Opioids are drugs derived from the opium poppy plant that have a special place in medical treatment practices for the essential relief of pain. Inclusively, heroin and synthetic opioids (those with similar molecular structures), such as fentanyl and methadone, make up a large portion of the drug-involved overdoses and deaths we, in the United Sates, are witnessing at alarming rates. The following, are some important things you should know about opioids and treatment needs.
Opioids are Indispensable in Medicine
Medical providers are tasked with the obligation to manage pain needs appropriately and under-treatment of those needs is considered a deviation from standard care practices compromising quality of life and functional status for the patients being treated. More recently, new guidelines from the CDC have put forth alternative treatment recommendations to the large increases in opioid overprescribing practices that contribute to the opioid abuse epidemic.
Limitations on dosages and durations, reevaluations of chronic pain sufferers, improved coordination between doctors and pharmacies, and rehabilitation/physical therapy alternatives are just a few of the CDC guidelines that impact this cause. This may help to curb some overprescribing practices, but, ultimately, millions of people will continue to need opioids to relieve pain and discomfort leaving opportunities open for diversions and abuse.
Tolerance and Cross Tolerance
Tolerance is a condition of opioid dependency which requires the person to use more of the opioids or use them more frequently to get the desired effects whatever that may be; to get high, to feel normal, to relieve pain, or to prevent the onset of withdrawals. Common progressions from oral opioid painkiller use to addiction include consuming opioids in higher quantities and of variant types, then through alternative methods such as snorting, smoking, or injecting them intravenously, despite the negative consequences.
According to the Association for Addiction Professionals, “once tolerance develops for one opioid, the opioid dependent will experience tolerance to all opioids.” Cross-tolerance is a natural progression in opioid drug abuse that many people overlook, but, once a more powerful opioid (such as heroin) is consumed, it becomes more difficult to manage desired effects or prevent withdrawals through prior levels of use and dosage potencies.
Dependency and Withdrawals
According to the National Institute on Drug Abuse, “Dependence develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug.” In the desperate efforts to prevent or relieve withdrawal discomfort, many opioid dependents will focus solely on finding more opioids as quickly as possible and this is when their drug use and behaviors become much more complex, often leading to addiction where their legitimate or impulsive use turns compulsive even in the face of consequences to self or others.
When an opioid dependent talks about being “dope sick”, they are generally referring to the flu-like symptoms that are compounded with physical pain and psychological distress symptoms when the opioid levels in their brain drops below the accustomed dependency range. The most common acute withdrawal symptoms appearing quickly and lasting for several days are:
- Uncontrollable cravings
- Runny nose
- Watery eyes
- Fever, chills, and sweats
- Rapid heart rate and respiration
- Anxiety and irritability
- Dilated pupils
- Abdominal distress – cramping, vomiting, and diarrhea
- Muscle spasms and overall body pain
- Weakness and fatigue
Regardless of how long the acute withdrawals last, protracted withdrawals can go on for weeks or months and many people who attempt to quit using opioids do not make it past the acute stage of withdrawals with returning to opoid abuse. Most will relapse within a few days or weeks because of lingering symptoms or lack of sufficient treatment.
Treating Opioid Dependency with Opioids
Opioid Treatment Programs (OTPs) combine slow and long acting medications with other treatment services to help opioid dependents detox from shorter acting opioids or maintain long term abstinence through maintenance programs. Both methadone and buprenorphine work differently from other opioids in that, once a steady state of intake and elimination is achieved, the person is able to get on with their lives without the euphoria, cravings, withdrawals, and drug-seeking behaviors that disrupted their lives before.
Buprenorphine, like methadone, helps to relieve cravings and block the effect of other opioids to deter abuse while improving health and social functioning capabilities, correcting imbalances in brain functions along the way. While methadone has played a part in the rise in opioid overdoses, the majority of those individuals were naïve to methadone’s effects and not methadone treatment participants. According to the SAMHSA, “Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access.”