many people using it in a way that it was not intended.
Hydrocodone – Hydrocodone is typically prescribed for the treatment of severe chronic pain. Due to its habit-forming potential, it is only prescribed to those for whom other medications have been unsuccessful.
Pethidine – Pethidine is also known as meperidine and is used for the treatment of moderate to severe pain.
Heroin – Heroin is derived from morphine and is an illegal opioid drug.
Prescription Opioids and Heroin – What’s the Difference?
Although heroin belongs to the same class of drugs as medications such as morphine, fentanyl, and codeine, it is an illegal drug with no accepted medical benefits. Heroin is used primarily for recreational purposes and induces feelings of pleasure, warmth, relaxation, and euphoria.
Opioid drugs are designed for the treatment of moderate to severe pain. However, because they work on the same receptors in the brain as heroin does, they too can produce feelings of warmth and euphoria and can affect the reward centre of the brain in the same way that heroin does. This is why opioid drugs are also habit-forming and can be highly addictive when abused.
Opioid Use Disorder
Opioid use disorder is the medical term given to the problematic use of opioid medication. If you are affected by opioid use disorder, you are likely to have a strong desire for your medication and an urge to use it even when you know that it will cause harm or distress.
If affected by opioid use disorder, you will have an increased tolerance to opioid medication and you are likely to suffer withdrawal symptoms should you try to stop taking your medication. This occurs with a physical dependence on the drug and you may also develop an addiction.
Treating Opioid Use Disorder During Pregnancy
Opioid use disorder can have devastating consequences in pregnancy, including:
low birth weight
impaired placental function
neonatal abstinence syndrome
It is necessary to treat opioid use disorder during pregnancy to prevent harm to the unborn baby as well as the mother. Treatment often includes the use of a substitute drug such as methadone or buprenorphine, which have proven to be safe for use during pregnancy.
It is important to remember that babies born to mothers using either methadone or buprenorphine can still be affected by neonatal abstinence syndrome (NAS). Nevertheless, the effects are much less severe.
Substituting opioid medications for methadone or buprenorphine is seen as preferable to the reduction of opioid dosage during pregnancy because the latter can often lead to an increase in illegal drug use, which can then result in greater harm to the unborn baby.
Studies have also shown that while methadone appears to have greater treatment retention levels in pregnant women, those treated with buprenorphine had a ten per cent lower incidence of NAS. In addition, the treatment time required for babies was reduced by 8.46 days and the amount of morphine needed to treat babies born with NAS was reduced by 3.6mg.
The American Society of Addiction Medicine and the American College of Obstetricians and Gynaecologists support using buprenorphine and methadone for the treatment of pregnant women with opioid use disorder. This is due to the fact that these medications can stabilise the levels of opioids in the foetus and lower the risk of NAS. Babies born with NAS tend to have a less severe form and require shorter treatment time.
Opioid Epidemic Data & Statistics
It has been estimated that 23% of those who abuse heroin will also develop an opioid addiction.
In the US, drug overdose is the leading cause of accidental death.
Of the 52,404 fatal drug overdoses that occurred in the US in 2015, 20,101 were caused by prescription painkillers.
More than 2 million people in England alone are believed to have taken a prescription painkiller that was prescribed for another person in 2016/2017.
In 2016, around 3,700 people died in England and Wales due to drug misuse. More than 2,000 of those deaths were opioid-related.
Opiate substitution is a common treatment for opioid use disorder and is linked to reduced risk of death, according to a study published in the British Medical Journal. As mentioned above, opioids such as methadone and buprenorphine are commonly used for the treatment of opioid use disorder in pregnant women, but they are also used in the treatment of the condition in those who are not pregnant.
In the case of heroin addiction, for example, methadone has been used as a replacement drug for decades. Quitting opiate drugs is associated with unpleasant withdrawal symptoms that many affected individuals have likened to having severe flu. The use of opiate substitution drugs can help to prevent the severity of the withdrawal process.
As opiate drugs depress the central nervous system, taking too much can lead to disastrous consequences. The risk of overdose increases with high doses of opiates but also when they are mixed with other depressant substances such as alcohol, benzodiazepines, or other opiates, which they commonly are.
After becoming tolerant to opioid drugs, there is the increased temptation to increase the dosage, mix them with other substances, or take in a manner different to that which they were intended to be taken. Some people, for example, will crush opioid pills and either snort the powder or mix it with a liquid and inject it.
Opioid addicts are regularly chasing the elusive high that they got when they first began abusing the drug. Nonetheless, more often than not, they will never achieve this aim because of how their body and brain have adapted to the drug. But this relentless pursuit can cause them to take too much of the drug and often results in an overdose – frequently with fatal consequences.
It must be mentioned that you do not need to be an addict to overdose on opiates. If you misuse your medication and take more of it than advised to by your doctor, or if you mix your medication with alcohol, you could suffer an accidental overdose.
