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What Is Opioid Addiction?

David Hunter, MA.Ed, LPC

Medically reviewed by

David Hunter, MA.Ed, LPC

April 4, 2019

Opioids have become a prevalent issue in the United States today with many individuals abusing and becoming addicted to prescription opioids. But what is opioid addiction and how can you avoid it? Find out more below.

Type the phrase “opioid epidemic” in Google’s search bar and you get almost 600,000 results. To put this into perspective, if you take another category of drugs—central nervous system stimulants such as crack, cocaine, or methamphetamine, for example—and follow it with the word “epidemic,” the same search only nets a little more than 1,000 results.

So what makes this particular category of drugs so dangerous to our society as a whole, increasing to the point where it is labeled an epidemic? Answering this question begins with first recognizing which drugs are referred to as opioids and then gaining a clearer understanding of how they work or, more to the point, why they’re so addictive.

Opioids: What They Are and Their Common Street Names

According to the Drug Enforcement Administration Museum & Visitors Center, opioids are a category of drugs derived from the “milky fluid” taken from unripened opium poppy seed pods.

The DEA Museum goes on to explain that only three countries are currently allowed to legally grow opium for “medicinal use,” and they are India, Turkey, and Australia.

Some of the most commonly known and recognized opioids are heroin, codeine, morphine, oxycodone, and methadone. notes that opioids such as these have a variety of street names as well. These include:

  • Opium: Aunti Emma, Midnight Oil, Dover’s Powder, Chinese Molasses
  • Heroin: H, Smack, Skag, Horse
  • Hydrocodone (Lortab, Vicodin): Hydro, Vikes
  • Codeine (Robitussin): Captain Cody, Schoolboy, Doors & Fours, Syrup
  • Fentanyl: China Girl, Goodfella, Murder 8
  • Methadone: Fizzies, Chocolate Chip Cookies
  • Morphine: White Stuff, Miss Emma, Monkey, M
  • Meperidine (Demerol): Demmies
  • Oxymorphone: O Bomb, Biscuits, Stop Signs
  • Hydromorphone (Dilaudid): D, Dillies, Dust
  • Oxycodone (OxyContin, Percodan): Hillbilly Heroin, Percs, Ox, Oxycotton

Opioids vs. Opiates

While it’s rather common to hear the terms opioids and opiates used interchangeably, highlights that there is actually a difference between the two.

Opiates are “drugs naturally derived from the active narcotic components of the opium poppy”; whereas opioids are “modified versions of these opiate building blocks,” making them synthetic or semisynthetic in nature.

All opiates are opioids, but not all opioids are opiates. Whether natural, synthetic, or semisynthetic, they all work very similarly.

How Opioids Work

The National Institute on Drug Abuse (NIDA) describes opioids simply as “medications that relieve pain,” but the way they accomplish this goal is twofold.

First, opioids work because they lessen the strength of pain signals that are sent to the brain. If your brain doesn’t recognize that you’re in pain, neither will your body.

Second, opioids also impact the areas of the brain that aid in emotion control. So, in essence, they affect you by inhibiting the communication between your brain and your body, reducing the emotions commonly associated with experiencing pain.

How does use of these types of drugs, whether illegal or not, turn into an addiction, even if the original use was solely to relieve some type of pain?

Opioid Addiction is a Four-Step Process

In an article published by Addiction Science & Clinical Practice, two doctors from Yale University (Thomas R. Kosten, M.D., and Tony P. George, M.D.) share that opioids change the brain’s complex processes in a four-step process.

They define this as a transitional pattern that involves “drug liking,” which leads to increased tolerance and then dependence, ending with the individual developing an actual opioid addiction. Let’s look at each one briefly.

“Drug liking” occurs when your brain’s reward system is activated by the opioids. Put simply, you take the drug and discover that you like its pleasurable effects, so you keep on taking it. Your brain starts to become conditioned to associate the opioid with feeling good, making you crave it more, which is where tolerance comes into play.

