Opioid Addiction

What is Opioid addiction?

Opioid addiction is a chronic condition that alters brain function, driving a compulsive desire for opioids. By acting on the opioid receptors of the brain, opioids – which include prescription medications, such as oxycodone and hydrocodone, as well as illegal drugs, like heroin – produce an intense, pleasurable feeling, or “high,” often combined with a fleeting sense of pain relief. Opioids are highly addictive, especially when misused.

Addiction happens when a person can no longer control their need to use opioids, even when they are no longer medically necessary. This compulsion can have devastating consequences for a person’s relationships and career and may contribute significantly to declining health.

Types of Opioids

There are three types of opioids: natural, semisynthetic, and synthetic. All these types of opioids interact with the opioid receptors in the body, but they differ in their source and potency.

Natural Opioids

The natural opioids directly derived from the opium poppy plant include:

• Morphine
• Codeine

Semi-synthetic opioids

Semi-synthetic opioids are partially manufactured – they are chemical modifications of natural opioids. They include:

• Oxycodone (OxyContin®)
• Hydrocodone (Vicodin®)
• Oxymorphone (Opana®)

Synthetic Opioids

Synthetic opioids, however, are totally manufactured. They act just like natural opioids but are usually much stronger. Examples include:

• Fentanyl
• Methadone
• Tramadol
• Carfentanil (extremely potent, used in veterinary medicine)

Illegal Opioids

Heroin, which is the most well-known illegal opioid, is derived from morphine. This drug is extreme in potency, highly addictive, and has absolutely no legal medical use in the United States.

What is Opioid Use Disorder (OUD)?

Opioid Use Disorder (OUD) is the clinical term for opioid addiction. OUD is a pattern of opioid use that leads to significant distress or impairment in one’s daily life. With OUD, there is typically a compulsion to take the drug despite it causing harm.

The risk of developing OUD increases with the misuse of opioids, such as taking more than what a doctor has prescribed or using someone else’s prescription. Misuse also raises the risk of overdose, which can be fatal if not treated promptly.

What causes Opioid addiction?

Addiction to opioids depends on a very complex combination of genetic, environmental, and psychological factors.

• Genetics: Possibly, variations in genes that code for the opioid system of the body increase susceptibility.
• Psychological Issues: Conditions like depression, anxiety, and PTSD increase susceptibility. Traumatic events or abuse during childhood may also increase vulnerability.
• Environmental Factors: Some other specific factors are the availability of opioids – either through prescription or otherwise. Social groups, poverty, and lack of support systems further add to the addiction problem.

Opioids, including fentanyl, are particularly addictive when taken in ways not prescribed by a physician, like crushing pills into powder to snort or inject, increasing their potent effects and increasing the risk of dependence.

What is the main cause of Opioid addiction?

The main cause of opioid addiction is the euphoria induced by opioids, aside from pain relief. This ‘high’ feeling of well-being may lead to the abuse of opioids by individuals who want to feel this kind of euphoria and eventually become addicted.

Regular use is associated with tolerance – the doses need to be higher to achieve the same effect. Additionally, there is a genetic component: because of gene variation, people respond differently to opioids, and some are more susceptible to addiction than others.

What are the effects of Opioid addiction?

Opioid addiction can lead to serious physical, psychological, and social consequences, impacting nearly every aspect of a person’s life. Here are some common effects:

Short-term effects of opioid addiction include:

• Sedation (drowsiness)
• Confusion or mental fogginess
• Nausea and vomiting
• Constipation
• Respiratory depression: slow, shallow breathing

Long-term effects of opioid addiction include:

• Tolerance – which means the development of resistance. Higher dosages are required for the desired effect.
• Physical dependence, withdrawal symptoms when use is stopped
• Increased sensitivity to pain (hyperalgesia)
• Immune system dysfunction
• Sleep disorders: sleep apnoea, among others.
• Hormonal imbalance
• Increased risk of overdose and death

What makes a person addicted to Opioids?

Opioids affect the chemistry of the brain by releasing endorphins that, after that, create a feeling of euphoria or pain relief. After some time, that effect becomes diminished, and higher doses are required to produce that relief; this is what is known as tolerance. Continued use results in dependence, with the brain and body adapting to the presence of the drug. When usage is stopped, withdrawal symptoms will result.

Dependence is not the same as addiction, but the compulsive need for opioids certainly can lead to addiction.

Opioid Overdose

An opioid overdose occurs when a person consumes an amount of opioids that is harmful, and more than the body can handle. The intake triggers a chain reaction that upsets normal body functions, which could include breathing. The person could become unconscious, stop breathing, or even die.

Symptoms of opioid overdose may include

• Very slow, shallow breathing
• Pupils that constrict
• Loss of consciousness
• Pale or clammy skin

Opioid overdose deaths rose from nearly 50,000 in 2019 to 81,806 in 2022 in the United States alone. While immediate help in case of overdose with a medication called naloxone can restore normal breathing and halt the progression that leads to overdose death, medical help is still important right away.