It is therefore important to be aware of the symptoms of an opiate overdose so that you can react promptly. They include:
According to WHO, the following have a higher risk of suffering an opioid overdose:
people who have a dependence on opioids and who have recently reduced their tolerance due to being imprisoned, going through a detoxification, or finishing a programme of treatment;
people who inject liquid forms of the drug;
people who are using opioids with other sedative substances;
people who take opioids in high doses;
people who use opioids and have medical conditions such as liver disease, lung disease, HIV, or who have depression; and
people who live with others who have been prescribed opioids.
Quitting an opiate addiction is a two-part process that requires an initial detoxification to break the physical cycle of abuse. This is typically followed by a programme of rehabilitation to address the underlying issues associated with the addiction.
Detox can be a complicated process and there is always the risk of severe withdrawal symptoms. It is because of this that it is generally accepted to be safer and more comfortable to detox in a dedicated clinic. Within a detox clinic, there will be several options for treatment and it might include a combination of medication and therapy or therapy alone.
A sudden cessation of opiate medications can result in the onset of a range of unpleasant symptoms, so a medical detox is often preferable.
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What about Withdrawal?
Repeated use of opiate medications can change the way the brain functions and can cause both a physical and psychological dependence. This can result in you feeling as though you are unable to function normally without the medication. If you have developed a physical or psychological dependence, you are likely to experience withdrawal symptoms in between doses of the medication or when you try to stop taking it.
Withdrawal symptoms can be mild, moderate, or severe and are usually determined by the type of opioid drug that you have been taking, how long you have been abusing it, and the amount of the drug that you were taking. The severity of the symptoms may also be influenced by the presence of an underlying medical health issue.
If you have been taking a short-acting opiate, symptoms may begin as early as six hours after quitting the medication. For a longer-acting opiate, you may not notice any symptoms until around thirty hours after the last dose.
Do You Need to Go onto Rehab?
It is easy to assume that treatment has been completed upon successfully withdrawing from your opiate medication, but there is more to recovery than simply quitting the drug. It is rarely enough to detox alone without following on with a programme of rehabilitation.
You need to remember that addiction is typically made up of both a physical and a psychological element and that detox only addresses the physical. To fully overcome the addiction, you must also deal with the underlying psychological issues that may have led to your illness. It is for this reason that rehab is necessary.
While detox is an important part of opiate addiction recovery unless you follow on with a programme of rehabilitation, your recovery is likely to be very shaky and the risk of relapse will be high.
Frequently Asked Questions
Can meditation help you beat addiction?
Withdrawal from mood-altering substances such as opiates can often lead to symptoms like depression and anxiety. With meditation, these symptoms can be relieved. Those who practice meditation notice an improvement in both depression and anxiety. They also tend to develop better sleep patterns, helping to improve their overall wellbeing.
What are the causes & risk factors of opiate addiction?
There is no single cause of opiate addiction. There are actually a number of risk factors that increase the likelihood of developing it. For example, a family history of addiction can dramatically increase the chances of becoming addicted to a mood-altering substance such as opioid medication.
Mental health disorders can also increase the risk for addiction as many people will abuse mood-altering chemicals to help relieve symptoms associated with their condition, such as anxiety or depression.
While opiates are considered safe to use over a short period of time, regular use can increase the risk of dependence and addiction. Moreover, if you abuse your medication, your risk will also increase. Taking more medication than advised to or mixing it with other sedative substances can dramatically increase the risk for addiction.
What is the treatment for opiate addiction?
Treatment for opiate addiction comprises a comprehensive recovery programme of detoxification, rehabilitation, and aftercare. Detox is usually the first part of the process and is required to help break the cycle of abuse. It begins when you quit opiates and your brain and body naturally begins to heal.
Where can I find help, treatment, and support for opioid addiction?
There are many options available for those struggling with addiction in the UK. Treatment programmes tend to be either inpatient or outpatient based and are provided by various organisations. The NHS and many charities provide outpatient-based programmes, which are typically accessed free of charge. To access such programmes, you can get in touch with your doctor or look for details of providers online via various information databases.
Where else can I find help?
Help is also available from local support groups within your community. Fellowship support groups are a great resource and are ideally used alongside a programme of detox and rehabilitation. By joining a fellowship support group, you can access regular meetings with other recovering addicts, who will be there to offer support and advice as you progress on your recovery journey.
How much opiate causes withdrawal?
When taken as directed for a short period of time, opiate medication can be highly effective. However, when you take more than the recommended dose, you are increasing your risk of developing a physical dependence that will cause withdrawal symptoms should you try to quit.
You should also be aware that even when taken in therapeutic doses, opiate medication can cause dependence and withdrawal, particularly if the medication is taken for a prolonged period.
How to beat opiate addiction?
To overcome opiate addiction, you will need to quit your medication and make changes to your behaviour. You will need to learn how to live without mood-altering chemicals and develop strategies for dealing with temptations and triggers as these arise.
How to treat opiate addiction?
You can expect a treatment programme that has been tailored to your requirements and designed to be most effective in helping you to overcome your addiction once and for all.
This type of treatment programme is designed to treat the mind, body, and spirit as a whole, but the precise treatments used will depend on various circumstances. These include the severity of your illness, your overall physical and mental wellbeing, and your likes and dislikes.