Opioid addiction continues to rise in the United States. Americans struggle with the consequences every day. Opiates come in many different forms and strengths. Increasing tolerance and downplaying the number of pills taken often marks addiction.
Identifying the Problem
An estimated 100 million Americans suffer from chronic pain. In 2001, The Joint Commission labeled pain as the “fifth vital sign” in pain management. It required physicians to obtain a subjective measurement of a patient’s pain on a scale of 1-10. Feeling pressure to adhere to new quality standards, physicians overprescribed opioids for pain management.
The result is an epidemic in opioid abuse. Opioid overdose-related deaths have quadrupled since 1999. Opioid addiction affects the health and well-being of all genders, ages, races, ethnicities, and classes. The National Institute on Drug Abuse (NIDA) estimates 2.1 million Americans abuse opioids. The Obama administration recently allocated $1.1 billion for drug abuse initiatives and treatment options.
Types of Pain Management
Opioids take different forms and strengths. Each type has a unique half-life (the amount of time it takes for half of a drug to metabolize). Below are some commonly prescribed opioids.
Morphine – is known as the “gold standard” of opioids—the yardstick by which all other opioid analgesics are measured. Morphine has a half-life of 1.5-7 hours. Morphine is prescribed only in a clinical setting. It’s typically administered intravenously though it may be taken orally. Like other opioids, morphine may cause nausea, dizziness, constipation, respiratory distress, and certain cardiac problems. Unlike other opioids, morphine may also cause a histamine reaction.
Tramadol – is a synthetic opioid. It’s a relatively weak opioid with a half-life of 5-7 hours. Tramadol’s efficacy is about 10-20% of morphine. Tramadol is a centrally-acting pain reliever. It treats post-surgical, obstetric, and chronic pain of neurogenic or mechanical origin. Tramadol is the opioid of choice for those with poor cardiopulmonary function (such as the elderly, the obese, and smokers) or patients with impaired renal and/or hepatic function. Tramadol can be an effective treatment option for those who can’t take non-steroidal anti-inflammatory drugs or for whom these drugs ineffectively manage pain.
Codeine – is another fairly weak opioid with a half-life of 9-11 hours. It’s often prescribed to combat chronic back pain. When combined to paracetamol (e.g., acetaminophen and Tylenol), it provides effective management for moderate-to-severe chronic pain and acute pain after dentistry. Codeine is more easily tolerated than tramadol and has fewer common side effects. However, tramadol is more potent than codeine and has fewer cardiopulmonary effects.
Pethidine – also known as Demerol, is a synthetic opioid that works on mu and kappa receptors to relieve pain. Pain relief occurs quickly, making pethidine the logical option for relief of labor pains—particularly during the second stage. However, pethidine has a relatively short half-life of 2-3 hours. Pethidine is associated with a high risk of suicide. It has a high side-effect profile compared to other opioids.
Hydrocodone – is a schedule II opioid with a half-life of 2-4 hours. Hydrocodone is reportedly equal to the gold standard morphine. In fact, some doctors have suggested that hydrocodone may be even more potent in analgesic quality than morphine. Hydrocodone is also more powerful than codeine or tramadol. It’s more efficacious in providing pain relief for acute musculoskeletal pain. Even though it has a fairly low bioavailability, hydrocodone isn’t available in pure formulations. It’s typically combined with acetaminophen for pain relief (e.g., Vicodin).
Oxycodone – more commonly known as Oxycontin, oxycodone is a strong synthetic opioid with a half-life of 3-4.5 hours. It’s approximately twice as strong as morphine. Because of its high potency, oxycodone is only used to treat acute pain. Chronic pain sufferers are more likely to be prescribed tramadol or codeine.
Mechanisms of Action: How Do Opioids Work?
Opioids are known as mu antagonists because they work on the mu receptors of the brain. While opioids may have other differences—for example, some are also kappa antagonists—all opioids have mu antagonist qualities in common. Mu receptors are one of the brain’s endorphin receptors. Opioids work by triggering the rush of endorphins, which are the body’s natural opioids, to dull the sensation of pain. Endorphins also generate a sense of well-being.
How Does an Opioid’s Potency Relate to Its Addictive Qualities?
Any opioid can be abused, but some have a higher likelihood than others. The distinction lies in both tolerance and potency.
Opioids work by triggering natural opioid receptors, but over time, synthetic opioids can actually inhibit the body’s endogenous endorphins. When the body can’t produce enough endogenous opioids on its own, patients experience the following feelings of withdrawal:
These symptoms, coupled with the return of moderate to severe pain, results in addiction-seeking behavior. Patients build a tolerance to the drug and seek more to experience the same effect.
Other Forms of Abuse
Abuse may begin when patients seek alternate delivery routes to achieve the “high” associated with a rush of endorphins. Patients may take their oral medications and crush them into a fine powder and snort them. For example, oxycodone is known for both its high potency and long half-life. Yet when an oxycodone pill is crushed and snorted, it not only produces a strong high, but it also increases the risk of negative side effects—such as respiratory depression, cardiac arrest, coma, or death.
Extended release formulations are particularly dangerous. Abusers have access to all of the medicine at one time if they crush, snort, or smoke them. This increases the strength of the opioid and thus the high.
Addicts may also find other ways to increase the relative strength of an opioid. A patient may take a relative’s Vicodin when a codeine prescription runs out. Since Vicodin has a stronger potency and a longer half-life relative to codeine, the patient’s body will inhibit his or her own endogenous opioid systems more quickly.
Spotting Addictive Behaviors in Opioid Abusers
Those who abuse opioids may display behaviors similar to alcoholics or other addicts. Much like an alcoholic may downplay how much he or she drinks in a day, an opioid abuser may downplay his or her habit. While admitting to taking a much weaker Tylenol with codeine recreationally, he or she may actually be taking hydromorphone or oxycodone, which are extremely potent and dangerous opioids. Addicts can become incredibly good at lying (even to themselves) about the extent of their problems.
It’s important to realize that many opioid prescription problems have roots in real moderate to severe pain. When prescriptions run out, addicts may turn to other drugs of abuse, like heroin, to dull the pain and trigger a euphoric feeling. Indeed, heroin use is on the rise: according to NIDA, the number of heroin users doubled from 380,000 in 2005 to 670,000 in 2012.
Prescription drug addicts are at risk for more than just an overdose, especially if they turn to heroin. Intravenous drug abuse can lead to other complications, such as HIV, Hepatitis C, and other blood-borne disease transmission from dirty needles.
The Dangers of Opioids and The Solution
The addictive qualities of an opioid depend on its potency and half-life. The stronger the drug, the quicker the path to addiction. As tolerance develops, abusers may turn to alternate avenues to experience the “high”, from crushing and snorting pills to switching to a stronger opioid to using heroin. Addicts are creative with the way they administer prescription pills, leading to an increased risk of overdose because opioids continue to build in their systems. High amounts of opioids can lead to organ damage, tissue death, respiratory depression, and cardiac arrest.
As the full extent of the opioid epidemic comes to light, opioid abuse is becoming less stigmatized. Loved ones should be on the lookout for potentially abusive behaviors, such as downplaying the number of pills taken. Early intervention produces the best chance of opioid abuse recovery. Our staff here at Summit Estate specializes in Opioid addiction, let us help you or your loved one recover from this dangerous addiction. Click the button below to see more about our services offered on opioid addiction.