Opioids include prescription painkillers and illegal substances like heroin. When prescribed correctly, opioids usually treat conditions that involve pain effectively. However, powerful opioids like fentanyl are frequently abused due to their euphoric effects. In the U.S., opioid abuse has increased with devastating consequences. In 2022, a record-breaking total of 109,680 people died as the fentanyl crisis continued to deepen, according to data from the Centers for Disease Control and Prevention (CDC).

In recent years, the risk of opioids has been acknowledged and studied, and, as a result, many treatment options are now available.

Opioids vs Opiates

Opiates are labeled as natural or occurring in nature, because nature – the poppy plant – creates their active ingredient. Common opiates include opium, morphine and codeine, both made directly from poppy plants.

An opioid is a substance that is synthetic or semi-synthetic. This means the active ingredients are created chemically in a lab. Opioids act just like opiates in the human body. Common examples of opioids are OxyContin, hydrocodone, fentanyl, and others.

There are three different types of opioids categorized by how they are made:

Natural opiates: These opiates occur in nature and are found within the seedpod of the poppy plant. Examples include morphine and codeine, both commonly used prescription painkillers.
Semi-synthetic opioids: Oxycodone, hydrocodone, hydromorphone, and oxymorphone are examples of medications that combine naturally-occurring opiates and synthetic opioids. Heroin is an example of an illegal, semi-synthetic opioid made from morphine.
Synthetic opioids: Methadone, fentanyl, and propoxyphene are examples of opioids that are made in laboratories and recreate the effect of naturally-occurred opiates. Synthetic opioids can be made to be much more potent than their natural opiate relatives.

Common Opioids and Their Uses

Opioids are used for a variety of purposes. Some of the most commonly used opioids are:

Codeine: This opiate is naturally occurring and used to treat pain, coughs, and diarrhea. It is widely used in medications and combined with other painkillers such as co-codamol (codeine and paracetamol).
Morphine: A natural opiate, morphine is used to treat severe pain and includes brands such as Duramorph, Avinza, Roxanol, and Kadian.
Oxymorphone: Although it is derived from morphine, it is significantly more potent. It is used to treat pain or as an anesthetic and is prescribed under the brand name Opana.
Oxycodone: This semi-synthetic opioid is derived from thebaine which naturally occurs in the poppy plant. Oxycodone is used to treat patients with moderate to severe pain. Brand names include Dazidox, Endocodone, Oxecta, Percolone, and Roxicodone.
Hydrocodone: Hydrocodone is also made from codeine and often combined with acetaminophen and used for extreme pain relief. Medications containing this opioid include Vicodin, Anexia, and Lorcet.
Hydromorphone: Prescribed under the brand name Dilaudid, hydromorphone is used as an effective painkiller that works quickly with potent sedative effects. Hydromorphone is two to eight times stronger than morphine. It is highly addictive and often abused.
Buprenorphine: Another semi-synthetic opioid derived from thebaine. Buprenorphine treats opiate addiction as an opioid agonist-antagonist under brand names, including Suboxone, Subutex, and Buprenex.
Fentanyl: The Drug Enforcement Administration (DEA) reports that fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. Fentanyl is used for severe pain management through a skin patch during cancer treatment. Due to its strength, Fentanyl is often abused, manufactured illegally, and involved in a high percentage of overdose deaths involving opioids.
Heroin: This illegal opioid is derived from morphine. It is highly addictive and dangerous. Street names for heroin include Black tar, H, Horse, Junk, Skag, and Smack.

Opioid Effects on the Brain

When someone experiences pain, the brain produces natural opioids called endorphins. These bind to the receptors in the central nervous system (CNS) and reduce or inhibit pain signaling by stopping electric pulses in nerve calls. Opioids bind to the Kappa and Delta receptors, but the Mu-opiate receptor is responsible for the major effects of opioids. Sometimes, chronic pain is too intense for natural opioids to overcome, in which case, a doctor may prescribe an opioid medication.

All opioids have a similar effect on the brain; however, a National Institutes of Health (NIH) study found that opioid drugs activate receptors in a location that is not affected by naturally occurring opioids. This different and more rapid interaction may help explain why opioid drugs have undesired side effects and lead to increased levels of tolerance, dependence, and addiction.

Side Effects of Opioid Use

Opioids, like all medications, have side effects. When prescribed carefully by a medical practitioner and used accordingly, the benefit of taking the opioid will often outweigh the side effects. The two most common side effects of opioid use are constipation, which has a very high incident rate, and nausea. These side effects can be challenging to manage and continue throughout treatment. In some cases, it will be severe enough to require discontinuation of opioid use. Other side effects are also possible, although they are less commonly experienced and are either temporary or easier to manage during treatment.

