Opiate Addiction


Opiates are a class of substances that includes illicit drugs like heroin as well as several synthetic prescription opioids such as oxycodone and hydrocodone. Prescription opioids are commonly prescribed to relieve pain though some, including codeine, may also be used to manage coughs.

Opiates work by binding to and activating opioid receptors throughout the brain and body. One of the effects of this receptor activation is a change in the perception of pain. Since opiates also impact certain neural processes within the reward centers of the brain, some users experience an intense, rewarding euphoria when taking them at high enough doses.1

Some people who misuse opiates to get high may attempt to intensify the euphoria by taking them in ways other than as prescribed. For example, OxyContin is an extended-release opioid intended for the treatment of moderate to severe pain by steadily releasing opiates into the body after being taken orally, however people who abuse it may crush the pill to bypass the timed release mechanism and inject or snort it instead. Other methods of misuse involve combining opioids with alcohol or other drugs to amplify the subjective high.2

In the 2018 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that roughly 10 million Americans had misused prescription painkillers within the past year, with hydrocodone and oxycodone products at the top of that list.3 Prescription opioid misuse was the second most common form of illicit drug use that year, second only to marijuana.

Also in 2018, an estimated 2 million people above the age of 12 had an opioid use disorder,3 a diagnostic term commonly used for people who struggle with any type of opioid addiction, whether it involves heroin or prescription pain medications. The consequences of opiate abuse and untreated opioid addiction can be devastating, but it’s never too late to encourage a loved one to seek help for their addiction.

From Dependence to Addiction

Though there are additional diagnostic criteria for substance use disorders, addictions often have an element of physical dependence as a characteristic feature, which can develop when the body is chronically exposed to a drug. In situations where opioids are taken according to a prescription, a doctor will be careful to monitor their patients for any significant dependence development and, when the time comes, gradually adjust down their dose to prevent the arrival of severe withdrawal symptoms. Once someone starts abusing drugs—or using them nonmedically—they may no longer be taking them at the recommended dosage or via the proper route of administration. Dependence can build swiftly, unmanaged withdrawal may become a recurrent issue, and the situation may become largely out of the doctor’s control.

Though some people may be more susceptible to developing an addiction than others, addiction is ultimately an illness that can develop in nearly anyone under certain circumstances. For instance, a cycle of compulsive opioid misuse may become perpetuated when any individual reaches a point where they will experience uncomfortable withdrawal symptoms if they stop taking them. Making matters potentially worse, because tolerance has built up, they must take larger and larger doses every time if they want to merely stave off withdrawal.

Potential Effects of Opiate Addiction

The signs, symptoms, and characteristic behavioral changes associated with individual cases of opiate addiction will vary. Similarly, the precise impact that an untreated addiction has on someone’s life will depend on a number of variables, but many people will be at increased risk for several types of deleterious outcomes. Some of these potentially adverse consequences of opioid addiction include:5,6

  • A decline in social and interpersonal relationships.
  • Difficulty meeting schoolwork obligations.
  • Problems with job performance or loss of a job.
  • Debt from increased substance-related spending or loss of income.
  • Decreased time for previously enjoyed recreational activities.
  • Increased risk of disease contraction or other drug-related physical health issues. (e.g., HIV, tuberculosis, viral hepatitis, endocarditis, skin and soft tissue infections).
  • Intoxication-related injuries.
  • Increased risk of opioid-related respiratory depression and overdose death.

It might seem overwhelming, but if you or a loved one is struggling with an addiction to opioids, there are ways to treat it. Call 972-848-0221 to speak with a Greenhouse admissions navigator for more information about your treatment options.

Many of the aforementioned consequences of compulsive or problematic opioid use are, in fact, elements of the very criteria used to make the diagnosis of an opioid use disorder, or opioid addiction. Other diagnostic criteria include:5

  • A persistent desire and/or unsuccessful efforts to decrease or otherwise control one’s opioid use.
  • Strong opioid cravings.
  • Tolerance, or a need for increasing amounts of opioid drugs to achieve a desired level of intoxication.
  • The onset of acute opioid withdrawal when use slows or stops; or, the need to continue use to prevent the onset of opioid withdrawal symptoms.

