girl with opiate addictionOpiates are drugs that simulate the effects of endorphins in the body. Endorphins are released when you exercise or get injured, numbing you to pain and giving you a “natural high.” Opiate drugs displace endorphins and hijack this system, causing powerful pain-blocking effects and euphoria. This makes them valuable as medicine when someone is in pain, but their psychological and physical side effects also mean that they put users at risk for addiction.

Humans have been using opiates since at least 3400 BC, starting with the opium poppy. It naturally contains two opiates, codeine and morphine, which have painkilling, cough-suppressing, and euphoria-inducing properties. Two new developments in the 1800s changed everything – morphine was first isolated in its pure form, and heroin was first synthesized. These pure forms of opiates allowed already-problematic opium addiction to turn into a far more dangerous epidemic. By 1923, the United States had banned the legal sale of opiates without a doctor’s prescription.

Opiate use remains a problem today, especially nonmedical use of prescription opiates. The Substance Abuse and Mental Health Services Administration (SAMHSA) found that in 2012, 1.9 percent of people aged 12 or older had used prescription opiates for nonmedical purposes in the past month. To add to that, about 0.13 percent of people aged 12 or older had used heroin in the last month, and about 0.26 percent had in the past year. The National Institute on Drug Abuse (NIDA) reports that as of 2011, 1.6 percent (4.2 million) of Americans aged 12 or older had tried heroin at least once.

Types of Opiates

Opiates come in a number of types, differing in how powerfully they affect the mind and body.

Types of opiates include:

  • Natural opiates
    • Codeine is a mild opiate used as a painkiller and in cough syrup. Although it is not particularly addictive when used as a doctor directs, it can be abused.
    • Morphine is a painkiller that is widely used for severe pain. It can be administered as tablets or via injection. Morphine can be highly addictive, even when used under medical guidance.
  • Synthetic opiates
    • Hydrocodone (Vicodin, Lortab, Norco) is used as a painkiller and cough medicine, and taken orally. It is usually mixed with acetaminophen/paracetamol , making it dangerous to take outside of a doctor’s prescription because of the risk of liver damage. According to research in the Journal of Medical Toxicology, hydrocodone is about as addictive as morphine.
    • Oxycodone (OxyContin, Percocet) is a powerful painkiller for moderate to severe pain that can be taken orally or injected. Some formulations come mixed with acetaminophen/paracetamol, carrying the same risk of liver damage as mentioned above. The Journal of Medical Toxicology found that oxycodone has a greater potential for abuse than hydrocodone.
    • Hydromorphone (Dilaudid) is a highly potent painkiller, usually administered in hospitals via injection. An article in Drug and Alcohol Dependence found that hydromorphone is three to four times as potent as oxycodone.
    • Meperidine (Demerol) is taken orally and used to treat moderate to severe pain. It is addictive and using it outside of your prescribed dose can cause a possibly fatal overdose.
    • Fentanyl (Duragesic, Actiq) is a fast-acting, powerful painkiller used for moderate to severe pain. It is also used as an anesthetic. Fentanyl can be injected, taken orally, or absorbed via a patch on the skin. Fentanyl is highly addictive and can easily cause a potentially lethal overdose if used outside of a doctor’s recommendation.
    • Heroin is an illegal, highly addictive opiate with no medical uses. It offers a euphoric high and can be snorted as a powder, smoked, or injected. According to SAMHSA, heroin caused over 250,000 emergency room visits in 2011. SAMHSA found that about 620,000 people used heroin in 2011 – although some emergency room admissions may be repeat visitors, that’s still as many as 40 percent of heroin users having a medical emergency.

All pharmaceutical opiates together caused about 488,000 emergency room visits in 2011, SAMHSA found. Prescription opiates also remain the bigger killer – the Centers for Disease Control and Prevention (CDC) reports that there were about 14,800 prescription painkiller deaths in 2008, compared to the CDC’s report of 4,397 heroin deaths in 2011.

What Do Opiates Do to the Body?

Opiates displace the body’s own endorphins and bind to sites in the brain called mu-opioid receptors. This causes feelings of painlessness, well-being, and pleasure. However, it also causes a number of other effects, such as:

  • Flushed skin
  • Dry mouth
  • Feeling of heaviness in the extremities
  • Pinpoint pupils
  • Itching
  • Drowsiness
  • Nausea
  • Vomiting
  • Constipation
  • Clouded mental function
  • Slowed heart rate
  • Impaired breathing

If individuals take too high a dose of opiates, they can fall unconscious. They run the risk of vomiting, inhaling the vomit into their lungs and choking to death. At even higher doses, their breathing can slow enough to stop. These dangers make it very important to never use prescription opiates in doses higher than your doctor prescribes.

According to NIDA, repeated use of opiates can cause changes in the structure and chemistry of the brain. The body’s natural endorphins stop working normally, making the person hypersensitive to pain when not using opiates. Opiate use can also damage the pleasure system, such that activities that don’t involve opiate use seem less rewarding. These imbalances also boost the risk for depression and antisocial personality disorder, says NIDA.