Tolerance is an effect that occurs in many drug and alcohol abuse scenarios because, over time, it takes more and more of the drug to produce the desired effect. In this case, this leads to dependence on the opioids as your body compensates to the increased drug amount to the point where the only time you feel “normal” is when you’re taking the drug.

The final stage in the process is the development of an opioid addiction. In this phase, your brain actually changes in a way that further promotes continued opioid use. This is partially what makes opioid addiction so difficult to kick. However, there’s another factor to consider as well.

Opioid Withdrawal Avoidance

Doctors Kosten and George point out that another reason—and this is actually one of the major reasons people tend to continue to use opioids to the point where it’s abusive or addictive—is because they want to avoid the difficulties typically associated with opioid withdrawal.

Healthline breaks these up according to how soon after ceasing opioid use they begin. Within 24 hours of discontinuing opioids, Healthline says that it’s not uncommon to feel achy, restless, and anxious. You’ll also likely experience tearing of the eyes, excessive sweating, a runny nose, and, though you may frequently yawn, an inability to sleep.

After this initial 24-hour period, more intense and oftentimes scarier symptoms of withdrawal may develop. These include diarrhea, cramping, vomiting, blurry vision, a racing heart, and increased blood pressure. These secondary symptoms can continue for a few days before beginning to subside, finally offering the withdrawing opioid addict some relief.

While these symptoms can certainly be extremely unpleasant, in a post published by Psychology Today, addiction expert Adi Jaffe, Ph.D. states that opioid withdrawal cannot actually cause death “in the vast majority of cases.” This differs from those abstaining from other drugs such as alcohol and benzodiazepines, but the powerful nature of opioid addiction is shown in its statistics.

Addiction Statistics: An Opioid Epidemic

Over time, opioids have made a greater appearance in our society, to the point where many health and drug experts are calling it an epidemic. While it may be easy to try to pin the blame on the users, many suggest that doctors are contributing to this growing issue.

Case in point: The American Society of Addiction Medicine (ASAM) reports that in a one-year time frame (2012) 259 million opioids were prescribed. To help you better understand just how many prescriptions this is, the ASAM says that it is “more than enough to give every American adult their own bottle of pills.” Undoubtedly, this has at least partially led to the 1.9 million people in the U.S. currently struggling with a pain pill addiction.

More statistics provided by the ASAM indicate that drug overdose is the number-one cause of accidental deaths and “opioid addiction is driving this epidemic” The Centers for Disease Control and Prevention (CDC) expands on this by sharing that, when it comes to all of the drug overdoses combined, more than half involve some type of opioid. Furthermore, this number has increased fourfold within the last 20 years.

Heroin, an illegal and non-prescription opioid, can be especially addictive. The Foundation for a Drug-Free World gives a stern warning that “even a single dose of heroin can start a person on the road to addiction.” NIDA adds to this statement by explaining that roughly one out of four people who use this drug develop a dependence.

Efforts to Stop the Epidemic

Because of the increase in opioid use and overdose deaths, many agencies have made it a point to address this epidemic and are working to come up with some type of effective solution.
One such agency is the CDC, which suggests that slowing the trend is going to take a multi-faceted approach. This includes changing the way opioids are prescribed (which would involve greater scrutiny of “opioid selection, dosage, duration, follow-up, and discontinuation”), creating and enforcing prescription drug monitoring programs, and better tracking of opioid-related trends.

The White House has also entered this fight. On Oct. 21, 2015, it was reported that President Barack Obama issued a memorandum directed toward federal departments and agencies, requesting that they do two things. First, they are to ensure that opioid prescribers are properly trained and, second, they are to “improve access to treatment for prescription drug abuse and heroin use.”

