Opiates are a synthetic drug that doctors typically prescribe to relieve pain. According to the National Institute on Drug Abuse (NIDA), popular opiates include hydrocodone, oxycodone, morphine, and codeine. Hydrocodone products are the most commonly prescribed opiate to treat pain related to injuries. Doctors often prescribe morphine before and after surgery to alleviate severe pain, while codeine is used to treat mild pain and found in many prescription-strength cough medicines.
Opiates work by attaching to opioid receptors in the brain and spinal cord, and minimizing the body’s perception of pain. Since opiates affect the reward centers of the brain, some users experience intense euphoria when taking them. People who abuse opiates will attempt to intensify the euphoria by taking them in ways other than as prescribed. For example, OxyContin is an oral medication that treats moderate to severe pain by steadily releasing opiates into the body, but people who abuse it may inject or snort it instead.
In the 2012 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), researchers found that an estimated 2.1 million Americans were suffering from a substance use disorder that involved prescription opioid pain relievers. The consequences of opiate abuse can be devastating, but it’s never too late to encourage a loved one to seek help for drug abuse.
From Dependence to Addiction
The road to addiction often starts with physical dependence, which occurs when the body undergoes chronic exposure to a drug. Doctors who prescribe opiates are careful to monitor their patients for any signs of a dependence developing; however, once someone starts abusing drugs, they are no longer taking them in the recommended dosage or delivery system, and the situation is 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 affect anyone under certain circumstances. As with many drugs, an addiction to opiates develops when individuals reach a point where they will experience uncomfortable withdrawal symptoms if they stop taking them, so they continue to do so even if the condition that prompted them to take opiates in the first place is no longer present. Because their bodies have built up a tolerance to the drug, they must take larger and larger doses every time if they want to get the same sensation of euphoria.
Addiction is dangerous because misjudging a dosage or the body’s tolerance level can lead to overdosing, which can have devastating consequences. According to the Centers for Disease Control and Prevention (CDC) and NIDA, the number of fatal overdoses that involved prescription opioids increased nearly 400 percent between 2001 and 2014, from approximately 5,000 in 2001 to slightly less than 20,000 in 2014. The CDC reports that men are more likely to die of an overdose of prescription painkillers, but women are more likely to have chronic pain and subsequently be prescribed pain relievers, which they take in higher doses and for longer periods of time than men. Though women may become dependent on opiates more quickly than men, anyone can ultimately develop an addiction.
Effects of an Opiate Addiction
The signs of an opiate addiction will vary among individuals, but there are a few general ones that become harder to hide as the addiction grows stronger. According to NIDA, someone who is addicted to opiates will seek them compulsively despite any negative consequences of doing so. Consequences of addiction include:
- Physical illnesses
- Serious injuries
- Problems maintaining healthy personal relationships
It is hard to confront a loved one who is addicted to opiates because people who are addicted often believe they can stop anytime they want, when in reality they cannot do so without professional help. Support from family and friends is critical when it comes to getting an individual to seek help.
Those who are addicted to opiates might put up a fight when it comes to entering treatment; however, it is essential that they get help as soon as possible because chronic opiate abuse can have devastating long-term effects on the body. The National Institutes of Health confirms that researchers have found a link between opiate overdose and depressed respiration, or slowed breathing, which reduces the amount of oxygen the brain receives. This condition is called hypoxia, and it can have long-term neurological and psychological effects, including permanent brain damage and coma.
The longer an individual abuses opiates, the worse the physical impact can be. According to SAMHSA, there are also a few infectious diseases that are prevalent among opiate users, including HIV, tuberculosis, and viral hepatitis. It might seem overwhelming, but if a loved one appears to be struggling with an addiction to opiates, there are ways to treat it.
Withdrawing from Opiates
The first step of recovery is to stop using, which means undergoing opiate withdrawal via medical detox. People who abuse opiates eventually develop a dependence on them, which means they will experience some uncomfortable symptoms once they stop using. Going through withdrawal might sound scary, but it is important to remember that an experienced healthcare team can manage even the worst of symptoms for their clients.
