Opioid Use
In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive. Opioid overdose rates began to increase.
In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid.
Opioids are strong prescription medicines that are used to manage severe pain. Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made by scientists in labs using the same chemical structure. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Opioids can also make people feel at ease and “high” – which is why they are sometimes used for non-medical reasons. Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience. This can be dangerous because opioids can be highly addictive. In the short term, opioids can relieve pain and make people feel relaxed and happy. However, opioids can also have harmful effects, including drowsiness, confusion, nausea, constipation, euphoria, and slowed breathing.
Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can have short- and long-term psychological and neurological effects, including coma, permanent brain damage, or death. Too much opioid medicine in your body can cause your breathing to stop. This can lead to death. This risk is greater for people taking other medicines that make you feel sleepy or if you have sleep apnea. Addiction is another risk that can occur with opioid usage. Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs. Addiction is when you crave drugs because they make you feel good in some way. Addiction is not always due to a drug makes you feel good but could also be because the drug lessens the negative feelings. Whether those negative feelings are due to pain or emotion. You keep taking the drug even though you know it is not a good idea and bad things are happening to you. At times you may not even realize you have become addicted to the pain medication. If you take an opioid medicine for more than a few days, your body becomes physically dependent. Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects. Drug dependence occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life-threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug. This is normal and it means your body has become tolerant to the medicine. You may need to taper off the opioid medicine slowly once you no longer need it to avoid withdrawal symptoms. People addicted to an opioid medication who stop using the drug can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. These symptoms include muscle and bone pain, sleep problems, diarrhea and vomiting, cold flashes with goosebumps, uncontrollable leg movements, and severe cravings. Due to the negative side effects withdrawal can give you some continue to take the pills thinking they are helping and not realizing they are becoming addicted to the medication. Unfortunately, the medication is putting you in danger and not helping. Addiction is a brain disease that may require ongoing treatment.
There are risk factors for opioid abuse. Those risk factors are a history of addiction, a family history of addiction, being on the medication for a long period of time, or taking medications to treat your mental health problems. There is research showing that those under the age of 65 tend to have a higher risk of addiction. You can become addicted to opioids even if you have not taken them for a long period of time. While taking opioids you should avoid alcohol, benzodiazepines such as valium or Xanax, muscle relaxants such as soma and Flexeril, sleep medicines like Ambien or Lunesta, and other prescription opioid medicines. Mixing these substances with opioids can lead to respiratory depression, which could cause you to stop breathing and lead to death.
To take opioid pain medication safely, you need to tell your healthcare provider about all medicines you take. This includes vitamins, herbal supplements, and over-the-counter medications. Read all medication guides that come with your medication. Take the opioid medications as prescribed, do not take more than what is prescribed. Do not cut, break, chew, crush or dissolve your medicine. Call your healthcare provider if the opioid medication is not controlling your pain. Do not increase the dose on your own. Do not share or give your opioid medicine to anyone else. A dose that is okay for you could cause an overdose and death for someone else. It is against the law to share or sell your opioid prescription. Store your opioid medicine in a safe place where it cannot be reached by children or stolen by family or visitors to your home. Use a lockbox to keep your opioid medicine safe and keep track of the amount of medicine you have. Do not operate heavy machinery until you know how your opioid medicine affects you. Your opioid medicine can make you sleepy, dizzy, or lightheaded.
Opioids are not the only thing that can help your pain. Ask your healthcare provider if your pain might e helped with a non-opioid medication, physical therapy, exercise, rest, acupuncture, types of behavioral therapy, or patient self-help techniques.
Naloxone is a medicine that treats opioid overdose. It is sprayed inside your nose or injected into your body. If you or someone else has taken an opioid medicine and is having trouble breathing, is short of breath, or is unusually sleepy call 911. They will treat the overdose immediately with naloxone. Even if you have naloxone to give to the person, it is not a substitute for emergency medical care, always call 911. Naloxone is available in pharmacies. In some states, you may not need a prescription for the medication.
Once you have stopped taking the medication you need to dispose of any additional pills you may have. If there is a drug take-back option available to you in your area this is the best way to dispose of the medication. If there is not a take-back option, you may flush them down the toilet.
If you or someone you care for has become addicted to opioids there are a range of treatments including medicines and behavioral therapies that are effective in helping with addiction. Two medicines, buprenorphine, and methadone, work by binding to the same opioid receptors in the brain as the opioid medicines, reducing cravings and withdrawal symptoms. Another medicine, naltrexone, blocks opioid receptors and prevents opioid drugs from affecting. Behavioral therapies for addiction to prescription opioids help people modify their attitudes and behaviors related to drug use, increase healthy life skills, and persist with other forms of treatment, such as medication. Some examples include cognitive behavioral therapy which helps modify the patient’s drug use expectations and behaviors and effectively manage triggers and stress. Multidimensional family therapy, developed for adolescents with drug use problems, addresses a range of personal and family influences on one’s drug use patterns and is designed to improve overall functioning. These behavioral treatment approaches have proven effective, especially when used along with medicines. Please contact your health provider for recommendations on how to treat the addiction.
Again any questions or concerns please do not hesitate to reach out to us or another healthcare provider.