The response plan suggestions made by the CDC and White House also included making the drug naloxone more readily available. Project Lazarus, a public health model that operates under the notion that drug overdose deaths can be prevented and that our communities are responsible for preventing them, describes naloxone (aka Narcan) as “the antidote that reverses an opioid overdose.” notes that naloxone is given via injection to the outer thigh and it works by reversing the effects of opioids in emergency situations, such as when an overdose occurs. It doesn’t have to be given by a trained medical professional either, because “a family member or caregiver who is trained to properly give a naloxone injection” can give it.

How can you tell if you or someone you love may have an opioid addiction?

Signs of an Opioid Addiction

A person regularly under the influence of opioids will often exhibit physically apparent signs, such as constricted pupils and a slower breathing rate. However, there are some personality or behavior-based signs that opioid use has become addictive in nature.

These include:

  • Going to multiple doctors (often referred to as “doctor shopping”) in order to get multiple opioid prescriptions
  • Running out of pain pills before the prescription can be renewed, causing the person to try to “borrow” them from a family member or friend
  • Dramatic mood shifts
  • Acting confused
  • Exhibiting feelings of euphoria
  • Being excessively tired or fatigued, possibly even falling asleep or completely losing consciousness
  • Withdrawing socially
  • Financial issues because of increased opioid use and the subsequent costs

NIDA adds that long-term use of opioids may also lead to damage to the brain because of the reduced respiration created by the drug, thus limiting the oxygen that goes to this important organ.

Heroin use specifically has also been found to negatively impact white matter of the brain, causing it to deteriorate. This ultimately affects “decision-making abilities, the ability to regulate behavior, and responses to stressful situations.”

Opioid Addiction Risk Factors

There are certain segments of the population at higher risk of developing an opioid addiction when compared to others.

One of these is adolescents, with the ASAM reporting that roughly 467,000 children between the ages of 12 and 17 use pain relievers without a prescription, 168,000 of which have an addiction. Around 28,000 kids in this age range also admit to taking heroin in the previous 12 months, with more than half (26,000) admitting that they used this drug currently.

It’s important to note that while adolescents being prescribed this type of pain-relieving medication almost doubled in a 13-year timeframe, a majority of the abusers indicated that they obtained them from family or friends. They were not the person originally prescribed the drug.

Females are also at special risk as the ASAM says that they “are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher does, and use them for longer periods than men.”

They’re also more likely to die from a prescription opioid overdose, reports the ASAM, with female opioid overdose deaths increasing 400 percent from 1999 to 2010. For men, opioid-related deaths rose at about half that rate (237 percent) in the same time frame. Heroin overdoses for women increased during this 11-year stretch as well, tripling in size.

In an article published in Pain Physician, researchers from University of Wisconsin School of Medicine and Public Health cited additional risk factors for opioid addiction and misuse, some of which include:

  • Having more than one pain complaint
  • Facing limitations because of the pain
  • Experience pain that is back-related
  • Abuse of other substances
  • Suffering from depression
  • Being on psychotropic medications

Opioid Misuse and Alcohol Abuse

Some opioid users mix this drug with alcohol, a combination that can be extremely dangerous because combining these two substances amplifies the reduced respiratory effect of the pain killers. When this occurs, it can potentially lead to a coma or even death.

Opioid-alcohol use is a major issue. CDC numbers show that approximately one-fifth of all opioid-related emergency room visits involve some type of alcohol consumption. Additionally, almost one out of four prescription opioid deaths involved the person drinking in combination with this type of drug.

The CDC shares that signs someone may be lethally combining these two drugs include:

  • Poor judgment
  • Sleepiness
  • Slurred speech
  • Nausea or vomiting
  • Excessive itching
  • Difficulty walking or moving around
  • Memory issues
  • Lack of appetite
  • Focus issues
  • Trouble sleeping
  • Sweating
  • Depression

Help Is Available

Opioid addiction is extremely powerful, but it is possible to overcome and establish a new “normal.” And we’re here to help you begin this process.

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