Introducing Opioids and Opiates
and How They Work
In our society, the terms “opioid” and “opiate” are used interchangeably, and have become, for a number of reasons, household names. Each year in the United States, over 250 million prescriptions are written for “legal” opioid medications, a fourfold increase since 1999. This fails to take into account the burgeoning use of heroin and other illegal street opioid substances. Sadly, every community in America is now impacted by opioid abuse and addiction, and soon it will touch all families, including yours if not already. Over 50,000 Americans died from opioid-related drug overdoses last year in this country, many of them cut down in their prime.
The labels opioid and opiate do not actually mean the same thing. Opiates are natural substances which act as sedatives or narcotics derived directly from the opium poppy plants. Heroin, morphine and codeine are prime examples. They all typically induce relaxation and sleep, while also reducing pain in our bodies. The term opioid encompasses opiates plus any synthetically-manufactured drugs that induce similar pharmacological effects to those from natural opium. So the class of narcotics known as opioids actually encompasses those called opiates. For the remainder of this article, and for simplicity’s sake, the term opioid will henceforth be used only.
Opioids act upon the human body by blocking pain receptors in our brains, thus reducing the perception of pain we experience. Our bodies naturally produce their own pain killers including endorphins, also referred to as opioids, which are released when we get hurt. In addition, opioid substances further act by giving a “false positive” to our brain’s pleasure and reward center, providing the resulting “high” users experience. And, opioids further alter our cardiovascular and respiratory systems, inducing relaxation to their various structures, while also doing the same for the user.
Examples of opioids, including drugs directly derived from natural poppies, or those synthetically created that mimic the narcotic effects experienced from opium, include morphine, codeine, heroin, methadone, hydrocodone, fentanyl, and oxycodone. As aforementioned, use of these substances has skyrocketed in recent years, due mostly to the explosive popularity of heroin as it nears epidemic levels. But when did all this start, and how far back does opioid use go? Believe it or not, our answer lies somewhere in ancient Sumer…
Opioid Use Began Over 5400 Years Ago
The history of opium use can be traced all the way back to the Sumerians of ancient Mesopotamia, and the 35th Century, B.C. The inhabitants of that region called their newfound,
high-inducing product “Joy Plant”, and later passed its use on to the Assyrians, who in turn brought it to their trading partners the Egyptians. Opium use continued on, in one form or another, for many centuries, including its being embraced by the ancient Greeks. In fact, Hippocrates, the “Father of Medicine” (Hippocratic Oath), found opium to be useful as a pain reliever and styptic to treat his patients around 400 B.C.
Later, the noted Greek general and “world empire” builder known as Alexander the Great brought opium to India, an ideal climate for growing poppies. China traded with India at that time, and eventually picked up the opium “habit”. Over time, the Greeks, Arabs and Romans all found medicinal, along with recreational, applications for the drug.
At some point the fledgling nation known as the United States saw its borders infiltrated by opium, and later in its other forms of heroin and morphine. During the 1800’s, open and unrestricted opium use, including the smoking of it, was common. However, as the 19th Century in America drew to a close, opium addiction was becoming a problem. As a result, in 1909 Congress passed the Opium Exclusion Act, which prohibited the smoking of opium. By the end of 1914, the Harrison Narcotics Act had been voted into law, requiring any sales and distribution of opioid-containing products to be conducted only by registered pharmacists and physicians.
By the early 1920’s, and even with the aforementioned legislation, heroin abuse had led to a proliferation of addicts, leading Congress in 1924 to pass The Heroin Act, which more stringently restricted its availability. Soon thereafter, the other marketed forms of natural opium were completely taken over by the government, spearheaded by the formation of the Food and Drug Administration (FDA) in 1938. But then some smart chemists, notably in Germany, found a way to circumvent our new laws by coming up with synthetic forms of opioids, a process which had actually begun back in 1916 when oxycodone was created in one of their labs.
By the 1950’s and 60’s in America, Percodan (oxycodone and aspirin) tablets were widely being prescribed by doctors. Opioid abuse and addiction also started to rise. Heroin, which had dwindled in popularity due to the aforementioned Federal Government control of its sales and distribution, saw a dramatic rise in use during the tail end of the Vietnam War, when cheap and potent varieties of it from Southeast Asia found their way to the states. Heroin has been a problem on our city streets ever since, but its use and addiction issues have exploded just within the past 5 years, as it has trickled down to nearly every rural community in our nation.
