Opioid use side effects outweigh benefits of pain relief
The amount of prescription opioids dispensed in the US has increased dramatically in recent years. In 1991, approximately 76 million opioid prescriptions were written. By 2013 that number had increased to 207 million. The drugs have important medical uses, but they are also highly addictive.
One recent trend in opioid abuse and addiction is crossing over to heroin. An increase in heroin production, an illicit opioid, has brought the price of this drug way down. People who become addicted to prescription pain relievers are now switching over to heroin because they need larger amounts of the opioids to satisfy their growing habits, and heroin is cheaper.
What Are Opioids?
Opioids come from opium, a highly addictive drug derived from the poppy plant indigenous to Southeast Asia. The habit of smoking opium came to the US from Asia in the 1800s. Before the real dangers were understood, many Americans were addicted to this exotic form of recreation.
Since then, the properties of opium have been studied, analyzed, recycled and reproduced for medicinal purposes. Morphine was produced from opium in an attempt to ease the opium addiction. It was also discovered to be an extremely effective pain reliever. Heroin and later codeine were also derived from opium and initially used for pain relief.
From there, opium drugs gained synthetic ingredients. Some drugs were designed with a combination of opium derivatives and synthetic ingredients, such as these that contain morphine: oxycodone, hydrocodone and hydromorphone. Finally, there are drugs that are full synthetics. They are made from chemical ingredients and are designed to mimic the effects of opium.
Synthetic opioids include:
Common Uses of Opioids
Opioids have a number of important medical uses. Although they are highly addictive, they also have pain-relieving properties that are far superior to other drugs on the market. The common medical uses of opioids include:
Used to relieve pain during surgery, opioids also induce muscle relaxation to facilitate manipulation during surgery and loss of memory to avoid post-surgery trauma.
Diarrhea suppression. Opioids cause constipation and therefore can be helpful in reversing diarrhea. They do not treat the underlying cause of diarrhea, however.
Pain relief. The most popular use for opioids is pain relief. They are effective in treating acute pain following surgery or the severe pain from injury or trauma. Opioids are useful in relieving cancer pain, especially in the end stages of the disease. They present one of the only ways to effectively control terminal pain. Pain caused by chronic diseases like rheumatoid arthritis is also well controlled with opioids.
Cough suppression. Some opioids have the side effect of suppressing a cough. A dry non-productive cough, especially when it is combined with body aches, can be controlled properly with opioids.
Addiction treatment. Certain opioids like methadone are used as a drug replacement to wean addicts off other opioids. Methadone is believed to satisfy a heroin craving without producing a high or withdrawal symptoms. Patients are then slowly weaned off the methadone.
Opioids have legitimate medical value. Their ability to relieve pain, for instance, is unequalled in any other substance. The relief of extreme pain then allows doctors to utilize different options for healing patients. Opioids can be used to break the cycle of pain which would otherwise impede healing.
How Opioids Work
To understand how opioids relieve pain, its necessary to first understand how the brain perceives pain. The brain and central nervous system are connected to all areas of the body by a sophisticated communication system. Sensory input information travels through this system to the brain where the message is received. The brain then issues a response that might include instructions for repositioning, defensive measures or pleasure.
Messages are sent throughout the central nervous system in chemicals called neurotransmitters. The neurotransmitters are produced at various points in the system and travel along cell structures. Receptor cells connect with neurotransmitters and read their message. Receptors are specialized cells that only fit with certain neurotransmitters.
In order for this complex messaging system to work, the right number of receptors have to line up with the proper neurotransmitters. If the neurotransmitters arrive at their destination and there are no receptors to take them in, they are reabsorbed by the system, and their message is lost. When the brain is flooded with a particular chemical, like the feel-good chemical dopamine, it responds by adding appropriate receptor cells to try to take in all of the neurotransmitters.
This communication system is further complicated by the fact that many neurotransmitters work in combination to produce more complex thoughts and emotions. Getting a message through the brain is not as simple as one neurotransmitter meeting up with one receptor. It is dependent on a number of different neurotransmitters in a certain volume meeting up with the right number of the right type of receptors.
Opioids interfere with the chemical messaging system in the brain. They block certain types of pain signals so they are never received. Opioids also increase the feel good chemicals in the brain, which is how they create the euphoric effect at higher doses.
The group of neurotransmitters involved in the perception of pain is collectively referred to as endogenous. Opioids mimic the characteristics of the endogenous and bind with the corresponding receptors in the brain, blocking them from receiving the natural chemical messages of pain from various parts of the body. Once they bind with the receptors, opioids release a large amount of feel-good chemicals into the brain.
Causes of Opioid Addiction
Opioid abuse and addiction is believed to come from the abundance of feel-good chemicals they release into the brain. The pleasure centers of the brain are where habits are created, and opioids set themselves up to become habits very quickly.
