Opioids Addiction and Abuse

The country is in the grips of an epidemic of opioid abuse with a high casualty rate. That means it’s more important than ever for friends, employers, and family members to understand the nature of the beast and recognize the signs of opioid abuse. 

More About Opioid Abuse

In 2017 alone, nearly 50,000 people died from opioid overdose, and more than 2 million are in need of treatment for opioid use disorder. Approximately 17 percent of Americans were prescribed some form of opioid-based pain medication in 2017, most without developing a dependency. That’s about 58 prescriptions for every 100 people in our country. Of that number, an average of 25 percent abused their prescription, and 12 percent of that group developed an opioid use disorder.

What Are The Signs of Opioid Use?

Anyone who takes narcotic prescription pain medications will experience intoxication. It’s what habitual users refer to as an “opioid high”, and the intensity depends on the type and strength of the prescription. For example, medications like codeine or tramadol are considered at low risk for abuse because of their relatively mild formulation, where drugs like OxyContin and fentanyl are extremely potent and addictive.

Opioids are usually taken in pill form, but some brands are manufactured as nasal sprays or wafers that are dissolved under the tongue. Those who abuse them will sometimes crush the pills into a powder and snort them or dissolve them in water and inject them. Street drugs like heroin, morphine, and opium can also be injected, snorted, or smoked.

The mild euphoria occurs because the active ingredient, a natural opioid or synthetic opiate, is activating the body’s natural pain response by triggering a release of endorphins. Recreational users become addicted trying to recapture the buzz. The longer the medication is taken, or the higher the dosage, the more likely it is that this response will lead to tolerance and eventual dependency or opioid abuse.

When use crosses the threshold into abuse, changes occur in behavior and personality. The person may become easily agitated, seem preoccupied with their medication, such as anticipating their next dosage or becoming overly concerned with how many pills they have left. They may start doctor shopping to obtain prescriptions, stealing medications from friends and family members, or buying drugs illegally. Approximately 80 percent of those in treatment for heroin addiction began by abusing legal prescriptions.

Abuse is defined as taking any illegal drugs, including other people’s prescription medication, or using more than the prescribed dosage. Other signs of opioid abuse include:

  • Attention and memory problems
  • Slurred speech
  • Lack of visual focus
  • Extreme drowsiness
  • Constricted pupils

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What Are the Effects of Opioid Use?

Short-term opioid side effects aren’t necessarily related to opioid abuse. They include dry mouth, constipation, dizziness, and nausea. However, opioid abuse or medications taken for long-term pain management can result in more severe, even life-threatening, side effects.

Long-term side effects of opioid use can include:

  • Slow or shallow respiration
  • Weight gain
  • Abdominal cramps
  • Muscle spasms
  • Low libido or sexual dysfunction
  • Disrupted menstrual cycles
  • Mood swings and irrational behavior
  • Sleep disturbances and nightmares
  • Heart, liver, and respiratory ailments

One of the biggest dangers of opioid use is the chance that each dose, line, or injection could be the last. A contributing factor to the increase in death by overdose is the practice of mixing heroin with fentanyl, which can be up to 100 times the strength of heroin alone. Increased tolerance also leads to unexpected overdose and death because the amount needed to achieve the desired effect increase, but the lethal dosage doesn’t. It’s also difficult to know what contaminants are added to street drugs or the potency of any given batch.

Watch for signs of an overdose like loss of consciousness, bluish lips, cold, clammy skin, and weak or undetectable vital signs. Overdose can be treated with an antidote like Naloxone, which is sold under the brand name, Narcan® if it is administered fast enough. First responders in areas with high rates of opioid use and overdose deaths are required to carry an antidote. If an overdose is suspected, it’s essential to call 911 or seek medical assistance immediately.

Addiction vs. Dependence

Addiction and dependence are sometimes confused. Although the signs and conditions can share traits and often cross into each other, they are different. An addiction is an uncontrollable craving for something that takes over every aspect of someone’s life. Addicts will continue to seek and use drugs regardless of the consequences. Their entire life becomes a vicious circle of seeking the gratification of that opioid high.

Eventually, the only objective is to get rid of the pain of withdrawal and craving.

Opioid dependency is a physical need for the drug in order to feel “normal” again. With abuse or long-term use, the brain ceases to function properly. Its normal chemical balance is disrupted and artificially stimulated by opioids, which adhere to the receptors in the brain that control pleasure and pain. More of the drug is needed to achieve the desired effect due to increased tolerance, which often results in an overdose.

Dependence comes with its own set of signs and symptoms, which include:

  • Taking the drug for longer than prescribed or in higher dosages
  • Repeated attempts and failure to reduce use or stop taking the drug
  • Time wrapped up in obtaining, using, and recovering from use
  • Intense desire to use opioids
  • Shirking obligations and responsibilities
  • Continued use despite consequences or knowledge of the danger

Preventing Opioid Abuse

The runaway epidemic of opioid death in the United States has led politicians, drug addiction specialists, and others to try to devise proactive measures that curb opioid use and prevent fatalities. Some of the measures taken include changing the formulation by adding coating or other ingredients to make abuse or some delivery methods more difficult. Doctors are also reducing initial dosages and prescription duration, and patients are looking into other methods of pain management. Patient education about the risks of abuse plays a big part in prevention as well.

Is Opioid Use Disorder Treatable?

A deeper understanding of the nature of addiction and substance abuse brings new hope to those suffering from substance use disorders and the people who care about them. Until prevention begins to make a larger impact on the statistics, further research is needed into detecting the signs of opioid abuse earlier and mitigating the opioid side effects that make quitting so difficult. In addition to medically assisted detox and comprehensive treatment programs, aftercare and maintenance can help prevent relapse.

There are new drugs available to keep severely addicted individuals on an even keel. Methadone and buprenorphine are still used in many outpatient rehab programs, and the development of drugs like suboxone and naltrexone shows promise.