Some of the earliest symptoms of opiate withdrawal include:
- Excessive yawning
- Muscle aches and pains
- Increasing tearing and runny nose
The precise duration and intensity of withdrawal will vary among individuals, but most people experience withdrawal in stages. According to the US National Library of Medicine, later symptoms of opiate withdrawal include:
- Abdominal cramping
- Dilated pupils
Though the symptoms can be painful, they are not life-threatening, and with the right care in place, anyone can come out on the other side healthy, invigorated, and ready to tackle sobriety. Going through withdrawal at home is incredibly challenging and can be dangerous because complications could arise. In a treatment facility, clients have access to drugs like methadone, clonidine, and buprenorphine, a partial opioid agonist according to NIDA, which can help ease the most painful withdrawal symptoms. Once clients have completed the medical detox phase, doctors can then taper them off the maintenance drugs in a safe and healthy way.
Though withdrawal is different for everyone, it often follows a general timeline. On average, symptoms appear within 6-48 hours of the last dose and continue for one week or more. The most uncomfortable symptoms usually peak around the second or third day and start subsiding after one week. A rough timeline of opiate withdrawal symptoms looks like this:
- First 48 hours: Symptoms will typically arise within the first two days of the last dose. Many people experience aches in their muscles, bones, or joints. At this phase of detox, it is also common to experience sweating, abdominal cramping, and nausea.
- Days 3-5: As the body starts adjusting to life without opiates, the severity of withdrawal symptoms peaks. By day three, the body usually starts to dispel toxins through diarrhea, vomiting, and excessive sweating. Some people also experience lingering muscle aches or the shakes.
- Days 6-7: Most of the physical symptoms subside by the seventh day, leaving people to tackle the psychological symptoms of withdrawal. One week after the last dose, it is common to experience anxiety, depression, and a strong desire to use again, which is why an inpatient rehabilitation program can be so effective. Since clients do not have access to the drug, they cannot undo all their progress by using again no matter how badly they are craving it. At this stage, people also tend to start feeling remorse for the things they said and did while they were using, and they can benefit from professional and peer support and encouragement.
- Day 8 and beyond: Depending on the individual and the extent of the addiction, psychological symptoms may linger for weeks after stopping use.
If individuals are on a replacement medication, the withdrawal timeline will, of course, be prolonged; however, symptoms will be significantly mitigated. According to SAMHSA, some chronic symptoms may even persist for months as part of protracted withdrawal. Protracted withdrawal is the occurrence of signs and symptoms directly related to the addiction that persist after the generally expected timeline. The most common protracted withdrawal symptoms for those who have quit opiates are anxiety, depression, trouble sleeping, fatigue, and irritability.
No single treatment option works for everyone; however, all treatments for opiate addiction must begin with medical detox. Following medical detox, there are a number of treatment modalities that people have found success with after their withdrawal symptoms have subsided.
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 using in the first place. During inpatient or residential treatment and outpatient programs, clients take part in several different types of therapy to identify why they became addicted and how they can prevent relapsing in the future.
Motivational Interviewing (MI) is one counseling style that attempts to elicit behavioral changes by encouraging clients to explore and resolve their own ambivalence. The concept evolved from the process of treating alcoholism, and MI is now used to treat all kinds of addictions. According to a study originally published in The British Journal of General Practice, it has a significant and clinically relevant effect on recovery and general health following an addiction.
Other forms of therapy that are used during addiction treatment include Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, Rational Emotive Behavior Therapy, expressive art therapy, and Solution-Focused Therapy. Clients attend both individual and group therapy sessions, where they will be able to interact with others who are experiencing many of the same symptoms and struggles that they are.
The most 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 is a disease, and it’s not one that anyone should have to fight alone. Family members can encourage recovery by avoiding blame and instead focusing on the road to sobriety and how things can only get better.