The natural purpose for pleasure is to encourage survival behaviors. Sexual pleasure is the best demonstration of this system. The pleasure associated with sexual activity is the brain training the body to repeat these acts. Procreation is required for the survival of the species, and by associating it with good feelings, the brain is encouraging survival.
The pleasure centers of the brain work in a way similar to positive conditioning. Each time pleasure is experienced, the brain develops more receptors for the feel-good chemicals. This additional capacity to perceive pleasure creates cravings that stimulate a desire to repeat the pleasurable activity.
Opioids flood the pleasure centers of the brain with feel-good chemicals at a greater rate than could ever naturally be produced. The cravings develop faster than with any other experience, physical or chemical, until larger amounts of opioids are needed to satisfy them. The brain’s natural system for creating habits is overstimulated by opioids.
Pros and Cons of Opioid Use
The biggest argument in favor of using opioids is pain relief. Opioids relieve extreme pain that no other substance can, and the use of opioids in pain management has become essential for some.
Relieving pain is an important step in healing. Pain causes extra stress and anxiety that can compound the problems of an underlying disease. Pain also detracts from the body’s ability to heal itself, and in extreme cases, it actually worsens the condition. The cycle of pain must be broken to promote healing.
The biggest drawback to opioid use, however, is addiction. Anyone who has a history of substance abuse should not use opioids. Unfortunately, it is nearly impossible to predict the reaction opioids will have on everyone else. They are highly addictive, although some people can tolerate them in small doses for a short period of time without developing an opioid dependency.
Opioid abuse and addiction is a serious health threat that some people end up fighting for a very long time. Finding a way to capitalize on the healing benefits of opioids without the serious health risks is a challenge for medical science.
Side Effects of Opioids
Since the brain is a complicated organ and many functions overlap, all drugs have side effects. It is virtually impossible to create the desired change in brain chemistry without also tipping the delicate balance in some other area.
Endogenous neurotransmitters that create pain messages also regulate hunger, control moods, manage immune response and are involved in vital functions like respiration. By interfering with the natural chemical messaging system in the brain, opioids also effect these other systems.
The short-term effects of opioids include:
Loss of consciousness
The effects of long-term opioid use include:
Combining Opioids With Other Substances
Opioids are very strong pain relievers that can be extremely dangerous when mixed with other substances. Anti-depressants, antihistamines and sleeping pills, for instance, when combined with opioids can lead to overdose and death. Opioids reduce the rate of respiration, as do these other medications. The combination can cause someone to stop breathing entirely.
At least one third of long-term opioid users are also taking Xanax or Ativan for anxiety. Another third of opioid users also have prescriptions for muscle relaxants. All three medications: muscle relaxants, anti-anxiety and opioids are prescribed to at least 8% of opioid users. Almost 60% of all opioid users in 2013 were taking at least one other drug that is dangerous to combine with opioids.
Alcohol and opioids is another dangerous combination. Both drugs act as depressants and slow heart rate and respiration. The side effects of taking opioids with alcohol include:
Impaired motor functions
Slow heart rate
Treating Opioid Addiction
Addiction is both a mental disorder and a chronic disease. It is caused by the interference of substances in the normal operation of brain chemistry that create physical changes in the brain. Mental health, stress and coping mechanisms are other factors that contribute to the development of addiction.
With any substance, the first step in treating addiction is detox. Opioids present a few complications in the detox stage. Withdrawal symptoms are the first serious concern with opioid detoxing. When the brain is used to opioids, and even craves them, suddenly removing them is shocking to the system.
The brain gets used to having opioids onboard, and it adjusts itself accordingly. It manages to keep all of the vital signs within reasonable ranges despite the interference of the drug. When the opioids are suddenly stopped, the brain goes into a sort of shock. It is not able to properly regulate vital systems, and there is need for medical intervention.
Over time, the brain will adjust to the new normal conditions without opioids and take over its job regulating vital functions. In the meantime, there are withdrawal symptoms that could be serious. Opioid withdrawal symptoms can include:
When it comes to opioid withdrawal, medically supervised detox is recommended. Depending on the length of use and the size of the doses, a step-down approach may be required. Instead of stopping the drug all at once, smaller doses might be given each day until it is slowly weaned out of the system.
There are also opioid addiction treatments that include replacement medications. Drugs such as methadone can be administered in place of opioids to reduce cravings and ease withdrawal symptoms. The replacement drug is then tapered off slowly.
In addition to withdrawal symptoms, opioid detox can be accompanied by strong cravings. Detox can be a difficult step for any addict because it is really just the beginning of a recovery program. It takes time to learn successful strategies for dealing with the anxiety and cravings that drug detox leaves behind. In order to get through detox, however, it is imperative not to give in to those cravings.