Dizziness
Vomiting
Diarrhea
Dry mouth
Skin itching
Slowed breathing rate
Drowsiness
Mood swings and irritability

Effects of Opioid Abuse

Taking opioids for a limited time as prescribed by a doctor has minor risks of side effects. Still, the chances are far greater, and the side effects are more severe if opioids are taken over a more extended period or abused. As previously discussed, long-term use can lead to mental health concerns such as chronic depression, but opioids also affect other parts of the body.

Effect on the Endocrine System

The endocrine system is the body’s hormone system, and it controls all biological processes. Long-term administration of opioids is associated with endocrine abnormalities. The impact of opioids on the hormones in the body can have many repercussions, including:

Reduced libido
Erectile dysfunction
Infertility
Absent or missed menstruation
Depression
Fatigue

Immune System Deficiencies

A healthy immune system helps to protect the body from disease. Opioids can interfere with the immune response and make the user more vulnerable to illness. People with a weakened immune system are more prone to pneumonia, bronchitis, infected sinuses, or skin infections. They may also have blood disorders such as anemia and digestive problems.

Opioid-Induced Hyperalgesia

When someone uses opioids to manage pain long-term, it can lead to hyperalgesia, which is heightened pain sensitivity. This condition is identified when a patient’s pain intensity increases, but the underlying medical condition has not worsened, or the pain extends beyond the site of the original pain. In this situation, physicians often taper the patient off opioids by gradually reducing the dose and treating pain with non-opioid medication.

Risk of Fractures and Falls

Opioids increase the risk and incidence of falls, leading to severe injuries such as fractures or head injuries. The risk is also higher for fall from height in opioid users. These risks are of particular concern to elderly patients due to the chance of suffering a serious injury that may result in chronic pain or even death.

Risks of Opioid Overdose

The chance of overdose death due to opioids is high. The National Institute on Drug Abuse reports that opioid-involved overdose deaths increased from 47,600 in 2017 to 68,630 in 2020. Opioids were involved in nearly 3/4 of all drug-involved overdose deaths in the U.S. in 2020.

The Substance Abuse and Mental Health Services Administration (SAMHSA) explains that an opioid overdose can occur for a variety of reasons, including:

Overdose on an illicit opioid drug such as heroin or morphine
Overdose on an opioid drug used in medication-assisted treatment (MAT), many of which are controlled substances with the potential for misuse.
Misusing opioid-based pain medication or using a medication prescribed for someone else.

Factors That Increase the Chances of Opioid Overdose

Although all opioid abusers are at risk, some factors increase the chances of opioid-involved overdose. These include:

Having an opioid use disorder
Injecting opioids
Using prescription opioids without medical supervision
High-dosage opioid use
Resuming opioid use after a period of abstinence, such as detoxification or release from prison.
Having a co-occurring medical condition such as mental health disorders, HIV, liver or lung disease.
Males, people of older age, and those with low socio-economic status all have an increased risk of overdose.
Combining opioids with alcohol or other substances can be fatal. This especially includes substances that also repress the respiratory system, such as benzodiazepines (known as benzos); the most common of which are Xanax and Valium. The National Institute on Drug Abuse (NIDA) reports that those who use opioids and benzos at the same time are at higher risk of visiting the emergency department, being admitted to a hospital for a drug-related emergency, and dying of drug overdose.

Opioid Overdose Signs and Symptoms

As opioid overdose is extremely common, knowing the signs and what to do is essential. Signs of opioid overdose include:

Clammy, pale face
Limp body
Purple or blue fingernails and lips
Vomiting or gurgling
Unable to speak
Cannot be awakened
Breathing rate or heartbeat reduced or stopped
Very small (pinpoint) pupils

If you see signs of an opioid overdose, you need to call 911 immediately.

Use of Naloxone to Treat Opioid Overdose

Naloxone is a medication that can quickly reverse the effects of an opioid overdose and save someone’s life. The CDC recommends that anyone at risk of an opioid overdose or who knows someone struggling with opioid use disorder should carry Naloxone and keep it at home. There is a bystander present in 40% of opioid and stimulant-involved overdose deaths. This points to a need to increase public training, access, and use of Naloxone.

Who is at Risk of Becoming Addicted to Opioids?

With high prescription numbers and opioids being so addictive, it is easy to see why so many people develop a dependency and abuse them. The National Center for Drug Abuse Statistics states that 3.8% of American adults abuse opioids.

