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Opiates: From Prescription to Street Drugs

Everything you need to about Opiates

You may have heard the term “Gateway Drug”, which is the idea that the use of one drug such as alcohol, increases the likelihood of a person using a more dangerous drug in the future, such as cocaine.

According to The National Institute of Drug Abuse (NIDA), 80% of heroin users started out using, then misusing prescription opioids. That is an astoundingly high number.

Switching over from prescription opioids to heroin isn’t exactly in line with the Gateway Drug theory since the drugs are so similar to each other and equally dangerous, but the concept is similar, and one could argue even more of a threat to the user. Addiction to any substance can be dangerous and possibly life-threatening, but there were a reported 49,860 fatalities related to natural and synthetic opioids in 2019 1, and those numbers don’t appear to be going down.

What are Opioids?

Opioids are a class of drugs that come from the opium poppy plant. Opioids can be found both on the streets and in your local pharmacy.

Common Opioids:

These are a few commonly known forms of opioids that can be prescribed as medication for pain management. Some of those drugs are made from the plant, while others are created in labs using the same chemical structures.

Heroin is an opioid-based illegal street drug that produces effects very similar to those found with prescribed medications.

How do Opioids Work?

Opioids activate opioid receptors that are located in the brain, spinal cord, and other organs of the body that are related to feelings of pleasure and pain.

Opioids are often referred to as narcotics, and they relieve pain by blocking pain signals between the body and the brain. They also produce feelings of euphoria, making the user feel relaxed, happy, or “high”.3

When opioids attach to those receptors, they not only block pain and induce feelings of pleasure – they also release large amounts of dopamine throughout the body.

Dopamine is also responsible for feelings of pleasure and reward, and when such large amounts of it are released into your body, it reinforces the desire to keep taking the drug in order to continue or repeat those good feelings.

Seeking out these feelings of euphoria and pleasure by ingesting opioids can be dangerous for those who suffer from, or are vulnerable to addiction.

How do Opioids Affect You?

Opioids can be very effective at relieving moderate to severe pain in the short term. They can also make the user feel relaxed and happy.

They can also have harmful effects, even with short term use such as:

Slowed breathing is one of the side effects of opioids, which can lead to hypoxia. Hypoxia occurs when the brain does not receive enough oxygen. This can have both long and short-term effects on the user, neurologically and psychologically. Hypoxia can lead to coma, permanent brain damage, and even death.

It is possible to develop a tolerance to opioids, even when taken as prescribed. Tolerance can lead to dependence, which can lead to addiction.

Tolerance, Dependence, and Addiction

Tolerance occurs with long-term use of opioids (as well as most substances), and it means that it starts taking more of the drug to produce the desired effects. Tolerance can occur even when the drug is taken as prescribed.

When a person has built up a tolerance and continues taking more and more of the drug, dependence can develop. Dependence means that the neurons in the brain have adapted to the drug, making it necessary to take it in order to feel and function normally. If you’ve ever been a coffee drinker, you understand the need for that first cup in the morning to get you going.

Addiction is a chronic and progressive disease that is characterized by uncontrollable and compulsive use of the drug, despite negative consequences that can result. People suffering from opioid addiction may start seeking out the drug even after their prescription has run out.

What is Addiction?

Addiction is a chronic and progressive disease. People do not make the choice to become addicted. In fact, once a person has become addicted to a substance or behavior, the choice to cease the use of that drug or behavior has essentially disappeared.

There is stigma and shame surrounding addiction, for the one suffering as well as for the people who love them. It is confusing to see someone continuing a behavior that seems to bring on nothing but trouble and pain. Why don’t they just stop?

It is confusing for the addict as well. As addiction takes over their world, and they start losing the things they love they wonder, why can’t I just stop?

When you ingest a substance that makes you feel good, you’re releasing large amounts of dopamine into your body. That dopamine is what makes you feel pleasure and reward. It will start taking more and more of the substance to activate the dopamine and achieve the good feelings, and eventually, your brain will convince you that the only way to feel good (or normal) is to take that substance.

Addiction is confusing, complicated, and oftentimes debilitating. It changes the chemistry in your brain and your body. It is not a moral failing, and addiction does not make you a weak or bad person.

Recovery is possible. If you or a loved one are suffering from opioid addiction, please reach out to a doctor or counselor for help. The sooner the better. You don’t have to feel this way forever.

Opioid Addiction

Endogenous opioids (natural opioids, produced by the brain. Think of endorphins when you exercise), as well as synthetic opioids, work by binding to and activating the surface of nerve cells. This is what produces the “high” you get, whether it’s from ingesting an opioid or going for a strenuous run.

However, fairly new research shows that those molecules also activate receptors within the cell – and natural and synthetic opioids each do so in different areas of that cell.

This may help to explain why the effects of synthetic opioids are so much more intense than natural ones, and why they are so incredibly addictive.4

Anyone can develop a dependency or addiction to opioids. Students, teachers, stay-at-home parents, grandmas, and athletes have all struggled with opioid misuse. Since it is prescribed as a pain medication, pretty much anyone is susceptible to becoming addicted.

Symptoms of Opioid Addiction

The brain gets used to having opioids bind to opioid receptors very quickly. That is why it is so important to take pain medications only as prescribed, and no longer than necessary. Opioids are one of the most addictive substances on the planet.

Symptoms of opioid addiction are:

Opioid Withdrawals

While it is possible to misuse opioids and not become dependent on them, it is a slippery slope.