Opioids have a very strong effect on the pleasure centers in the brain. They create addiction quickly by using the brain’s natural means of developing habits. With each subsequent dose of opioids, more is needed to reach the same level of euphoria. For this reason, opioid cravings can be very strong during detox.
No matter what detox method is used, eventually the desire to use opioids again must be faced without any chemical assistance. Relapse in the recovery from opioid addiction is a very strong possibility. It does not mean that the recovery has failed, but it does require going back through detox and renewing efforts to overcome the addiction.
Relapse in opioid addiction recovery has some other dangers, as well. Overdose is a serious concern with high doses of opioids. The drugs suppress the respiration rate, and in high doses can actually stop it. The more you use opioids, the larger the dose you need to feel the same effects. People who are addicted to opioids can quickly work their way up to dangerously high doses.
After detox, the brain gets used to not having those opioids around. The structure of the brain begins to change, becoming more like it was before the addiction. The extra receptor cells that developed to handle the influx of feel-good chemicals die off and are replaced with other types of cells. The amount of feel-good chemicals naturally produced in the brain increases to make up for the lack of opioids. Over time, the brain can heal much of the damage caused by the drugs.
In the case of a relapse, though, a brain that has begun to return to normal is suddenly dosed with opioids. During the addiction, the brain might have been able to handle such a dose because it became used to it and had structurally adapted. The brain that is in recovery and starting to heal, however, is not able to tolerate that same dose. Opioid addiction relapse can easily lead to overdose.
Recognizing the warning signs of possible relapse can help prevent it from happening. These are indicators that a relapse is imminent:
Complacency about your recovery. When you stop doing the things you need to do to maintain your abstinence, you are likely to relapse.
Daydreaming about the “good old days.” When you have romanticized fantasies about how much fun your life was when you were using drugs, you are headed for a relapse.
Looking for old friends. When you try to reconnect with the people and places you used to go when you were using, you are headed for a relapse.
Belief you can use just one more time. When you start thinking your recovery is strong enough that you could use one time and not fall back into the old habit, you are likely to relapse soon.
Reliving an old pattern of denial. When you start becoming defensive about your activities the way you used to when you were taking drugs, you are headed for a relapse.
When you start sabotaging your relationships and closing yourself off from everyone, you are likely to relapse.
Loss of interest in positive hobbies. When you lose interest in the healthy activities and hobbies that replaced your drug habits, you are headed for a relapse.
By recognizing these warnings and getting help right away, you can prevent a relapse. There are several things you can do to avoid a relapse, even when the warning signs are beginning to show:
Go to a meeting. Increasing your involvement in your recovery program will help avoid relapse. Even if you don’t believe it will help, add an extra meeting or counseling session to your schedule right away.
Take one day at a time. Instead of trying to look at “forever,” which can quickly become overwhelming, just focus on the day in front of you. Avoiding a relapse for one day is a much easier task.
Call a good friend. Reconnect with your support system to break the isolation you are building around yourself. Let someone know you are feeling vulnerable. Sometimes just admitting it makes it easier to handle.
Get busy with something. Occupy your time and energy with positive, healthy activities. Practice your hobbies, go for a walk in nature or plan and cook a healthy meal.
Reduce stress. Stress is a major relapse indicator. Combat your stress with yoga, meditation or any other strategies you have learned.
The most important thing you can do when you recognize the warning signs of a relapse is to do something. If you ignore the signs, they will get worse until you finally do relapse. You may not know what to do, but doing nothing will not help. When you recognize the warning signs of a relapse, get help right away.
Getting Help for Opioid Abuse
Even legitimate opioid users can become addicted to the drug without realizing it. Once you are addicted, you will need a lot of help and recovery support to overcome an opioid abuse. You are not alone, though. There are many resources available to you.
Timing is critical as well. The longer an opioid addiction goes on, the more damage is done. As soon as you realize the problem, reach out for help right away. Recovery takes time, but the sooner you start, the easier it will be.
Drug addiction still has a stigma attached to it which makes it hard for some people to talk about. Drug addiction is not a sign of failure or weakness, however. Especially when it comes to opioids, addiction can happen to anyone. You need to speak up about your addiction in order to get the help you need.
If someone you love is suffering from opioid addiction, don’t be afraid to talk about it. Bringing the problem out of the shadows will make it easier to get help. Addiction causes a lot of embarrassment and shame, and that is what allows it to continue. Hiding a bad habit out of shame will only make the habit worse.
Addiction can be overcome with a good treatment program and a lot of hard work. Despite the withdrawal symptoms and cravings, most people who have experienced detox say it is not as bad as they expected. A lasting recovery after detox requires behavioral counseling to deal with underlying mental and emotional issues and to change behaviors. A holistic approach that includes exercise and nutrition will help you heal, body, brain and spirit.