Withdrawing from Opiates

Recovery requires a person to stop using the abused opioid in question, which often means experiencing some degree of opioid withdrawal. People who have consistently used opioid drugs eventually develop physiological dependence on them; opioid dependence increases the likelihood of a potentially uncomfortable withdrawal experience at the point that a person stops using. Going through withdrawal can be challenging and scary, but it is important to remember that medical detox can help stabilize a person in withdrawal, and make this inevitable hurdle to recovery much more comfortable and bearable.

Some of the earliest symptoms of opioid withdrawal include:4

  • Insomnia.
  • Anxiety.
  • Agitation.
  • Muscle aches and pains.
  • Sweating.
  • Increasing tearing and runny nose.
  • Yawning.

The precise duration and intensity of withdrawal will vary among individuals and will be influenced by the type of opioid having been used; in some cases, the characteristic withdrawal symptoms may change over the course of a somewhat stepwise progression.

As an example, some of the later-stage symptoms of opioid withdrawal may include:4

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

Though opioid withdrawal can be intensely unpleasant, it is seldom life-threatening; with the right withdrawal management care in place, many progress comfortably through this earliest stage of treatment and come out on the other side re-invigorated and ready to begin additional recovery efforts.

As part of medical treatment for opioid use disorder, physician staff may administer opioid agonist medications like methadone and buprenorphine to stabilize people in withdrawal and maintain them through longer-term recovery. Clonidine may additionally be used to manage opioid withdrawal symptoms, as well as other adjunctive pharmacotherapies for better management of symptoms such as insomnia, body aches and pains, and headache.7,8 At some point after being stabilized on an opioid agonist regimen, the choice may be made to then taper the recovering individual off the maintenance drugs in a slow, controlled manner, though many people remain on maintenance therapy for longer periods of time.

Treatment Options

No single treatment option will be the right fit for everyone; however, some inclusion of pharmacotherapy (i.e., medication treatment) is widely recognized as the standard of care for long term management of opioid use disorders. As discussed, this often starts with medical detox and opioid withdrawal management. Attempts to manage the acute opioid withdrawal syndrome without medications is increasingly recognized as having the potential to result in needless suffering for those in early recovery.8

As important an element of treatment as they are, comprehensive treatment for opioid addiction does not stop with medications alone. As part of an ongoing medication-assisted treatment strategy, several behavioral treatment modalities have helped many people find continued recovery success after their withdrawal symptoms have subsided.9,10

Behavioral therapeutic interventions used during addiction treatment include cognitive behavioral therapy, motivational interviewing, and contingency management. Different behavioral approaches are commonly utilized in both individual and group counseling or therapy sessions.9 One benefit of such treatment in a group setting is that recovering individuals are able to interact with others who have experienced many of the same symptoms and struggles that they have, which allows them to draw upon the collective wisdom and experiences of their peers.

Treatment for substance use disorders may take place on an inpatient or outpatient basis, depending on patient needs. Many people find inpatient rehabilitation effective because it provides them with a safe environment in which they can tackle their addiction directly without worrying about the outside world or having to face situations that led them to misuse drugs in the first place. During inpatient or residential treatment and outpatient programs, patients take part in several different types of therapy to identify why they became addicted and how they can prevent relapsing in the future.

Many effective rehabilitation programs encourage family members to aid in recovery as well, and offer family therapy sessions and other programs that incorporate loved ones. Addiction’s impact is often felt family-wide, and it’s a struggle that no one should have to fight alone if they have support systems available to them.

References

  1. National Institute on Drug Abuse. (2020). Drugs of Abuse—Opioids.
  2. National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs—What classes of prescription drugs are commonly misused.
  3. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
  4. U.S. National Library of Medicine (2018). Opiate and opioid withdrawal.
  5. Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  6. Substance Abuse and Mental Health Services Administration. (2005). Treatment Improvement Protocol (TIP) Series, No. 43. Chapter 10: Associated Medical Problems in Patients Who Are Opioid Addicted.
  7. National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs—Medications for Opioid Use Disorder.
  8. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
  9. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction.
  10. National Institute on Drug Abuse. (2016). Effective Treatments for Opioid Addiction.


About The Contributor

Scot Thomas, M.D.
Scot Thomas, M.D.

Senior Medical Editor, American Addiction Centers

Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More


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