Opioid drugs are those that interact with the body’s opioid sensors in the central nervous system. These drugs are able to reduce pain and depress the nervous system.1 This can often lead to opiate addiction.
Some common kinds of opioids include:
Some specific drugs include:
Opioid drugs may be synthetic, natural opioids, or semi-synthetic.
When opioids are abused, there are several side effects2 that could occur. Some of the short-term side effects of opioid abuse include:
In some cases, the slowed breathing that results from opioid misuse may lead to hypoxia. This is a condition in which the brain doesn’t get enough oxygen. As a result, the misuse of opioids can have significant short- and long-term neurological and psychological effects. Signs of acute opioid abuse or an overdose may include:
It is necessary for people to understand that overdoses are possible when taking opioids. Prescription opioid overdoses are life-threatening and have resulted in people’s deaths in the past. Usually, people stop breathing when they overdose, because the central nervous system is too depressed to function normally.
Fortunately, Naloxone can be used to reverse the symptoms of an opioid overdose if it is administered quickly.
The reason that some people misuse opioids is that they relieve pain and can give a feeling of intense relaxation or euphoria. Euphoria, specifically, is common among those who misuse the drug.
Opioids are known to release dopamine, which is a “feel good” chemical in the body. As a result, the act of abusing opioids is reinforced, and an addiction may form.
According to the National Institute on Drug Abuse,2 opioids are commonly misused by:
Misusing opioids is unfortunately common, and the drugs may be swallowed, injected, dissolved in water, or even snorted.
Opioids are known to have a high potential for abuse. Repeatedly misusing a prescription opioid or illicit opioid drug may result in a substance use disorder. An SUD happens when the drug’s continued use leads to health problems, changes in the brain, and a failure in the ability to maintain normal daily activities.
Opioid Use Disorder, the medical term for addiction to opioids, is treated in one of a few possible ways. According to American Family Physician,3 OUD can be treated with pharmacotherapy, which may also be called medication-assisted treatment, behavior therapy (like cognitive behavioral therapy), and Naloxone, which reverses the effects of an opioid overdose. These three options combined give patients a well-rounded treatment plan.
Physicians agree that OUD needs to be treated as a chronic condition. There are genetic, behavioral, and environmental causes of the condition, and the disorder responds best to long-term treatment and medication supplementation.
Yes. The first step of treatment is to enter into a detoxification program. This is because stopping opioids suddenly could result in withdrawal. Withdrawal can be painful, uncomfortable or dangerous. In some cases, it may be life-threatening.
When someone is withdrawing from opioids, they may have symptoms such as:
The symptoms may be severe and extremely uncomfortable, which is why most people aren’t able to stop using opioids on their own. Fortunately, there are detoxification programs that can help with medication-assisted treatment and other options.
Opioid withdrawal may start as soon as eight to 12 hours after the last dose of heroin, for example, or within 36 hours of the last dose of methadone. Each type of opioid is a little different, so when the symptoms begin will depend on:
It’s a good idea to enter into a medical detoxification program, because serious complications4 can occur during withdrawal, like severe gastrointestinal issues leading to dehydration or autonomic arousal, which increases your blood pressure, pulse and other stats.
Medication-assisted treatment, which is also known as MAT, is a therapy where certain medications are used to replace a more dangerous drug or to minimize the symptoms of withdrawal. They also help manage the risk of relapsing.
Two of the most commonly used drugs in MAT include buprenorphine and methadone. Sometimes, Naloxone is also used in these programs. Some more information about the medications is listed below.
Buprenorphine5 is one of three drugs approved for the treatment of opioid dependence.6 Buprenorphine is an opioid partial agonist. What that means is that the drug does not produce euphoria or respiratory depression at the same level as a full opioid. While it can produce those symptoms, it’s much less likely.
