Opiates and opioids are narcotics used to treat clients with mild to severe pain. The substances activate the central nervous system’s receptors to create feel-good chemicals known as endorphins, substances that give users feelings of relaxation and calmness while relieving pain. Due to these effects, opiates have a high rate of abuse that may lead to addiction. According to a study conducted by Carlson RG, between 8 and 12 percent of patients prescribed opiates will develop an use disorder.
Even though both substances have the similar effects, there is a slight difference between the two. Opiates such as codeine and morphine are naturally derived from opium, while opioids are synthetic or partially synthetic substances that people create to mimic the effect of opium.
Regardless of their origin, the abuse of opiates has become a public health crisis that affects millions of Americans, a crisis that killed more than 42,000 Americans in 2016 alone. Even when they don’t kill, opiates and opioids are dangerous. According to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), 80 percent of people who use heroin misused prescription opioids or opiates first.
Types of Opiates
Depending on the effect opioids have on the brain, they can be classified as antagonists and agonists. Antagonists such as clonidine and buprenorphine are used to help with the detoxification process because if they attach themselves to brain receptors, they don’t trigger them.
Agonists such as morphine and fentanyl are used in medical settings. They attach themselves to and trigger specific receptors in the brain to relieve pain.
Common opiate agonists may be found in the list below.
- Codeine: Codeine is a primary ingredient for some cough syrups and is also used as a pain reliever. Although it is not as potent as morphine, it may also be habit-forming. The substance binds to opioid receptors in the brain producing a sensation of a high.
- Darvocet/Darvon: Darvocet was a narcotic pain reliever that was pulled off of the market in 2010 because it contained the active ingredient propoxyphene, a drug that may cause dangerous abnormalities in heart rhythms.
- Demerol: The U.S. Food and Drug Administration (FDA) has issued warnings against Demerol (meperidine) because of its addictive properties. People should take this medicine only with a prescription and only for a short period. Prolonged use can be dangerous. It is listed on schedule II of the U.S. Drug Enforcement Administration’s list of controlled substances.
- Dilaudid: This drug with the generic name of hydromorphone is used by people with a tolerance to opioid painkillers. It is also extremely addictive. Overdose may lead to respiratory depression. This drug is highly regulated and should never be used without a doctor’s prescription.
- Fentanyl: Fentanyl is a very potent drug that is fifty times more powerful than heroin and 100 times more powerful than morphine. In 2017, fentanyl was responsible for about 30,000 deaths out of the total 72,000 drug-related deaths that year.
- Hydrocodone: This drug is classified as a narcotic analgesic. It blocks receptors to the central nervous system (CNS) and thus helps manage pain. It may also create physical and mental dependence in cases of prolonged use. Sometimes, people use and abuse medications that contain combinations of hydrocodone and acetaminophen, which may be fatal to the liver.
- Methadone: Methadone traces its origins to World War II when it was introduced by German doctors. People use it for pain management and to manage recoveries. Its addictive properties also mean that other people abuse it. While some consider methadone a safer drug compared to the other drugs on this list, users and doctors still need to take precautions.
- Morphine: This is an potent painkiller, so people should be careful about following their doctors’ prescriptions for dosage and frequency. Morphine is used to treat extreme pain from injuries and from illnesses such as cancer. It blocks signals between the brain and the nerves.
- Oxycodone: This is an opioid analgesic that controls pain. Oxycodone may be used for prolonged periods if people are supervised by their doctors. Percocet (oxycodone and acetaminophen) and OxyContin are common brand names for this drug.
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Opiate Abuse Statistics
The Centers for Disease Control and Prevention (CDC) reported that the rate of heroin use quadrupled between 2002 and 2013. The increase in use was directly proportional to the rate of heroin overdose. One problem is that drug dependents often use more than just heroin. They often mix it with other drugs and alcohol, which may create lethal cocktails. Using both alcohol and heroin may be deadly because both are depressants.
According to CDC data, almost 50 percent of people who abuse heroin are also hooked on prescription opioid painkillers, while almost all of them combine heroin with another drug.
