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There are two kinds of opioids: prescription drugs used for pain relief such as oxycodone (Oxycontin), hydrocodone, fentanyl, and tramadol, and illicit drugs like heroin that are sold illegally. Both can be misused and result in addiction. Opiates derived from the opium poppy include morphine, codeine, heroin, and opium. There are also synthetic opioids, including hydrocodone, oxycodone, methadone, Vicodin, or Dilaudid (hydromorphone), all of which have similar effects. For the purposes of this article, we’ll use opioids as a blanket term to describe all types of these drugs.

Opioid drugs can be legitimately prescribed by a doctor for pain management after surgery or given to someone with cancer or dealing with chronic pain. In their street form, such as heroin, opioids can be used recreationally, too.

It is possible to safely take opioids by following the directions of the prescribing physician, never sharing the medication, and never taking more than the prescribed dosage. However, when used outside of a doctor’s orders or recreationally, opioids can be highly addictive.

How Opioids Affect the Body

The body naturally produces its own opioids to decrease some pain, lower a person’s breathing rate, and even reduce depression and anxiety. But the body doesn’t make enough of these chemicals to handle more severe pain, like a broken bone, or enough to result in an overdose.

Opioid drugs help block pain in the body by affecting nerve cells in the brain and body, specifically opioid receptors on nerve cells. In addition to blocking the perception of pain, opioids can also create a sense of euphoria or well-being. This is what gives the drug their “high.” Over time, the body develops a tolerance to opioids and requires higher doses to create the same level of pain management. This can occur whether an individual is taking opioids for medicinal purposes or recreationally and can often cause them to take higher doses, sometimes dangerously so.

Opioid Abuse Statistics

According to the Centers for Disease Control and Prevention (CDC), between 1999 and 2019, about 450,000 Americans died from opioid overdoses. This number includes both illegal opioids and those prescribed by a doctor.

In Massachusetts alone, more than 80% of drug overdoses in 2018 were linked to an opioid, most commonly prescription drugs or heroin. Deaths involving the powerful opioid painkiller fentanyl also increased in 2018.

As a result of the misuse of prescription opioids, doctors have reduced the rate at which they prescribe opioids in recent years. From 2006 to 2017, the prescription rate of opioids declined by 19%, according to the CDC. Unfortunately, that still translated to approximately 58 opioid prescriptions written for every 100 Americans in 2017.

Despite the attention paid to opioid abuse, the overdose numbers are still discouraging. In 2019, The Lancet shared that “reported deaths from drug overdose in the USA reached an all-time high of almost 72,000, with opioids involved in more than two-thirds of the total deaths.” The numbers showed no improvement in the first half of 2020 either, with drug overdose deaths estimated to have risen on average 13% higher when compared with the previous time period in 2019. In some states, The Lancet found that the number was almost double that, or an approximately 30% increase.

Avoiding Opioid Addiction

What then, should someone ask their doctor if they have been or will be prescribed opioids to help them ensure that they take the medications safely and to reduce their risk of developing an addiction? Start by asking if opioids are the right choice for you or if there is another option for your pain management. If the doctor feels that an opioid prescription is the best option, the next step in the conversation is to find out how long you should take the prescription. Other questions to ask include:

  • How can the side effects of opioids be reduced?
  • Can I take a smaller dosage?
  • What about other medications I’m taking? Will opioids react with those?
  • When and how should I taper off my opioid use?
  • Where should I store my opioids?
  • If some of the prescription is unused, how should I dispose of the remaining opioids?

Opioid prescriptions should never be shared with anyone else. Only the person prescribed the medication should take them and only in the dosage recommended by the doctor. If the person prescribed the opioids has a history of substance abuse, or if anyone in their family has a history, the health care provider should know this before prescribing the opioids to address the risks involved with these issues.

Finally, discuss with the physician if a prescription for naloxone also makes sense. Naloxone is a drug used to reverse the effects of an opioid overdose should misuse occur.

Remember: this isn’t medical advice. If you have any specific questions about your opioid use, please consult a medical professional.

Side Effects of Opioid Use

There are both short-term and long-term effects of opioid use. Some of the common short-term effects include:

  • Drowsiness
  • Mental fog
  • Nausea
  • Dizziness
  • Constipation

Individuals who take opioids regularly also run the risk of developing a tolerance, which requires them to take a higher dose to reach the same effects, a condition that often results in addiction.

Opioids may also cause breathing to slow, which can lead to coma or death. When breathing slows, individuals can develop a condition known as hypoxia, in which too little oxygen reaches the brain. This can cause both short- and long-term damage. Some of the psychological and neurological effects of hypoxia include coma, permanent brain damage, or death.

Researchers do not yet fully understand the long-term effects of opioid addiction on the brain, and they must conduct more studies to determine if this damage can be reversed.

There is also a risk to individuals taking multiple medications when they begin an opioid prescription. Interactions between the opioid and other prescriptions are possible, in addition to a slowed metabolism, which can impact how medications are broken down by the body. All of this can lead to potential misuse or abuse of the prescribed opioid.