Buprenorphine is safe when it’s used as directed. It has special effects that make it suitable for treating opioid disorders, such as:
Methadone7 is a full opioid agonist and controlled substance used to treat opioid addiction and dependency. Like morphine, it is an opioid used to treat pain. Methadone can be habit-forming, but it is largely safer than taking other kinds of opioids, such as heroin or fentanyl. It is a long-acting drug compared to other opioids, which makes it helpful for inpatient and outpatient detox.
Naloxone is an opioid antagonist.8 This drug binds to the opioid receptors and reverses or blocks the effects of opioids on the body. Naloxone is fast-acting and quickly reverses the effects of opioids, such as depressed respiration, which is known to save lives. Think of naloxone as an antidote to opioid drugs.
Naloxone can be given as an injectable, auto-injectable, or prepackaged nasal spray. Normally, people who are using opioid medications will also receive naloxone in case of an overdose. The most commonly used brand of nasal spray is NARCAN. NARCAN is suitable for home use in emergencies.
Yes, because MAT has been shown to decrease opioid use, increase social functioning, and retain patients in treatment programs. New drugs, and improved medications, are being worked on all the time for opioid addiction treatment. For example, in 2017, Sublocade9 was approved for once-a-month injection into those with an opioid use disorder. This kind of long-term dosing has been shown to eliminate the need for daily doses of opioids and to improve the outcomes of patients in treatment programs.
Despite the fact that MAT is known to have excellent outcomes, fewer than half of all privately-funded treatment programs offer it. Only around a third of people with opioid dependencies end up receiving MAT treatment.10
No. This is a common myth that is harmful to those who need MAT support. Methadone and buprenorphine aren’t used to substitute one opioid for another. The dosage prescribed isn’t designed to get the patient high. Instead, it’s enough to hold off opioid cravings and withdrawal symptoms, so patients can focus on other parts of their recovery.
These medications also give the person’s brain time to heal, so they recover over time instead of struggling through withdrawal cold turkey.
Once patients are in an addiction treatment program, there will be a variety of options available. To start with, patients will select from an inpatient or outpatient program.
Inpatient programs are created to give patients a place to have 24-hour, around-the-clock medical care. They live at the facility and may or may not have contact with the outside world, depending on the program. Generally speaking, these programs are between 30 and 90 days long, though there are some longer 180-day programs and other forms available.
Outpatient programs can be intensive or regular. Intensive programs meet frequently, as much as every day for several hours a day. A regular outpatient program may meet a few days a week for a couple of hours each time.
The difference between an outpatient and inpatient program is in the intensity of treatment and the ability to leave. Only outpatient programs give patients the chance to go home, work, or school.
After choosing an inpatient or outpatient program, there may be some other options. Some of the common programs offered by substance abuse disorder treatment programs include:
…and many others. There are so many different kinds of programs that it’s beneficial for patients or their families to reach out to a clinic they’d like to try to find out more about what is offered.
The best treatment for an opioid use disorder will depend on a person’s specific needs. Someone who is dependent, but not having psychological cravings, may do well with a tapering program or detox and private therapy. Someone who has strong cravings and an uncertain home environment may enjoy an inpatient program where they’re monitored and taught new coping strategies.
Sources
1National Institute on Drug Abuse. Opioids
2National Institute on Drug Abuse. DrugFacts- Prescription Opioids
3American Family Physician. Opioid Use Disorder: Medical Treatment Options
4U.S. Department of Health and Human Services. Detoxification and Substance Abuse Treatment
5MedlinePlus. Buprenorphine Sublingual and Buccal (opioid dependence)
6U.S. Food and Drug Administration. Information about Medication-Assisted Treatment (MAT)
7MedlinePlus. Methadone
8National Institute on Drug Abuse. Opioid Overdose Reversal with Naloxone
9U.S. Food and Drug Administration. FDA approves first one-monthly buprenorphine injection, a medication-assisted treatment option for opioid use disorder
10HK Kindsen et. Al. Journal of Addiction Medicine (2011).