What are opioids? Why are opiate drugs so addictive and lethal? Does rehab work for opioid addiction? As declared by the National Institute on Drug Abuse and the Centers for Disease Control and Prevention, the U.S. is in the midst of an opioid epidemic. It’s more important than ever to understand how prescription painkillers, heroin and other opiate drugs work, why dependence on opioids can develop before you realize it, and which treatment approaches and rehab options are most effective. What Are Opioids? “Opioids” is an umbrella term for natural and synthetic painkillers derived from or based on the poppy plant. The related term “opiate” applies only to medications that use natural opium poppy products. For example, the drug heroin is an opiate. Physicians often prescribe opioids to relieve acute pain—from injuries, surgeries, toothaches or other medical and dental procedures—or to alleviate chronic pain. However, studies show that long-term use of opioids for chronic pain is ineffective—and comes with the risk of addiction. You might recognize the names of some of the more well-known opioid drugs prescribed for pain, including: Morphine Codeine Heroin (Diacetylmorphine) Hydromorphone (Dilaudid) Hydrocodone (Vicodin, Lortab) Opium Oxycodone (OxyContin, Percocet) Oxymorphone Meperidine (Demerol) Methadone Fentanyl (Sublimaze, Actiq) Tramadol How Do Opioids Work? When opioid molecules travel through the bloodstream and into the brain, they attach to receptors on the surface of certain cells. The chemical response triggered in the brain’s reward center is the same as the reaction to intense pleasure and reinforces acts such as eating, drinking fluids, caring for babies and having sex—all necessary for survival of the species. These rewarding and survival-based activities result in release of dopamine in the brain’s reward center. But opioids, like all drugs of abuse, trigger the release of dopamine in excess amounts, far beyond what is needed to provide pleasure or keep us alive. The brain has been signaled: Something extremely important has taken place, and it needs to be repeated. Symptoms and Side Effects of Opioid Abuse Anyone exposed to opioids will experience excess dopamine release in the reward center of the brain. However, most people do not become addicted after such exposure. Your risk of dependence is higher if you or someone in your family has a history of substance abuse. Although most people take prescription painkillers responsibly and as prescribed, there has been an increase in nonmedical use of prescription opioids in the United States. Signs and symptoms of opioid intoxication include: Problematic mental health, behavioral or psychological changes such as agitation, impaired judgement or apathy Drowsiness or coma Impaired attention or memory Slurred speech Constricted pupils Side effects of opioid abuse can include: Dry mouth Drowsiness Nausea Constipation Abdominal cramping Depressed respiration Opioid use also can induce euphoria, an effect that can be intensified when the drug is administered by routes other than those prescribed or recommended. For example, the prescription painkiller OxyContin can be snorted or injected to enhance its euphoric effects. Unintended consequences of misusing opioid drugs in this way can include serious medical problems, even opioid overdose. Opioid Dependence Addiction is defined as the compulsive and uncontrollable use of drugs despite adverse consequences. Dependence occurs when the body adapts to the presence of a drug, causing withdrawal symptoms when drug use is reduced or discontinued. Prolonged and increasingly higher doses of opiate drugs changes the brain so that it functions more or less normally when the drug is present and abnormally when the drug is removed. This alteration in the brain results in drug tolerance (the need to take higher and higher amounts to achieve the same effect; “chasing the dragon”) and opioid dependence (susceptibility to withdrawal symptoms). Euphoria is the sensation most opioid users seek, but it’s also the effect most likely to diminish with regular opioid abuse. Prolonged use changes the brain’s opioid receptors at a cellular level, a protective response against overstimulation. That’s why it’s said an opioid addict uses the drug in order to feel “normal. Many people assume addicts take pleasure in their daily substance abuse, but most people who develop opioid dependence cannot recall the last time their drug use was enjoyable. After a certain point, substance abuse and dependence becomes drudgery and its own form of torture. Symptoms of opioid dependence include: Taking the drug in larger amounts or over a longer period than intended or prescribed A persistent desire or unsuccessful efforts to cut down or control opioid use An excessive amount of time and effort spent getting and using opioids and recovering from the effects of drug abuse Intense cravings or a strong desire or urge to use opiates Failure to fulfill obligations at work, school or home due to drug abuse Continued use of opiates despite persistent or recurrent social or personal problems caused by usage Continued use despite situations which could be physically hazardous Continued use despite awareness of potential physical or psychological problems Taking a large single dose of an opioid can cause severe respiratory depression with the potential for accidental drug overdose and death. Opioid abuse is also associated with a higher risk of suicide. Opiate Withdrawal and Relapse Opioid withdrawal can be especially challenging. In fact, the fear of experiencing severe opiate withdrawal symptoms prevents many addicts from getting the help they need and deserve. Opioid withdrawal symptoms include: Restlessness Muscle and bone pain Insomnia Diarrhea Vomiting Cold flashes with goose bumps ("cold turkey") Involuntary leg movements Agitation Anxiety Itching Irritability Rapid heart rate Mild hypertension Runny nose Sweating Fever Yawning At the height of opiate withdrawal, symptoms typically include intense anxiety, tremors, shakes, muscle cramps and joint and deep bone pain begin to manifest. Down the road are more serious, long-term consequences of opiate withdrawal. Anxiety, depression and cravings can continue for months, even years after being free of use. Addicts in recovery also have an increased sensitivity to real or imagined pain and are more vulnerable to stressful events. The desire to feel “normal” again, to escape this seemingly permanent state of dysphoria, puts addicts at a high risk of relapse, and, even more tragically, at a high risk of accidental opioid overdose and death. A user who returns to the same dosage after losing his or her drug tolerance risks respiratory suppression and death. Treatment for Opioid Use Disorder Because of the unique challenges in addressing opiate addiction, and because of the addict’s vulnerability to relapse and accidental death, Hazelden Betty Ford developed enhanced opioid addiction treatment protocols that include the use of certain medications, extended continuing care and close monitoring of medication use. These addiction treatment protocols are known as the Comprehensive Opioid Response with Twelve Steps (COR-12™). The approach is designed to provide addicts with a sufficiently long enough time in recovery to begin forming new relationships and taking in new information essential to addiction recovery. Treatment is delivered within the context of Twelve Step Facilitation and other evidence-based therapies, with abstinence from drugs as the ultimate goal. As part of the COR-12 addiction treatment protocol, physicians work with each patient to determine the treatment course that best fits his or her clinical needs. Patients may receive Suboxone®, a combination of buprenorphine and naloxone, for detox to ease withdrawal symptoms. Some patients may receive a recommendation for a monthly, extended-release injection of Vivitrol®, also known as naltrexone, to ease cravings. This medication works to block cravings and help prevent relapse. Although methadone is commonly used to ease opioid/opiate withdrawal, Hazelden Betty Ford provides buprenorphine instead, for a number of important reasons. Buprenorphine has been deemed a better medication for the Hazelden Betty Ford Foundation's patient population, in keeping with the goal of transitional use of medication-assisted treatment versus long-term medication maintenance. Learn more about methadone vs suboxone for treatment of opiate addiction and withdrawal. Learn more about our medication-assisted opioid addiction treatment program. You may also be interested in Prescription Painkillers: History, Pharmacology, and Treatment by Marvin D. Seppala, MD (Hazelden Publishing, 2010). Partially excerpted from Prescription Painkillers by Marvin D. Seppala, MD, chief medical officer of the Hazelden Betty Ford Foundation.