Opioid Withdrawal

An individual physically dependent on opioids will begin to develop withdrawal symptoms within hours of their last dose. The symptoms are uncomfortable, although rarely life-threatening; however, they can be intense.

Symptoms of opioid withdrawal include

• Sweating and chills
• Aching and cramping of muscles
• Nausea and vomiting
• Sleeplessness
• Anxiety and irritability

Symptoms of withdrawal peak at about 72 hours after the last dose and can continue for days and even weeks. Symptoms are moderated with medications such as methadone or buprenorphine to prevent relapse.

Diagnosis and Tests

How is Opioid addiction diagnosed?

Opioid Use Disorder, or OUD, is diagnosed based on a set of criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). One can be considered to have OUD if they continuously takes opioids and shows two or more signs of the following within a 12-month period:

Physical Dependence:

• Tolerance developed, more substance is required to achieve the desired effect.
• Withdrawal symptoms when ceasing use and continued use to avoid withdrawal.

Loss of Control:

• Taking more opioids than intended or for a longer period than prescribed.
• A strong urge or necessity to use an opioid.
• Spending a lot of time to attain, use, or recover from the use of opioids.

Negative Impacts:

• Opioids are abused when major responsibilities at home, job, or school are neglected.
• Giving up important activities or events to use opioids.
• Using opioids in dangerous situations – while driving, for example.
• Continued use despite an inability to manage important social or interpersonal difficulties.
• Continuing to use opioids even when aware of the physical or mental harm they cause.

An official diagnosis requires a comprehensive evaluation by a healthcare professional, and early identification improves the effectiveness of the treatment.

Treatment

What are treatments for Opioid addiction?

Treatment of opioid addiction usually takes a combination of pharmacological intervention combined with behavioral treatments. Outpatient treatment programs may often include one of many residential treatment centers or a dedicated opioid treatment facility. Key treatment modalities include the following:

Medication-assisted treatment (MAT):

• Methadone: Suppresses their desire for narcotics and lessens the severity of withdrawal symptoms. Available only at licensed clinics under careful supervision.
• Buprenorphine: It blocks the effects of other narcotics and is available for prescription by specially trained and certified health care providers. It is often used in concert with naloxone to discourage diversion.
• Naltrexone: Non-opioid medication blocking opioid receptors; it will block the euphoric effects of opioid use. In addiction treatment, it is often used to prevent relapse.

Behavioral therapies:

• Cognitive-behavioral therapy (CBT): This is a way of helping the patient learn to identify and modify negative thought patterns and behaviors associated with drug use.
• Contingency management: Provides rewards for positive behaviors like abstinence.
• Motivational enhancement therapy (MET): It builds motivation for a change and commitment to recovery.
• Family counseling: It helps the individual and their family understand and deal with the effects of drug addiction.
• Mutual-help groups: These are the practical peer-support networks that have been of help and assurance to addicts; Narcotics Anonymous is one good example.
• Harm reduction education: The education on overdose prevention, safe syringe use, and the use of naloxone will save the lives of people not ready to start full treatment.
• Sober living homes: These provide stable, supportive settings that enable individuals to maintain their state of sobriety and avoid relapse. Sober living houses try to uphold accountability and peer support, which is very crucial during sustained recovery.

Prevention

How can I prevent Opioid addiction?

Opioid addiction can be prevented through responsible use and discreet management. Here are the key steps to minimize risks:

• Opioids, if at all, in the treatment of pains of acute origin – such as postsurgical and post-traumatic – should be prescribed for no more than three days.
• Work with your healthcare provider to take the lowest effective dose for the shortest possible period.
• Always be sure to follow instructions carefully as prescribed.
• You can also ask your doctor for less addictive options in pain relief, like over-the-counter medications or other techniques such as physical therapy or alternative treatments.
• Store opioids securely, not allowing access to anyone else, most importantly if one has young children or teenagers around.
• Properly dispose of no longer needed opioids.

Outlook / Prognosis

Is there a cure for Opioid addiction?

Opioid addiction is a chronic disease and is treatable. There is no perpetual “cure,” but many individuals obtain long-term recovery through medication treatments combined with support.

Living With

How do I help someone I love who is suffering from Opioid addiction?

Supporting a loved one through any addiction, including opioids, requires compassion, patience, and educated action.

• First of all, learn to regard addiction to opioids as an illness, not as a personal moral failure; this will prevent judgment about what happened.
• Encourage your loved one to get professional help that may involve Medication-Assisted Treatment, therapy, or some other forms of treatment. Go with them to seek resources and attend appointments.
• Recovery is a long journey. Be patient, understanding, and non-judgmental; be willing to listen to them and encourage them – especially when setbacks happen.
• Addiction does not spare anyone in its way. Family therapy might help to enhance the quality of relationships and communication.
• Encourage them to participate in support groups like Narcotics Anonymous, to be in contact with other people who understand their experience.
• Set healthy boundaries by taking care of your own emotional needs and being supportive.