According to the U.S. Centers for Disease Control and Prevention, in 2016, more than 100 people a day died of an opioid overdose. Of those overdose deaths, roughly 46 per day were specifically due to prescription opioids.
The opioid crisis in the United States has reached a critical mass and unfortunately shows no signs of slowing down, with the CDC also reporting a 30 percent increase in opioid overdoses across America from 2016 to 2017.
And even if someone does overdose on prescription opioids, for many people that eventually become dependent on illicit opioids like heroin, prescription painkiller addiction is often the starting point.
Speaking of starting points, while it is not possible to mark the exact beginning of the opioid epidemic, its rise has been associated with the introduction of prescription opioid medications such as OxyContin in the late 1990s. When Purdue Pharma first introduced OxyContin, it was aggressively marketed far safer and with a much lower potential for addiction than other prescription opioids.
However, as prescription opioid addiction and overdose rates began to climb, it became clear that this was not the case. In fact, in May of 2007, about 10 years after OxyContin was made available for sale, the federal government charged Purdue Pharma with the criminal act of “misleading and defrauding physicians and consumers” by making false claims about OxyContin and forced them to pay 600 million dollars in fines.
But in many ways, the damage had already been done, and the opioid crisis was on its way to becoming a countrywide epidemic.
Previously, the term opioid was only used in reference to synthetic substances that were intended to work in the same manner as opiates like codeine and morphine, which are naturally-derived from opium. Today, opioid has become the catch-all term for any substance within the opiate family of drugs, both natural and synthetic, that act on the brain’s opioid receptors.
Prescription opioids, unlike illicit opioids such as heroin, are drugs that have an established medical use, typically as anesthesia and pain relievers, and are therefore able to be legally prescribed by a physician.
Prescription opioids are incredibly useful for managing chronic pain and suppressing cough in people with severe lung conditions, but they are nonetheless incredibly addictive and one of the most abused class of drugs in the country.
This is in part due to their legality, as those struggling with a prescription painkiller don’t fit the stereotypical of a “drug addict” injecting an illicit substance like heroin, but could potentially be anyone, especially when considering there are roughly 71 opioid prescriptions per 100 people in the country.
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Prescription opioids work by activating what’s known as the brain’s opioid receptors. These are neurotransmitters that are responsible for regulating the levels of stress within the body as well as transmitting pain signals throughout the brain and nervous system.
So what prescription opioids do, to varying degrees depending on potency, is bind to these receptors by way of mimicking the composition of neurotransmitters that occur naturally within the brain, providing an immense boost to opioid receptor activity and production. This boost works in three key areas of the body:
It is the way that prescription opioids act on the amount of dopamine in the brain that perhaps creates the biggest risk of addiction by inextricably linking prescription opioid use to the brain’s motivation and reward system. This creates the learned behavior of prescription opioid use activating the “brain’s pleasure center” along with blocking pain signals and begins the cycle of opioid addiction.
As the brain stops making its own dopamine to balance out the artificial dopamine provided by the prescription opioids, the body and brain become dependent on the neurotransmitters provided by regular prescription opioid abuse in order to function.
This is why when someone with a prescription opioid addiction suddenly stops using, their body “crashes” as it struggles to cope with the sudden loss of dopamine, which is what causes opioid withdrawal symptoms and prompts the user to continue abusing prescription opioids.
Prescription opioids, when used in excess will provide not only their intended effects but also a strong “high” that can vary from very short and intense, like the high from fentanyl, to almost as long as six hours if someone is using morphine. Nonetheless, the short-term effects of prescription opioids are all basically the same and include:
These side effects can vary; however, when prescription opioids are taken in what is known as nonstandard ways. This usually involves crushing the pills or tablets and either snorting them or mixing them with water and injecting them intravenously.
There are many signs and signals that mark when someone is suffering from a prescription opioid addiction, which can be seen through the physical and mental effects caused by prescription opioid dependency as well as through the behavior that is driven by prescription opioid addiction. Some common signs of prescription opioid addiction include:
As both getting and using prescription opioids becomes the top priority in someone’s life and the force behind essentially all of their decision-making, there are many behavioral signals that point to not only prescription opioid addiction but the majority of addictions in general. Some of these behavioral warning signs include:
If these are symptoms that you have either experienced yourself or observed in a family member or friend, there are indicative of prescription painkiller addiction, and you should seek out treatment immediately in order to avoid the damaging consequences of further abuse and the possibility of a potentially fatal overdose.