During the 1990’s medical doctors and pharmaceutical companies lobbied the FDA for less-stringent opioid regulations, and especially pertaining to looser indications for prescription pain pills. The government regulators, pressured by members of Congress, relented, and doctors began distributing opioids like candy. Today, one out-of-every five patients with a pain-related diagnosis is handed a script for an opioid pain medication. Unfortunately, now we are reaping the addiction and overdose “fruits” of our nation’s obsession for opioids. Let’s now investigate the warning signs, and impact on the human body, of opioid abuse.
Learn the Signs, Symptoms and Effects of Opioid Abuse and Addiction
As we learned above, opioids induce several physiological changes in a user’s body, affecting the brain’s pleasure and pain centers, along with their heart, body temperature, lungs and more. Opioids can be taken orally as pills, smoked, or for a faster effect, injected directly into a person’s blood stream. The latter form of intravenous administration, of course, is very popular among heroin abusers.
Once an opioid user has been on their drug-of-choice for even a short period of time, their brain’s biochemistry begins to change, as their pleasure and pain receptors are negatively altered. This eventually leads to a physical and psychological “dependence” on the opioid. Then, if their body is not fed progressively higher amounts of the opioid, those symptoms may intensify. At that juncture, use has now transitioned into “abuse”, or dependency. Full-blown addiction is the next step.
Let’s first address the warning signs that someone you know and love may be exhibiting that indicate they are overusing, or even abusing, an opioid of some type. These may include any or all of the following physical changes:
- Constricted pupils in any type of lighting
- Seem to be confused or disoriented at times
- Difficulty having a bowel movement (constipation)
- Exhibit slower-than-normal breathing patterns
- Appear to be drowsy frequently while even nodding off to sleep suddenly
- Unexpected episodes of being overly happy or euphoric
Further, here are some sociological and behavioral signs of opioid dependency:
- Isolating from others and behaving in an atypical, antisocial manner
- Openly or discretely going to numerous doctors for no new medical reason
- Asking you or others to borrow money, or engaging in criminal activities for money
- Drastic and unexpected mood swings
- Trying to hide pill bottles, or throwing away a large number of empty ones
When someone you know has an opioid abuse problem, the above changes will begin to exacerbate over time. In addition, if they are cut off, for one reason or another, from their drug supply opioid withdrawal can then take place, indicated by these physiological symptoms:
- Difficulty sleeping including the inability to fall asleep, or sleep through the night
- Noticeable sweating even on a cooler day or without exerting themselves
- Anxiety and/or depression
- Unusual fatigue and shortness-of-breath
- Complaining of frequent and intense headaches
- Nausea, vomiting and diarrhea
If your friend, family member or co-worker is exhibiting these various signs of opioid abuse, and possibly addiction, without some type of intervention the physical, mental and emotional impact of the drug will probably get progressively worse. The greater the dependency upon the opioid, the faster their lives will spiral towards “bottoming out”, while taking many around them along for the regrettable ride, in one way or another.
Unchecked Opioid Addiction Causes these Negative Physical Changes
As time plays out, and a person’s opioid dependency moves into full-blown addiction, there will manifest a myriad of detrimental, long-term physiological effects upon their body and mind. Here are just a few:
- Problems with normal breathing, respiration and possibly an irregular heartbeat
- Frequent illnesses as opioids weaken a person’s immune system
- Gastrointestinal issues such as constipation, severe diarrhea, bowel perforations and potentially an intestinal ileus (obstruction)
In addition, if the addict is an intravenous (I.V.) opioid abuser, such as heroin, the effects of I.V. insertion, over time, can cause medical problems like embolisms, systemic body infections, susceptibility to blood-borne diseases like Hepatitis C or HIV, and localized abscesses. As you can see, the prognosis for someone you care about who abuses opioids typically is not positive.
But the good news is that more and more effective opioid addiction treatment modalities are becoming available, in lock step with recent scientific research on the disease of opioid addiction itself. Having said that, let’s now investigate some of the more current and proven opioid addiction treatment opportunities out there.
Those Who Suffer from Opioid Addiction Don’t Need to Go it Alone
The first major hurdle with any addict is getting them to admit that they have a problem, and opioid addiction is no exception. Once that major hurdle has been overcome, and the opioid abuser realizes that they need professional assistance, the road-to-recovery can begin. Based upon addiction research studies, the most effective treatment program needs to start with an inpatient facility of some type. Inpatient facilities include hospitals or stand-alone addiction treatment clinics and centers, where the addict stays there 24/7, minus outside distractions, for several weeks.
