Opioid addiction can be a chronic (long-lasting) condition that can lead to major economic, social and health problems. Opioids, a group of drugs that affect the nervous system, produce pleasure and pain relief. Healthcare providers may legally prescribe opioids to treat severe or chronic pain. Oxycodone, methadone, hydrocodone, morphine codeine and fentanyl are some of the most commonly prescribed opioids. Other opioids such as heroin are also illegal drugs of abuse.
Opioid dependence is defined as a strong, compulsive urge for opioid drugs to be used, even if they are not required medically. Even when prescribed properly and taken according to instructions, opioids have the potential to cause addiction in some people. Many prescription opioids are misused and diverted to other people. Addicts may choose to use these drugs over other activities, which can negatively impact their professional and personal relationships. It is not known why certain people are more susceptible to becoming addicted than others.
The brain’s chemistry is altered by opioids, leading to drug tolerance. This means that the dosage must be increased over time to get the same effects. Dependence is when opioids are taken for a prolonged period of time. This can lead to withdrawal symptoms such as anxiety, muscle cramping, diarrhea and other psychological withdrawal symptoms. While dependence is a form of addiction, it is not the same as dependency. Only a few people who have taken opioids for a long time will experience compulsive, persistent cravings for the drug.
Overdose can lead to life-threatening health issues, such as opioid addiction. Overdose can occur when the body’s ability to take in high amounts of opioids causes breathing to stop or slow down. This can lead to unconsciousness or death. Overdose can occur with legal or illegal opioids. It is possible to take too many of these drugs, as well as opioids that are mixed with tranquilizers (benzodiazepines).
Complex causes can lead to opioid addiction. The exact cause of one’s opioid addiction are complex. Some of these factors have yet to be identified.
Many genes thought to be involved in opioid addiction are part of the endogenous opioid systems, which is the body’s internal system for regulating reward and pain. It is composed of opioid substances that are naturally produced in the body (called endogenous painkillers) and their receptors. These opioids can be inserted like keys into locks. Exogenous opioids, which include heroin and opioid medication, are also exogenous opioids. They act on these receptors. As a result, genetic risk factors for addiction to opioids include variations in genes that make opioid receptors. Researchers believe that the receptors’ structure or function may influence the body’s response to opioids.
The nervous system contains opioid receptors. They are embedded in the plasma membrane that surrounds cells. Endogenous and exogenous opioids can attach to receptors and trigger chemical changes that lead to pleasure and pain relief. The primary opioid receptor for most opioid drugs is the mu (m), which is made from the genetic code. Common variants in the OPRM1 gene may influence how the body reacts to opioids. This includes the amount of opioid medication required to provide pain relief. These variations have been linked to the possibility of addiction in at least some populations.
As risk factors for addiction to opioids, genetic variations in genes that are involved in other functions of the nervous system have been investigated. These genes are involved in different neurotransmitter pathways. This is where chemicals called neurotransmitters and receptors relay messages from one neuron into another. Some genes also provide instructions for proteins that control the growth, survival and specialization (differentiation of neurons). While opioid addiction has been linked to variations in many of these genes, it is not clear how these genetic changes affect the nervous system’s response to opioids.
Nongenetic factors play an important role in opioid addiction. A history of substance abuse, depression and other psychiatric disorders, childhood abuse or neglect, and certain personality traits such as impulsivity or sensation-seeking have been shown to increase the likelihood of developing opioid addiction. A person’s likelihood of becoming addicted to opioids can be increased by living in poverty or in rural areas, as well as being able to access prescription and illegal opioids easily. A combination of genetic, socioeconomic, and health factors can determine an individual’s risk.
The US continues to have an epidemic level of opioid addiction and opioid use disorder. Opioid use disorder (OUD) has been reported in the United States by three million people and 16 million worldwide. Over 500,000 Americans are dependent on heroin. OUD can be diagnosed by meeting at least two of the 11 criteria within a one-year period.
These are the key elements:
Tolerance/Dosage augmentation
You want to reduce your use
It takes too long to get or use the medication.
Strong desire to use
You can’t use your obligations.
Continued use despite life disruption
In physically dangerous situations, use of opioids
Reduced or eliminated of vital activities due to usage
You can continue to use the drug even if you have psychological or physical problems
Increased doses are required
When the dose is reduced, withdraw from the medication.
Overprescribing opioid medication can partly explain the rise in OUD. In response to the “pain is fifth vital sign” campaign in 1990s, healthcare providers increased opioid prescribing. They also downplayed the potential abuse of opioids and promoted drugs like Opana and Oxycontin. These medications can be misused if they are taken orally or ingested at an early age.
Individuals with opioid addiction are affected by all socioeconomic and educational backgrounds. Four million people have admitted to using prescription opioids for non-medical purposes. Based on data from 2015 to 2016, 400,000 people have used heroin in the last month. According to data from 2015 through 2016, roughly 80% of heroin users in America report that they were prompted by pills and then use opioids.
Between 2002 and 2011, 25 million Americans used pain relievers for non-medical purposes. The medication was misused by more than 11 million people.
Since 2010, emergency department visits for overdose and complications have been increasing annually. From 1999 to 2013, the number of ED visits involving opioids has more than tripled.
The United States declared 2017 the year of opioid overdose a national emergency.
Opioid Use Disorder (OUD) patients should be offered inpatient and outpatient treatment by their doctors. Long-term benefits are not available from the short-term prescription of opioids. In the United States, state laws are becoming more restrictive in opioid prescriptions.
Patients presenting with opioid withdrawal often require antiemetic/antidiarrheal therapy and IV hydration. For effective treatment in an opioid withdrawal medically supervised, you can start medication for OUD (MOUD), such a Buprenorphine. This is a partial mu agonist or kappa antagonist. Patients with mild-to moderate withdrawal symptoms (Clinical Opioid Withdrawal Scale [COWS] greater than 10 or 12, should be prescribed buprenorphine. Methadone, which can be used to control opioid withdrawal symptoms, is also a full-agonist mu receptor. It is also able to complete opioid detoxification.
To reverse the effects of opioid overdose, especially respiratory depression, it is important to immediately administer naloxone. An adequate intravenous access is required to administer IV fluids and continue naloxone doses when necessary. To reverse symptoms such as neurologic and cardiovascular problems, start with an intravenous dose between 0.4 and 0.8 mg. Larger doses may be required for patients who have previously taken very powerful opioids. Naloxone can be administered intramuscularly or intranasally.
Treatment utilizing Suboxone® has shown promising results with Medications. To decrease the abuse of heroin and oral opioids, nabumetone, buprenorphine and methadone can be combined with each other. Patients at high risk of overdose should be provided with naloxone kits to use at home. There are many drug testing lab companies that can test for the metabolites of drug compounds to give the most accurate testing results.
The Ascend Health PLLC S team is comprised of addiction-medicine trained physicians, nurse practitioners (NPs), and physician assistants (PAs) who are committed to providing safe, confidential, and affordable treatment with Suboxone® for opioid use disorder. At Ascend Health PLLC, we combine buprenorphine/naloxone (Suboxone®) treatment with behavioral health support to help our patients live a life free of opioid abuse.
Contact our Team today to learn more about our personalized opioid addiction treatment programs.
Suboxone® is a registered trademark of Indivior UK Limited. Ascend Health is not affiliated with Indivior UK Limited or its affiliates ("Indivior"), and any reference to it or its intellectual property is for informational purposes only and is not endorsed or sponsored by Indivior."