The first step in prescription opioid addiction treatment, and any other kind of addiction treatment, is flushing the substances from the body via detoxification.
While prescription opioid withdrawal is very rarely a life-threatening process, many of the symptoms such as hallucinations and seizures can be unpredictable and often very intense, which is why anyone undergoing prescription opioid detox should do so at a medical detox center under the supervision of a detox medical professional.
Detoxing at a medical facility not only guarantees an individual’s safety through around the clock monitoring, but also avoids the risk of relapsing midway through the withdrawal process and potentially overdosing. It also means that someone undergoing prescription opioid detox can be put on a tapering schedule to slowly lower their dosage over time until they can safely stop using without triggering a seizure or other serious health issue.
As part of the tapering process and also to ease the symptoms of prescription opioid withdrawal, many detox centers will utilize medical maintenance therapy, working to wean people away from opioid usage by way of other drugs that have similar effects and can reduce cravings, but are much weaker and less addictive.
The drugs typical used during a course of medical maintenance therapy include:
The medication with perhaps the longest record of treatment use, methadone helps ease cravings while also blocking the euphoric effects associated with prescription painkiller abuse.
This medication is what is known as a “partial” opioid, which means that it can also help to decrease cravings by taking up space in the brain’s opioid receptors and blocking the effects of opioids that are unable to get in. It has been shown to have a much lower potential for abuse than methadone.
This is the brand name for a drug that is a combination of both buprenorphine and naloxone, which is a drug that completely cuts off the effects of opioids entirely and is therefore too strong to be used on its own to taper down usage.
As we’ve mentioned; however, even though these three drugs are much weaker than other prescription opioids, they do so still have the potential for both abuse and addiction, and their administration requires very strict monitoring. And, of course, if the prescription opioid that someone is detoxing from is methadone, Suboxone or other opioids used in maintenance therapy, they may instead be given:
This is a different kind of drug in that is does not carry any kind opioid-esque qualities and is therefore not addictive. Like naloxone, it negates the effects of prescription opioids and can also be used in the long-term as a medical alternative to using in the form of an extended-release injection known as Vivitrol.
Clonidine is mainly used as a treatment for the symptoms associated with high blood pressure but has shown in recent studies to help ease opioid cravings and reduce stress levels.
Once someone has completed their detox and moved on past the withdrawal phase, the next step in prescription opioid addiction treatment is to check into an addiction rehabilitation treatment program. Otherwise, they will most likely be unable to successfully remain sober for any significant length of time.
Detox is not the solution to prescription opioid addiction but merely the beginning of recovery. In a recovery treatment program, an individual will be able to learn the skills they need to address the root of their addictive behaviors and learn how to manage them and maintain long-term sobriety.
Typically, those in a treatment program will work with their counselor or therapist to create a treatment plan that will be evaluated and assessed for effectiveness in best treating their needs. It may involve everything from individual counseling and support groups to educational workshops, more holistic therapies, and other types of individual therapies.
In the wake of the current opioid epidemic, there is just no way to overstate the dangers posed by prescription opioid abuse. Apart from the irreversible damage that regular long-term prescription opioid abuse can inflict on the body and brain, it’s the alarming frequency of prescription opioid overdose deaths that put experiencing an overdose at the top of the list of serious consequences of prescription opioid addiction.
Of these side effects, depressed breathing is perhaps the most dangerous, as a lack of oxygen in the brain can not only lead to a coma and potentially death, it can also cause permanent brain damage and total organ failure.
Emergency assistance must be sought out immediately so that first responders can arrive in time to reverse the overdose with Narcan. However, in the case of extremely potent prescription opioids such as fentanyl, it may take at least three doses or more for Narcan to effectively reverse the overdose.
The danger posed by prescription opioid abuse is even greater when they are used in combination with other drugs or alcohol. Alcohol and benzodiazepines have particularly severe side effects when mixed with prescription opioids due to their depressant, sedative effects. This combination can essentially create the same overdose scenario described above, with extremely depressed breathing, slowed heart rate, and a loss of consciousness that could prove fatal. According to the CDC, roughly half of the overdose death caused by prescription opioids involved a secondary drug acting as a contributing factor with the benzos Xanax and Valium accounting for about 17 percent of them.