The most telling symptom of abuse and addiction to opioids are withdrawal symptoms when one stops taking them.

Immediate Opioid Withdrawal Symptoms:

These are the types of effects you’ll see very quickly after ceasing the use of opioids.

Delayed Withdrawal Symptoms that occur after 24 hours:

Opioid withdrawal can feel excruciating. It has been described as “…physical and mental torture. Like you’re coming undone at the seams”.5

Your body reaches a sort of homeostasis when you take opioids for a prolonged period of time. Being on opioids feels “normal”, and like everything is how it should be, physically, emotionally, and psychologically.

When you stop taking them everything starts to feel terrible.

These intense feelings of withdrawal are what lead many users to start using heroin.

Heroin

Prescription opioids are expensive. Doctors are becoming more aware of the addiction risks, and are prescribing them less generously. It is possible to find prescription opioids on the streets without a prescription, but again, it’s not cheap.

Opioid withdrawal can feel like torture, so when the prescriptions run out and the street pills become too costly, many addicts turn to heroin. It’s cheaper, and sadly, easier to acquire.

Heroin works much like prescription opioids. It blocks the pain receptors of the body and brings on feelings of pleasure and relaxation.

And just like prescription opioids, when heroin starts to wear off, the feelings of withdrawal can be unbearable.

A vicious cycle has been born.

Repeated heroin use changes the physiology of the brain, making you dependent on it to feel normal. Heroin users often use the term “get well” when they talk about needing the drug. They don’t talk about getting “high”, or “partying”, or having a good time; without heroin in their system heroin users feel miserably sick, and they need more heroin to get well.

Recovery from Opioid Addiction

On average 130 Americans die each day from an opioid overdose. That includes heroin, hydrocodone, codeine, morphine, and fentanyl. More than half of those deaths were caused by prescription opioids.

You, or the person you care for, do not need to become one of those numbers. Recovery from opioid abuse is possible, and life can become manageable and joyful again.

There are medications available to help with the withdrawal symptoms from opioids, which are often the biggest obstacle to getting sober. These medications work by normalizing the brain chemistry, relieving cravings, and in some cases minimizing or eliminating withdrawal symptoms completely.8

Relieving the physical symptoms of withdrawal is just the first step towards recovery. It is important to have a support system to help you maintain your abstinence from opioids. Building and maintaining an active and supportive community is vital to remaining free of opioid addiction in the long term.

Reach out if you need help, and be supportive and non-judgmental if someone reaches out to you. Addiction is painful, scary, overwhelming, and incredibly isolating. It takes a huge amount of courage to reach out for help, but once you do you will feel so much less alone.

Recovery from addiction is not an easy road, but it’s worth it. Everyone deserves the opportunity to reclaim their own lives, free of drug use and free from the shackles of addiction.

If you or someone you know is suffering, reach out for help. Call your doctor or a respected treatment center.

There is help, there is hope, and there is recovery.

Sources

1. Heroin Overdose Data. (2020, March 19). Retrieved from https://www.cdc.gov/drugoverdose/data/heroin.html
2. National Institute on Drug Abuse. (2021, May 17). Opioids. Retrieved from https://www.drugabuse.gov/drug-topics/opioids
3. Butanis, B. (2018, April 30). What Are Opioids? Retrieved fromhttps://www.hopkinsmedicine.org/opioids/what-are-opioids.html
4. Smith, N. B. (2021, May 13). Body’s ‘Natural Opioids’ Affect Brain Cells Much Differently than Morphine. Retrieved from https://www.ucsf.edu/news/2018/05/410376/bodys-natural-opioids-affect-brain-cells-much-differently-morphine
5. The science of opioid withdrawal. (2016, May 27). Retrieved from https://www.youtube.com/watch?v=CduCr-kJXtk

6. Assistant Secretary of Public Affairs (ASPA). (n.d.). What is the U.S. Opioid Epidemic? Retrieved from https://www.hhs.gov/opioids/about-the-epidemic/index.html

7. The Opioid Crisis in America. (2021, April 22). Retrieved from https://online-learning.harvard.edu/course/opioid-crisis-america?delta=2
8. Kleber H. D. (2007). Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues in clinical neuroscience, 9(4), 455–470. https://doi.org/10.31887/DCNS.2007.9.2/hkleber
9. Monico, L. B., & Mitchell, S. G. (2018, January 29). Patient perspectives of transitioning from prescription opioids to heroin and the role of route of administration. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789586/
10. Oxycodone to heroin: They made the deadly switch. (2018, July 11). Retrieved from https://heroin.palmbeachpost.com/oxycodone-to-heroin-they-made-deadly-switch/
11. The Connection Between Prescription Opioids and Heroin. (n.d.). Retrieved from https://www.pharmacytimes.com/view/the-connection-between-prescription-opioids-and-heroin
12. Evans, W. N. (2018, April). HOW THE REFORMULATION OF OXYCONTIN IGNITED THE HEROIN EPIDEMIC. Retrieved from https://www.nber.org/system/files/working_papers/w24475/w24475.pdf
13. Lopez, G. (2018, April 16). The maker of OxyContin tried to make it harder to misuse. It may have led to more heroin deaths. Retrieved from https://www.vox.com/science-and-health/2018/4/16/17234008/opioid-crisis-oxycontin-abuse-deterrent-heroin
14. Assistant Secretary of Public Affairs (ASPA). (n.d.). What Are Opioids? Retrieved from https://www.hhs.gov/opioids/prevention/index.html
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