Drug overdoses killed more than 70,000 Americans in 2017, according to the estimates from the Centers for Disease Control and Prevention (CDC). Many of the deaths involved illicit opioids such as heroin and illegally produced fentanyl as well as related medications such as oxycodone and hydrocodone.
The health epidemic caused by opiate addiction has forced the federal government and other authorities to resort to different measures. They made the drug naloxone available in most pharmacies without doctors’ prescriptions. Also known by brand names such as Narcan and Evzio, naloxone is an opiate antagonist that may reverse the fatal effects of an overdose. People use it as a first-aid tool until medical rescuers arrive on the scene.
Telltale signs related to opioid/opiate overdoses include:
- Constant vomiting
- Confusion and disorientation
- Delirium or hallucination
- Loss of consciousness
- Erratic heart rate
- Problems breathing
- Temporary respiratory arrest
- Pinpoint pupils
- Appearance of drunkenness
If an opiate overdose occurs, call 911 immediately for help. Monitor the condition of the affected person at all times.
Withdrawal from opioid may be extremely uncomfortable. If you are withdrawing from only opioids, not a combination of drugs or alcohol, the withdrawal from opioid may be uncomfortable but not life-threatening. Nevertheless, it is best to undergo detoxification in a controlled setting within a drug rehab facility where you may receive monitoring by trained professionals.
Opioid Withdrawal and Symptoms
The intensity of the withdrawal symptoms will depend on how severe people’s drug abuse or addiction are. Other factors that may affect withdrawal symptoms are the clients’ current health and well-being, if they have any underlying mental or behavioral disorders, or whether their families have histories of drug dependence.
Withdrawal symptoms after 24 hours:
- Muscle spasms
- Runny nose
- Abdominal cramps
- Stomach aches
- Constricted pupils
- Fluctuating blood pressure
Stages of opioid withdrawal:
There are four stages of withdrawal from opiates: anticipatory, early acute, fully-developed acute, and protracted abstinence.
Anticipatory (3 to 4 hours after the last dose):
At this stage, clients may start experiencing cravings and drug-seeking behavior. They may have anxiety or fear about oncoming symptoms of withdrawal.
Early acute (8 to 10 hours after the last dose):
At this stage, anxiety and drug-seeking behavior may continue accompanied by flu-like symptoms such as nausea, vomiting, sweating, and stomach aches.
Fully-developed acute (1 to 3 days after the last dose):
At this stage, the symptoms may reach their peak, and individuals may experience body tremors, muscle spasms, diarrhea, insomnia, and high blood pressure. Cravings at this stage may be the strongest.
Protracted abstinence (up to 6 months after the last dose):
At this stage, acute symptoms are no longer present. People may experience symptoms such as blood pressure issues, chronic insomnia, and a loss of energy.
Also at this time, people may be highly susceptible to environmental triggers that may contribute to a relapse.
Treatment for Opiate Addiction
Regardless of the type of opiate addiction, whether to heroin, fentanyl, oxycodone, or another drug, medical detox is necessary to manage the effects of withdrawal. Medical detox is the first stage of treatment for opiate addiction.
Detox typically lasts about a week but may last for two weeks or so, depending on the gravity of the problem. During the detox process, doctors may prescribe methadone or other drugs to treat withdrawal symptoms.
After going through detox, if people have severe addictions, they typically enroll in residential inpatient treatment programs for drug addiction. The treatment usually lasts from twenty-eight to ninety days. During this time, clients live with regimented schedules and may have limited visits with family members and friends.
Other people with less severe drug-related problems may go to outpatient programs where they may go on with their lives with minimal disruptions as long as they follow through with therapy or other protocols. Regardless of the type of drug rehab, people typically participate in cognitive behavioral modification to understand the root cause of their addiction. After they complete their programs, other services are available to ensure that they will not relapse.
This means that treatment does not end when people leave rehab facilities. While services differ according to facility, many people attend intensive outpatient programs (IOPs) to receive continued assistance and help them transition into a life of recovery.