Opioids in 2019: How Addictive Are They? (Is It Really an Epidemic?)
The opioid overdose epidemic began in the 1990s when doctors, who were assured by pharmaceutical companies that opioids were not addictive, began prescribing them more and more frequently. Within a short amount of time, opioids became widely misused substances, and it quickly became clear that they are actually highly addictive.
The Toll of the Opioid Overdose Epidemic
Thousands of Americans began to die every year due to opioid-related overdoses. People were experiencing problems with legally obtained prescription opioid medications as well as illicit opioids bought on the street.
According to the National Institute on Drug Abuse (NIDA), 47,000 people died in the U.S. from an opioid related overdose in 2017, and 1.7 million people met the diagnostic criteria for an opioid use disorder. As a result, the opioid overdose epidemic was declared a public health crisis in 2017.
The opioid epidemic grew out of people who were initially prescribed opioids to manage chronic pain. According to NIDA, up to 29 percent of people prescribed opioids for pain management misuse them. About 8 to 12 percent of people prescribed opioids develop an opioid use disorder.
Of the people who misuse prescription opioids, up to 6 percent will go on to abuse heroin. In fact, about 80 percent of people who use heroin started with prescription opioids.
The Addictive Potential of Opioids
Since the opioid epidemic began to take shape, it’s been acknowledged that opioids are highly addictive. Even when used exactly as prescribed by a doctor, opioids have a likelihood of leading to dependency and addiction.
Opioids act on opioid receptors in the brain and stimulate the release of dopamine, a neurotransmitter responsible for sending signals of pleasure and reward. As such, when taken consistently, opioids change the chemistry of the brain, which can lead to tolerance, dependence, and addiction.
Tolerance to opioids develops relatively quickly. Within just a couple weeks of daily use, you may not experience the same pain-relieving effects as when you first started taking the medication.
To address this tolerance, you can either switch to a similar but different pain-relieving drug or increase your dosage. The risk of increasing your dosage, however, is that you will eventually become tolerant to that amount of the drug as well.
Increasing the amount of any opioid you are taking also increases your chances of developing a physical dependence on the substance, followed by an addiction.
Dependence is not the same as addiction, however. Most people who take opioids for an extended period of time will become dependent on them, but only a small percentage of people develop an opioid use disorder marked by a physical and psychological compulsion to continue using the drug.
Different Types of Opioids
- Natural opiates. Alkaloids derived from the poppy plant, natural opiates include morphine, codeine, and thebaine.
- Semisynthetic opioids. These drugs are created in labs and derived from natural opiates. Examples include hydromorphone, hydrocodone, oxycodone, and heroin.
- Fully synthetic opioids. Completely man-made in labs, fully synthetic opioids include fentanyl, pethidine, levorphanol, methadone, tramadol, and dextropropoxyphene.
All opioids, including natural opiates, provide pain-relieving effects and can be highly addictive. In general, opioids are only meant to be considered as an option to treat pain when nonopioid analgesics have not been successful at providing enough relief.
All opioids are narcotic medications, and their use must be closely monitored.
There are a few different ways that opioids can be consumed. They can be administered intravenously through an IV or pain pump, taken orally as a liquid or pill, or applied topically as a patch on the skin. When misused, people also snort or inject opioids.
Risks and Dangers
There are many dangers associated with opioid use. Whether you are taking a prescription medication or illicitly experimenting with opioids, you are likely to experience negative side effects, some of which can be life-threatening.
There are many mental and physical risks of taking opioids.
- Nausea and vomiting
- Lowered immune system
- Slow breathing rate
- Loss of consciousness
- Mood changes
- Collapsed veins
- Clogged blood vessels
- Increased risk of contracting HIV or hepatitis B and C (with intravenous drug use)
- Risk of choking
The chances of experiencing any of these symptoms increase with prolonged and increasing use. The greater the amounts of opioids you use, the greater the impact on your body; thus, your risk of developing associated complications also increases.
Suffering an opioid overdose is one of the greatest dangers of opioid use. Opioids act on the part of the brain that monitors breathing, so when too high a dose of opioids is taken, breathing is dramatically slowed, sometimes to the point of death.
According to the U.S. National Library of Medicine’s MedlinePlus, an opioid overdose can occur for a number of reasons that include:
- Using opioids to get high.
- Taking an extra dose of a prescription opioid.
- Taking your prescription too often.
- Mixing opioids with other medications, drugs, or alcohol.
- Taking an opioid medication that was prescribed to someone else.
Anyone who uses opioids for any reason is at risk for an overdose. Many overdoses happen accidently, in fact, such as when people mix up how to take their medication or consume illicit opioids that are laced with additional substances.
Symptoms of an overdose include:
- Pale and clammy face.
- Limp body.
- Fingernails or lips that are bluish in color.
- Loss of consciousness.
- Inability to speak.
- Drastically slowed or stopped breathing and heartbeat.
If you are in the presence of someone having an opioid overdose, call 911 right away. Try to keep the person awake and breathing as best as you can until emergency medical help arrives. Lay the person on their side and make sure there are no objects around that they could hurt themselves on in the event of a seizure.
If you have naloxone on hand because the person you are with was already at a high risk for overdosing, administer it. Otherwise, medical responders should administer a dose of naloxone as soon as they arrive.
Naloxone is a safe and effective medication that can be administered in the event of an overdose. It can stop and reverse the life-threatening effects of an overdose and help the victim start breathing again.
Anyone who wants to stop using opioids after having become physically dependent on them is likely to experience withdrawal symptoms.
Withdrawal symptoms typically start to be felt about 24 hours after your last use, peak around day three, and will taper off over the course of the next week. The extent of your opioid use and personal health conditions will impact how severe your withdrawal symptoms are.
Symptoms of opioid withdrawal include the following:
- Muscle aches and pains
- Teary eyes
- Runny nose
- Stomach cramps
- Dilated pupils
- Nausea and vomiting
While these symptoms can be highly uncomfortable, they are not life-threatening and will resolve with time.
Participating in a medically assisted detoxification program is one way to manage unpleasant symptoms and ensure mental and physical safety throughout the process. The withdrawal process is difficult, but it is far less difficult than continuing down the road of opioid use and abuse.
The Opioid Epidemic in 2019
Updated statistics provided by NIDA reflect that the opioid epidemic remains a significant public health concern. As of January 2019, more than 130 people die every day from an opioid overdose.
Public health and the social and economic welfare of the country are seriously impacted by this crisis. The Centers for Disease Control and Prevention (CDC) estimates that $78.5 billion is spent every year on opioid-related health care expenses, lost job productivity, addiction treatment, and involvement in the criminal justice system.
Recent data on opioid drug use suggests that the number of prescriptions being written for opioids has declined in recent years. Public concern and efforts made by the government and other health organizations have made a strong push for tighter prescribing practices, and doctors appear to be listening. Even so, overdose rates continue to rise.
Prescription opioid use may be declining, but the manufacturing and consumption of illicit opioids remain a public health concern that continues to fuel the opioid epidemic.
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Opioid Addiction. (January 2019). U.S. National Library of Science: Genetics Home Reference.
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Opioid Overdose. (December 2018). U.S. National Library of Medicine: MedlinePlus.
Opioid Overdose Crisis. (January 2019). National Institute on Drug Abuse.
Real Teens Ask: What Are the Different Types of Opioids? (September 2013). National Institute on Drug Abuse for Teens.
Types of Opioids Used to Treat Chronic Pain. (February 2018). Verywell Health.