Risk Factors for Opioid Abuse

Taking any opioid in a method other than how it was prescribed increases a person’s odds of developing an addiction. For example, individuals may crush an opioid pill in order to snort or inject it. Ingesting opioids in this way is also highly dangerous because it increases the chance of overdose, particularly if the pill is a long- or extended-acting formulation.

A person’s addiction risk is also elevated when they don’t follow the appropriate dosage of a prescription, either by taking the opioid in a higher amount or more frequently than what the doctor prescribed. Also, the risk of addiction goes up the longer someone takes opioids. There are also genetic, psychological, and environmental factors that put some people at a higher risk of developing an opioid addiction than others.

Some of the common risk factors that increase an individual’s risk of opioid misuse or abuse are:

  • Poverty
  • Unemployment
  • Family history of substance abuse
  • Personal history of substance abuse
  • Age
  • History of criminal activity or legal problems including DUIs
  • Regular contact with high-risk people or high-risk environments
  • Problems with past employers, family members, and friends
  • History of mental illness
  • Risk-taking or thrill-seeking behavior
  • Heavy tobacco use
  • History of severe depression or anxiety
  • Stressful circumstances
  • Prior drug or alcohol rehabilitation (relapse)

Additionally, women may be at a higher risk of developing an opioid addiction due to their increased odds of suffering from chronic pain. There are also biological factors that increase a woman’s odds of opioid abuse. Finally, it is more common for women to be given opioid prescriptions than men, and these prescriptions are often for higher doses and for longer periods of time, according to the Mayo Clinic.

Signs and Symptoms of Opioid Addiction

There are some common signs that indicate someone may be addicted to opioids. These include:

  • Changing their friend group or spending time with new and different groups of people
  • Avoiding loved ones and spending more and more time alone
  • Losing interest in activities they previously enjoyed
  • Stopping personal hygiene such as bathing, changing clothes, or brushing their teeth
  • Being very tired and sad
  • Eating more or less than usual
  • Acting overly energetic, talking fast, and saying things that don’t make sense
  • Being nervous or cranky
  • Having moods that change quickly
  • Sleeping at odd hours
  • Missing important appointments
  • Getting into trouble with the law
  • Attending work or school on an erratic schedule
  • Experiencing financial hardship

Signs of an Overdose

If you suspect a loved one is addicted to opioids, but they have not sought opioid treatment, it is a good idea to know the signs of opioid overdose and to have a plan to help. Signs someone has overdosed include:

  • Slow, shallow breathing
  • Extreme sleepiness
  • Inability to talk
  • Blue skin color and dark-colored lips
  • Snoring or gurgling sounds

If you suspect a person has overdosed, first shout or lightly tap or shake the person to get a response. If there is no response, rub your knuckles on the person’s breastbone. Keep the person awake if they respond to any of these efforts and call 911.

In the event that the person is unresponsive after shouting or tapping, call 911. If you have a prescription for naloxone, follow the instructions to administer that medication. Naloxone is an injection or nasal spray that can rapidly reverse the effects of an opioid overdose. It is sold under the brand name Narcan.

Should the person’s breathing be shallow or nonexistent, or if their skin is blue or lips dark, perform mouth-to-mouth rescue breathing. This is done by tilting the head back and lifting up the chin until the mouth opens, clearing the airway. Give two quick breaths to start and then a strong breath every 5 seconds.

If the person does not have a pulse or is not breathing, perform CPR. Push down repeatedly on the chest at a rate of 100 times per minute. Deliver rescue breaths after every 30 compressions.

While you wait for emergency responders to arrive, stay with the person who has overdosed. If for any reason you must leave the person, put them on their side, with the opposite hand supporting the head, mouth facing to the side and down, and their top leg on the floor to keep the person from rolling onto their stomach. This is known as the recovery position. They should also be put in this position if they have vomited to help avoid aspirating any vomit into the lungs.

Opioid Withdrawal Symptoms

Because of the way opioids affect the brain, over time individuals require more and more of the drug to reach the same impact. As a result, there are very real, and sometimes dangerous, physical withdrawal symptoms that someone will experience when they decide to stop taking opioids. These withdrawal symptoms happen in several stages. Early symptoms, which can happen within 24 hours of stopping the use of opioids, include:

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased tearing
  • Insomnia
  • Runny nose
  • Sweating
  • Yawning

While later withdrawal symptoms someone may experience include:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • Nausea
  • Vomiting

The symptoms are not comfortable, but typically they are not life threatening. Most symptoms start to diminish within 72 hours. After a week, individuals in recovery should experience a noticeable reduction in withdrawal symptoms. But different forms of opioids will leave the body at different rates, and how each person experiences withdrawal will be different as well.

Individuals should not attempt withdrawal from opioid misuse on their own because of an increased risk of issues such as aspiration and severe dehydration. Aspiration occurs when someone vomits and inhales their stomach contents. If this happens, the lungs can become infected or they can choke. Additionally, the vomiting and diarrhea that accompany the later stages of withdrawal can result in dehydration and chemical and mineral imbalances in the body.

Going through withdrawal treatment under the care of health care professionals can help the individual manage their symptoms better while also offering them a better chance of long-term success in staying off opioids.