Numerous ones are available within your community, and are based upon a person’s addiction severity, substance they use, income levels, criminal background, and other socioeconomic factors. The addiction specialist who first sits down and assesses your loved one will ask a battery of questions which are critical during the screening and program tailoring process. Those questions may include the following:
- What opioid(s) have you been using?
- On a daily basis, how much and often have you been using?
- When did you first begin using the opioid substance(s)?
- When was the last time that you used the opioid?
- From whom and how do you usually obtain your drug(s) of choice?
As was mentioned previously, inpatient therapy is one opioid addiction recovery method. Outpatient treatment centers are also common, and are initially less-effective due to the fact the patient is free to be influenced more-easily during their day by opioid “triggers”, including drug suppliers and fellow users. Inpatient opioid addiction treatment programs most always begin with a detoxification, or “detox”, period, which varies from days to weeks depending upon the severity of the patient’s symptoms, and the potency of the opioid they’ve been abusing.
Detox basically is a controlled, forced withdrawal of the patient from the opioid, conducted under the care and direction of trained medical professionals. If more powerful opioids have led to your loved one’s addiction, like the combination of heroin and fentanyl so popular today, prescription opioid drugs like methadone or buprenorphine may be employed to ease the severity of withdrawal. That course-of-action is referred to as a “medical” or “pharmacological” detoxing method. Symptoms of opioid withdrawal can be divided into “early” or “late” categories, and include these:
Early Withdrawal Detox Symptoms which take place within 6 to 30 hours, depending upon the opioid’s half-life (short vs. long-acting), and may last up to 72 hours:
- Rapid heart rate
- High blood pressure that doesn’t normally occur
- Fever, chills and excessive sweating
- Eyes tearing up unexpectedly
- Excessive yawning
- A persistent runny nose
Late Withdrawal Detox Symptoms that show up within 3 days of initial treatment and stick around for about a week:
- Gastrointestinal problems including nausea, vomiting and diarrhea
- Goosebumps on some or all areas of the patient’s body
- Depression or a depressed state
- Stomach or other body muscle cramping issues
- Agitation and even aggression towards others or themselves
- Mild-to-severe cravings for opioids
Under the direction of trained addiction counselors and medical professionals, these opioid withdrawal issues can be successfully managed. Once the detox period has run its course, the patient can then move on to the next phase of treatment, which entails getting their life back on the right track through learning to cope again, drug free, on the outside.
A significant part of any addiction treatment program is evaluating, treating and constantly monitoring the mental and emotional changes that are going on inside the head of an addict. Individual and group counseling, usually under the direction of a licensed mental health professional, is important as the opioid addict’s body and mind begin to heal. Most addicts have underlying emotional and mental issues, some worse than others, that need to be addressed and controlled with therapy and prescription medications. Any reputable opioid addiction program, whether inpatient or outpatient, will do so. To best optimize an individual’s successful adherence to their newfound life of being clean and sober, counseling should continue even after they re-enter society.
Long-Term Opioid Treatment Success Involves these Key Steps
Once a recovering opioid addict has remained drug-free for 3-4 weeks, or in other words not “relapsed” during that time, they will graduate to other less-restrictive addiction support and education programs in the area. These may include halfway houses, intensive outpatient sessions, being put under the care of a non-using family member or friend, 12-Step meetings like Narcotics Anonymous, psychiatric counseling and others. Recovering opioid addicts need to be constantly aware of their surroundings, at least for the first year or two, and avoid the people, places and things that “triggered” them to use in the past.
Twelve-Step meetings are everywhere, and the recovering opioid patient needs to find a “sponsor”, or fellow recovering addict with at least 6 months of clean time under their belt, to mentor them. Continued counseling with a mental health professional is advised, as the addict continues to develop life-coping mechanisms, along with overcoming the personal “demons” that they have locked inside for too long. Eventually, and over a period of months or sometimes years, life does get much, much better. Recovering addicts need to focus on the perceptible physical, mental and relational healing that takes place daily, and continue to build upon those.
One of the most important points about any type of addiction, including to opioids, is that it is a chronic illness, one that needs to be controlled for the duration of the afflicted person’s lifetime. Support groups, like Narcotics Anonymous, allow a recovering addict to see that they are not unusual, or “weird”, and that addiction, especially to opioids, is common in today’s world. However, the good news is that once identified, a person has many treatment and support options available to assist them in overcoming opioid addiction, while ultimately getting them back to a healthier and more enjoyable life, and also for everyone around them!