Other possible health effects include:

  • Lung complications, such as pneumonia, from impaired breathing
  • Sexual dysfunction
  • Irregular menstrual cycles
  • Damaged inner nose tissues, if opiates are snorted
  • Widespread damage if opiates are injected, such as:
    • Scarred veins
    • Collapsed veins
    • Boils
    • Bacterial infections of blood vessels and heart valves
    • Soft tissue infections
    • Arthritis
    • Cell death
    • Organ damage
    • Blood-borne infections like HIV, hepatitis B and hepatitis C (from sharing needles)

People who abuse opiates also are at higher risk of developing health problems due to a poor diet. Opiates cause nausea and loss of appetite, which in the long run can cause people to eat less regularly and become malnourished. This weakens the body, making it more vulnerable to infections and increasing the likelihood of triggering other conditions.

Over time, users of opiates will develop tolerance to the drugs, requiring higher and higher doses of the drugs in order to get the same effects. They may also develop dependence, meaning that they reach the point where they need to take the drug in order to feel normal. If they try ceasing opiate use abruptly, they are at risk for withdrawal symptoms.

What Happens When Someone Quits Using Opiates?

Regular opiate use reconditions the body to expect a daily dose of its endorphin replacement. When that disappears after a user quits (going “cold turkey”), the body goes into withdrawal. Symptoms of withdrawal can include:

  • Restlessness
  • Anxiety
  • Insomnia
  • Nausea
  • Diarrhea
  • Vomiting
  • Muscle aches
  • Bone pain
  • Sweating
  • Flashes of cold accompanied by goose bumps
  • Cramping
  • Leg twitching
  • Intense cravings

People who are able to successfully quit using opiates and get treatment for their substance abuse issues show improvements in the following areas:

  • Drug use levels
  • Medical health
  • Psychiatric conditions
  • Legal issues
  • Family and social relationships

Getting Clean Safely

treatmentGoing through withdrawal is an arduous process, and there’s no reason to face it alone. Although the symptoms of opiate withdrawal aren’t lethal, they can feel extremely uncomfortable. A number of medications exist to help people manage their addictions to dangerous opiates.

  • Methadone (Methadose) is a non-euphoric replacement for heroin that is taken orally. By switching from heroin to methadone, people addicted to heroin can quit using heroin without experiencing withdrawal or cravings and without getting high. This protects them against risks associated with heroin use, such as catching infections like HIV or hepatitis from shared needles, or the risk of overdose from batches of unregulated drugs. According to the CDC, switching to methadone is also more likely to result in better family stability, potential for employment, and crime reduction.
  • Buprenorphine (Suboxone, Subutex) is another replacement for opiates, allowing users to switch to a safer drug without going through withdrawal. According to SAMHSA, buprenorphine has a plateau effect, meaning that after a certain point, taking more of the drug won’t yield any additional effects (or risks).
  • Naltrexone (Depade, Revia, Vivitrol) blocks the euphoric, rewarding effects of opiate drugs. By preventing the drugs from feeling pleasurable, naltrexone removes users’ incentives to keep using so they are better able to quit.
  • Naloxone (Narcan) blocks opiate receptors, preventing opiate drugs from working on them. Naloxone is used in emergencies where someone has overdosed on opiates and needs the “antidote.”

Detoxifying from opiates in inpatient medical detox facility allows patients to get clean in a safe and stable setting under the supervision of health care professionals. In inpatient medical detox, patients can usually get access to medications like methadone and buprenorphine, which can allow them to detoxify without experiencing withdrawal symptoms. Many facilities additionally offer support services like nutritional counseling, massage therapy, fitness training, and yoga to help recondition the body as the mind recovers from opiate addiction.

During this process, patients will also receive screening and treatment for any other medical conditions or co-occurring mental disorders that they may have. If they are sick for other reasons, particularly with a mental illness, quitting opiates is even harder. Getting proper medical care helps smooth the path.

Once the patient has detoxed, the battle isn’t over yet. Residential services offer a peaceful setting with round-the-clock medical care available for patients to receive therapy treatment. In individual and group settings, patients learn new strategies for coping with the stresses that drove them to use opiates.

  • Cognitive behavioral therapy teaches patients to identify maladaptive thoughts and behaviors related to substance abuse, and it teaches how to replace them with healthier strategies, especially for high-risk situations.
  • Dialectical behavior therapy is a form of cognitive behavioral therapy that incorporates aspects of mindfulness, which teaches how to tolerate extreme or powerful emotions without using drugs.
  • Motivational enhancement uses an interview process to help the patient clarify their motivations for getting clean.
  • Contingency management offers tangible rewards for staying abstinent, such as a voucher or cash prize for attending meetings or submitting clean drug tests.
  • Self-help groups, such as the 12-step program, teach patients that their addiction has gotten out of control, that abstinence is the only healthy option, and that continued attendance at meetings and engagement with the community make the best path for abstinence.
  • Family/couples therapy helps patients understand how their opiate addiction has hurt their loved ones, and it helps family members learn how to guide and support the patient through the recovery process.

Patients who are ready to live on their own can also receive similar treatment in outpatient services, which provides access to therapy for patients living off site. They also have the option to seek out additional support on their own, such as by attending self-help groups or support groups.

According to a review by the World Health Organization (WHO), getting therapy for opiate addiction reduces rates of opiate use, increases adherence to treatment programs, decreases co-occurring psychiatric symptoms, and decreases risky behavior.

At Orlando Recovery Center, we want you, or your loved one, to make a full recovery from opiate addiction, and our progressive treatment services can give you the help you need. You’ll work with our medical experts to develop a specialized treatment plan that meets your unique needs. Detox in safety and comfort, as you work with our trained therapists to build a new, healthier life.

Each day brings new opportunities. Call us to learn more.