OPIOIDS AND ADDICTION
What are opioids?
Opioids are a class of drug that includes prescription painkillers and heroin. These drugs are derived from, or closely mimic, the pain-relieving compounds found in the substance opium and can be produced in natural, synthetic, or semi-synthetic forms. Common forms of natural and semi-synthetic opioids include morphine, codeine, heroin, hydrocodone, oxycodone, and hydromorphone. Synthetic opioids include methadone, demerol, and fentanyl.
Are opioids dangerous?
Prescription opioids are a widely used method of treating moderate to severe, acute, and chronic pain. When used under a healthcare provider’s supervision and in accordance with opioid prescribing guidelines, they can be an effective treatment. However, they also have great potential for dependence, recreational misuse, development of an opioid use disorder (OUD), and fatal overdose. These dangers are associated with how and how much of an opioid is taken. Methods of misuse include taking the drug in a way other than prescribed, taking someone else’s prescription medication, or taking medicine for the pleasurable effects it provides. Any use of illicit opioids, like heroin, is considered misuse. Negative outcomes related to misuse increase when opioids are ingested in ways other than swallowing, such as being crushed and injected or snorted. These methods deliver an increased concentration of the opioid and amplify the risk of overdose.
Immediate side effects of opioid use can include drowsiness, nausea, constipation, confusion, and dizziness. Serious side effects, often as a result of opioid misuse or opioid interaction with another substance, can include clammy skin, weak muscles, low blood pressure, and slowed breathing. In extreme circumstances, this can lead to a coma or death by overdose.
What is the difference between misuse, dependence, and addiction?
A person can become physically dependent on opioids when taking them at a high enough dose for more than a few days. Physical dependence involves the body’s natural adaptation to regular exposure to the substance, leading to tolerance or withdrawal. Tolerance means a person needs more of the drug to produce the same effect. Withdrawal is a negative series of symptoms that includes nausea, vomiting, diarrhea, agitation, and pain, that occurs when a person stops taking an opioid. There is a difference between physical dependence and the disease of addiction.
When a person has subjective distress or objective reduction in functioning because of opioid use, they may meet the criteria for OUD. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes OUD on a spectrum of severity: mild, moderate, or severe. The DSM-5 provides a list of criteria for behavioral health professionals to reference when diagnosing mental health or substance use disorders (SUD). Severe OUD is consistent with the chronic brain disease of addiction. OUD is a chronic and treatable disease requiring medical intervention. Similar to other chronic diseases, it often involves cycles of worsening symptoms and remission.
Although opioids work the same in all brains, not all individuals who take or misuse opioids will develop OUD. A person can become dependent, tolerant, or experience withdrawal on opioids without ever experiencing the symptoms associated with OUD. Complex interactions between a person’s environment and biology present risk and protective factors for individuals in developing OUD and its resulting clinical course. These factors do not determine whether or not an OUD will develop; however, they can interact to minimize or maximize the likelihood of its development.
Opioid Use Disorder Symptoms
An OUD diagnosis is applicable to a person who uses opioids and experiences at least two of the following 11 symptoms in a 12-month period:
- Taking in larger amounts than intended
- Desire to control use or failed attempts to control use
- Significant time spent obtaining, using, or recovering from the substance
- Craving for the substance
- Failure to meet obligations
- Social and interpersonal problems
- Activities given up or reduced
- Physically hazardous use
- Physical or psychological problems likely caused by use
Tolerance and withdrawal are not considered OUD symptoms when an opioid is being taken as prescribed.
What do opioids do the brain?
Opioids work by activating receptors in the body to block feelings of pain. The addictive nature of opioids is derived from their effect on the brain’s natural reward circuitry. Opioids produce an excess of dopamine; a neurotransmitter that contributes to feelings of pleasure and satisfaction. Opioids can produce feelings of relaxation, euphoria, and being “high.” The human brain is wired to repeat actions associated with these feelings and to avoid associated feelings of withdrawal; therefore, this excess of dopamine positively reinforces opioid-taking behaviors and biologically wires individuals to repeat them. With repeated exposures, a person’s brain circuitry and chemical systems are altered, affecting cognitive, emotional, biological, and social functions. Unlike substance misuse, addiction is a chronic brain disease. There are changes in specific areas of the brain which have been found to correlate with the behavioral manifestations we observe in people with addiction. While these brain areas trend back towards normal if the brain is not exposed to the drug of abuse, science has not shown a full return to normal in brains of people who have addictive disease.