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Opioids make up a class of drugs that bind to opioid receptors in the brain, blocking pain sensations and inducing relaxation as central nervous system depressants. There are many prescription opioids that are dispensed as pain relievers, such as OxyContin (oxycodone), Vicodin (hydrocodone/acetaminophen), and fentanyl.

Most prescription opiates are categorized as Schedule II controlled substances by the Drug Enforcement Administration (DEA) as they are considered to be highly addictive with a high potential for misuse and abuse. Heroin is an illegal Schedule I opiate that is a recreational drug of abuse.

Opioid drugs can create a surge of pleasure by increasing the level of dopamine present in the brain. Dopamine is a neurotransmitter, or chemical messenger, that the brain makes and uses to regulate emotions. It is also involved in thinking and memory formation, movement abilities, and sleep functions.

Recreational use of opioid drugs can cause a mellow high that may encourage people to keep using them. In 2016, the National Survey on Drug Use and Health (NSDUH) publishes that close to 12.5 million Americans aged 12 and older abused an opioid drug, including both heroin and prescription painkillers.

Heroin abuse is on the rise. According to the Centers for Disease Control and Prevention (CDC), abuse of the powerful opiate has risen among virtually all demographics in the United States. When it comes to prescription opioids, the NSDUH Data Report states that these pharmaceutical products are the most commonly abused type of prescription medications in America. The American Society of Addiction Medicine (ASAM) publishes that more than 2.5 million Americans struggled with addiction involving an opioid drug in 2016.

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Recognizing Opioid Use and Spotting Abuse

When someone takes an opioid drug, it slows down some of the autonomic functions of the central nervous system. This means that things like breathing, heart rate, temperature, and blood pressure are all lowered. A person is liable to feel mellow, relaxed, and free from pain. Drowsiness and an impaired mental state are additional side effects of opioid use.

Abuse of an opioid drug, which includes nonmedical use of a prescription drug or any use of an illegal opiate such as heroin, can lead to opioid intoxication, which can be similar to the feeling of getting drunk. Slurred speech, delayed reflexes, impaired motor control and coordination, decreased inhibitions, and trouble thinking clearly and behaving rationally can all be signs of opioid abuse.

A person is more prone to take bigger risks and not think through possible consequences when under the influence of an opioid drug. Accidents, injuries, engaging in unsafe sex, partaking in criminal behaviors, and acting in a manner that may be out of character and erratic can also be indicators of opioid drug use and abuse.

Itching and skin irritation, the appearance of “nodding off,” changes in sleep patterns that can include sleeping more frequently or at irregular times, appetite fluctuations and changes in weight, vision changes, clammy feet and hands, difficulties with short-term memory, and other cognitive issues can all point to opioid abuse.

With opioid drugs, abuse may begin with an authentic and medically necessary prescription for a painkiller. The abuse potential and addictive nature of these drugs often encourages people to misuse them. Signs of prescription opioid abuse to watch for include:

  • Taking the medication in between doses
  • Continuing to take a prescription after it is no longer medically necessary
  • Taking more than the prescribed amount at a time
  • Exaggerating or inventing symptoms to obtain more prescriptions
  • “Shopping” different doctors to get additional prescriptions
  • Altering the drugs and taking them in a manner that is not intended, such as crushing tablets to snort, smoke, or inject them

As prescription drugs have become more tightly regulated and controlled, it can be harder for people to obtain them through illicit channels for recreational use. This may be contributing to rising heroin abuse.

Illegal synthetic fentanyl is also being manufactured in clandestine labs and either used to “cut” and stretch out batches of heroin, or marketed on its own for abuse. The DEA warns that fentanyl is 50-100 times more powerful than morphine, can be absorbed through the skin on contact, and may be sold as counterfeit prescription painkillers. Abuse of both fentanyl and heroin is highly dangerous, as it can never be known exactly what is in the dose being taken. As a result, the risk for a possible life-threatening overdose is very high.

The National Institute on Drug Abuse (NIDA) publishes that over 115 people die from an opioid overdose in America every day. An opioid overdose occurs when levels of the drug overwhelm the body, causing a toxic buildup that it can’t break down. When this happens, respiration levels drop, which can make a person struggle to breathe or stop breathing altogether. Pulse and blood pressure also drop as does body temperature, making a person cold to the touch and creating a bluish tinge to the nailbeds, lips, and skin. Pinpoint pupils, an inability to stay awake or a loss of consciousness, and extreme mental confusion are additional symptoms of an opioid overdose.

An opioid overdose can be fatal. Immediate medical attention should be sought if one is suspected.

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Opioid Dependence, Withdrawal, and Addiction

a hand holding pills with bottle on table opened

Taking an opioid drug regularly, even with a medical reason and through a prescription, can cause a person to become tolerant to certain amounts of the medication. When this happens, dosage has to be increased to keep feeling the effects of the drug. With repeated use a dependence can form. Drug dependence means that the interaction of the opioid on brain chemicals, such as dopamine, has actually altered the brain’s ability to regulate and keep itself balanced on its own.

When the opioid drug wears off after a physical dependence has formed, dopamine levels can drop, leaving a person feeling drained, emotionally low, anxious, restless, and irritable. They may have trouble concentrating and suffer from physical flu-like withdrawal symptoms, including nausea, diarrhea, tremors, chills, sweats, vomiting, muscle aches, insomnia, back and joint pain, and dilated pupils. A person struggling with opioid dependence can suffer from drug cravings and difficulty feeling happy without the interaction of the drug.

Physical drug dependence, withdrawal symptoms, and drug tolerance are all warning signs of addiction. Addiction is more than just drug dependence, however. It is an actual brain disease that impacts behaviors as well as a person’s physical and mental state.

NIDA reports that for a diagnosis of addiction, the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, indicates that the person must suffer from at least two symptoms out of the following categories:

  1. Risky Use
  1. Social impairment
  1. Inability to control drug use
  1. Pharmacological factors

Risky use includes use of an opioid drug in situations that can be deemed physically hazardous and use of the drug even with the knowledge that using it is going to exacerbate or create physical, emotional, or social issues. Social impairment involves giving up things that may have previously been important and replacing them with time spent using drugs and shirking regular responsibilities related to things like family, work, and/or school. This can cause issues in interpersonal relationships, and individuals are likely to appear withdrawn and secretive. They may spend more time with others involved in drug use and less time with those not in this circle of influence.

As a behavioral disorder, addiction also means an inability to stop taking drugs even if there is a persistent desire and many attempts to do so. A person is liable to use more of the drug in a sitting and for longer periods of time than they intended to at the start. Large chunks of time are spent under the influence and intoxicated, coming down from opioids, and trying to determine where and how to get more of them. Cravings can be significant, and a person may use the drug even though they know it is at great personal risk. The pharmacological factors and signs of addiction include drug tolerance, withdrawal symptoms, and drug dependence.

Opioid addiction is multifaceted and individual. It will not be exactly the same for every person. Someone who takes more than one drug at a time may experience additional physical and emotional side effects and risk factors, for example. Individuals struggling with a co-occurring mental illness may struggle with more extreme mood swings, anxiety, and depression. Uncharacteristic and unpredictable behaviors, a shorter fuse than normal, significant emotional highs and lows, irregular sleeping and eating habits, changes in a person’s social circle, potential legal issues, and financial strain can all be possible signs of opioid abuse and addiction.

Opioid addiction is highly treatable. With medical detox and a complete addiction treatment program, families and individuals can heal and move toward balance in recovery.