Anyone prescribed an opioid is at risk of addiction; however, some groups in society are more at risk than others. Risk factors for opioid abuse identified by the U.S. Department of Labor include:

High dose: Those who have been prescribed a higher dose or a more potent opioid due to intense pain following an injury or operation are at higher risk for misuse and overdose death.
Prolonged duration: Addiction to opioids can develop within a few days, and one in four people taking opioids long-term struggle with addiction. The American Society of Addiction Medicine published a guide called the National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. It is designed to provide doctors with information about the practical and responsible prescribing of opioids to reduce the chance of addiction.
Extended-acting formulations: There is a greater risk of overdose and death with long-acting opioids such as morphine.
History of alcohol or substance abuse: People with a history of addiction to other substances are more likely to become addicted to opioids. This should be taken into account when opioids are prescribed.
Younger adults (18-25 years): Young people are at higher risk due to a family history of drug taking, childhood trauma, or a social or family environment that encourages misuse.
Mental health concerns: People with depression, anxiety, bipolar disorder, or other mental illnesses are more at risk of developing an addiction. People use opioids for the euphoric effect to counteract the symptoms of their mental health condition.

How Do You Know if Someone Has an Opioid Addiction?

According to data, some signs of opioid addiction to look out for include:

Continued use despite detrimental effect on health: Someone with an opioid addiction will likely be experiencing side effects and withdrawal symptoms associated with their dependency, including constipation, nausea, and mood swings, but, despite this, they are unable to stop taking the drug.
Impact on relationships: When someone has a drug addiction, they may distance themselves from friends and family members due to fear of being judged or feeling shame.
Decreased social activities and declining performance at work or school: Opioid use disorder can cause a person to lose interest in or the ability to gain pleasure from things that they previously enjoyed. They have developed intense cravings and become fixated on sourcing and using more opioids. They may also suffer from unpleasant withdrawal symptoms and cannot concentrate on anything else.
Taking increasing doses of opioids: When someone uses opioids long-term, they develop a tolerance to their effects, meaning they need to take more of the drug to have the same effect.
Multiple opioid prescriptions from different clinicians: “Doctor shopping” is a common sign that someone is addicted to opioids. As most opioids require a prescription and their use is monitored, people who are addicted will often seek out multiple doctors to get multiple prescriptions for the same opioid.

Opioid Withdrawal Symptoms

The time it takes for the withdrawal symptoms to start following the last dose depends on the opioid. For short-acting opioids like heroin, withdrawal symptoms can start within 8-24 hours and last for 4-10 days. For methadone and other long-acting opioids, withdrawal symptoms start within 12-24 hours and last for 10-20 days.

The symptoms of opioid withdrawal include:

Nausea and vomiting
Anxiety
Insomnia
Hot and cold flushes
Perspiration
Muscle cramps
Watery discharge from eyes and nose
Diarrhea

Opioid Addiction Treatment

Addiction treatment plans for opioid addiction are tailored to the patient’s circumstances, how long they have been using the substance or substances, which opioids they depend on, and whether they have co-occurring conditions. A medical practitioner should oversee the process to manage withdrawal symptoms safely and increase the chance of long-term success. Possible treatment options for those with Opioid Use Disorder include:

Detoxification: Medical detox is often proposed if someone has a severe addiction and is likely to suffer from extreme withdrawal symptoms. Under the care of medical professionals, users are monitored in a residential center to ensure that withdrawal from opioids is as safe and comfortable as possible.
Medication: When opioid withdrawal signs are present, pharmacological management is needed. Effective medications for the long-term maintenance treatment of opioid addiction include buprenorphine (Suboxone), methadone, and naltrexone (Vivitrol). These medications are opioid agonists and work to diminish the effects of opioids and reduce dependency. They are often used during the process of tapering the user off opioids. Rather than going “cold turkey” and risking severe withdrawal symptoms and relapse, the dosage of the opioid drug is reduced over time and replaced with opioid agonists.
Medication-Assisted Treatment (MAT): Medications should be combined with behavioral counseling for a “whole patient” approach. MAT decreases opioid use and opioid death and increases social functioning and retention in treatment. Behavioral counseling can occur in inpatient or outpatient treatment facilities. Examples of treatment plans focused on behavioral health include individual therapy incorporating Cognitive Behavioral Therapy (CBT). CBT seeks to understand why someone is addicted to opioids and find coping mechanisms to overcome it. Group therapy and peer support groups provide support from people in similar circumstances, which can help ensure that a patient feels understood and motivated to commit to sobriety.
Holistic therapies: Behavioral treatments are sometimes complemented with holistic therapies such as meditation, yoga, and mindfulness. These techniques are designed to give patients a sense of calm and control over their lives.

Opioids in all forms, prescription and illegal, are used by many people worldwide, but they are not risk-free. Many people develop an addiction, and the risk of overdose is high and should not be ignored. It is essential that patients take their medication as prescribed by their doctor and that use is only for a limited period. If opioid addiction develops, many opioid treatment programs are available to suit all circumstances.

The most important thing you can do is seek trustworthy advice and guidance to find the best treatment for you. It is possible to overcome opioid addiction and reduce your chance of long-term harm or overdose. The first step on your road to recovery is to make a call to a trusted advisor today.

Opiate Addiction