Finally, the biggest concern for someone after detoxing from opioid addiction is a return to their previous use, which can lead to overdose. After stopping opioids, the body’s tolerance changes and even taking a much smaller dose of the drug than they previously consumed can result in an overdose.

Prevention of Opioid Abuse

When it comes to preventing opioid abuse, doctors, pharmacists, and patients all play an important role in curbing this tragic epidemic.

For doctors and health care providers, preventing opioid abuse begins by asking patients about all the medications they are taking. This can help identify when they may be developing a problem with drug misuse. Physicians should also pay attention to any rapid increase in their patients’ use of opioids or unscheduled requests for refills. Both may indicate opioid abuse. There is also the practice of “doctor shopping” by patients in order to find multiple providers who will supply prescriptions for opioids, which is a common sign of opioid abuse.

State-run electronic databases, also known as prescription drug monitoring programs (PDMPs), can be used to track the prescribing and dispensing of controlled prescription drugs, such as opioids, to patients. These can be important tools for pharmacists in helping to prevent and identify opioid misuse. The research on the effectiveness of these PDMPs is inconclusive currently, but some states have indicated a lower rate of opioid prescriptions and overdoses since their institution. Pharmacists can help patients who have been prescribed opioids understand the instructions for correctly taking the medication, as well as answer any other questions about the prescription, including potential interactions with their other medications.

The federal government launched a program in 2015 to reduce opioid misuse and abuse. Included in these efforts was the publication of the CDC’s Guideline for Prescribing Opioids for Chronic Pain. The guidelines define clinical standards for health care providers to help balance the benefits and risks of opioid treatment.

Finally, patients who have been prescribed opioids can be sure to follow the instructions for how to properly take the medication. Be aware of potential interactions between the prescription opioid and other medications and drugs, including alcohol. Talk to a doctor before stopping or changing the dosage of the opioid prescription. And never take someone else’s opioid prescription or share a prescription.

Treatment for Opioid Abuse

Addiction treatment provides a person dealing with opioid abuse additional training, support, and resources to handle the risks of withdrawal and cravings, particularly in the long term, to avoid relapse. There are two main types of treatment: residential and outpatient.

Residential treatment is particularly effective for individuals who are recovering for the first time or who have recently relapsed. At Meta, we specialize in outpatient treatment, which provides our clients with high-quality treatment on a more flexible schedule. Outpatient treatment is ideal for individuals who have completed a residential treatment program, need additional support in their recovery, or have less severe addiction concerns.

Both types of treatment incorporate behavioral counseling as a key component of their programs. There are three main types of counseling: individual, group, and family.

Depending on the treatment program, they may use different forms of individual counseling. At Meta, we specialize in Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT), two forms of therapy that aim to change thinking patterns, particularly negative ones. These practices teach the individual new patterns of behavior as well as coping skills to manage stress and any triggers that may lead to relapse.

Other treatment programs may use methods like motivational enhancement therapy and contingency management therapy. The first is centered on creating internal motivation for the individual to stay on their treatment path. The latter is focused on providing external incentives to the person in treatment to continue to make positive progress.

At Meta, we also incorporate group counseling for our clients. Counseling in a group setting can be helpful in showing the person dealing with opioid abuse that they are not alone. This type of therapy provides a forum to interact with others experiencing the same struggles and to learn from their successes. It is a good way to learn how others handled difficulty on their path to sobriety, as well as share strategies about how to address future concerns.

Finally, because opioid addiction affects not only the individual but their family and loved ones as well, we also offer family counseling. This form of counseling gives partners, spouses, children, and friends a chance to redevelop trust and repair relationships that have become strained while dealing with their loved one’s addiction.

No matter the form of therapy, the end goal will be to help individuals change their attitudes and behaviors that led to drug abuse. Therapy and counseling should give individuals the ability to develop new and healthier life skills, as well as the encouragement to continue with any of their other treatments.

Medications to Treat Opioid Abuse

Some treatment programs also prescribe medication on a limited basis to assist clients with their opioid recovery. It’s important to note that medications cannot “fix” an addiction — only long-term behavior change can do so. Medications can, however, help individuals manage difficult aspects of recovery.

Two medications, methadone and buprenorphine, are most commonly prescribed to help with the symptoms of withdrawal that occur when someone is trying to stop misusing opioids. Both interact with the same parts of the brain that opioids do, but neither gives the user the same “high” as opioids. Instead, both medications help the person by giving the brain time to recover from the damage that opioids have caused.

Some physicians also prescribe a combination of buprenorphine and naloxone, the drug used to treat opioid overdose, that can be helpful.

Other treatment providers may prescribe Naltrexone. Instead of blocking the symptoms of withdrawal or the cravings for opioids, Naltrexone does not allow the person taking an opioid to experience a high. This is only prescribed after someone has already stopped taking opioids for at least seven days. It is not an option for someone who is trying to stop opioid misuse, but it can be helpful in preventing a relapse.

If you are concerned that you or someone you know may be abusing opioids, Meta can help. We provide flexible outpatient opioid treatment programs designed to work around your schedule and needs. If you or a loved one are struggling with opioid addiction in the greater Boston area, contact us today to get started on your recovery.