Opioids are a class of drugs made from natural opium found in the poppy plant or synthetic ingredients intended to resemble naturally occurring opium related drugs. Natural opioids include morphine, codeine, noscapine, thebaine and papverine. Synthetic derivatives of natural opioids include heroin, dihydrocodeine, hydrocodone, hydromorphone, oxycodone, oxymorphone, methadone, suboxone, subutex along with many others. These drugs are also referred to as narcotics.
Legal opioids are often used for pain relief, to suppress coughs and to inhibit bowel mobility. However, other legal opioids, including methadone, suboxone and subutex, are prescribed to treat opioid use disorders. Heroin is an illegal opioid with serious side effects. However, the highest rates of illicit narcotic use involves legally prescribed narcotics. This is often not from “doctor shopping.” Many individuals exaggerate their pain or symptoms to receive higher doses. Also, there are many online pharmacies that will prescribe medications without a prescription. Currently, narcotics are the fastest growing group of prescription drugs that are abused.
Opioids attach to specific receptors in the body leading to the reduction of pain and improved mood. For some people a euphoric feeling results since opioids have effects on the reward centers of the brain. Due to these positive feelings and sensations, many people take more of the medication than is prescribed. This is because the longer you take the drug the more your body will build a tolerance. Those who abuse the drug may seek to take the drug using non-traditional delivery methods. For example, generally opioids are taken through injection or orally – methods designed to lead to a steady release of the medication over time. Those who take the medication in pill form and want a quicker, stronger effect, may grind the pills and snort them or even learn to develop a way to prepare them so they can be injected intravenously. This significantly increases the risk of overdose or serious health complications. This is particularly the case with the drugs that lead to mental confusion since this leads to people failing to remember when they took their last dose and leave them too incapacitated to get help when they realize something is wrong.
Statistics
The occurrence of opioid abuse in this country is increasing rapidly each year. The prevalence rates of opioid use disorder is approximately.37 percent in those over the age of 18. This is likely an underestimate since many of those who are incarcerated use drugs, the most common of which are narcotics. In addition, unless individuals over-using narcotics present to clinics or hospitals they are not included in the calculation of prevalence rates.
Rates are almost twice as high in males than females (.49 percent compared to .26% respectively). However, the male to female ratio differs by drug of choice. For narcotics that can be obtained by prescription, this ratio is approximately 1.5 to 1. However, the rate increases to 3 to 1 for heroin. Many female adolescents report having abused narcotics at some point during their teenage years though they most often stop using them by the time they have reached early adulthood. When interviewed, these young women frequently retrospectively report that they took the drugs to feel more confident, to calm their social anxiety and decrease the worries about their body image. They also reported they felt they could more easily interact with potential romantic partners whom they had felt inhibited around when not using the drug. The highest prevalence rates (.29 percent) occur among adults aged 29 and begin to drop off with increasing age. In adults aged 65 and older the rates drop to .09 percent.
Causes of Opioid Use Disorder
Although there is limited evidence regarding the causes of opioid addiction, research has demonstrated support for several hypotheses.
- Direct Genetic Influences – It has been shown through numerous studies of families that opioid addiction runs in families. In particular, those with first degree relatives who have an opioid addiction are more likely to develop the same addiction.
- Indirect Genetic Influences – Overall, causes are believed to be related to social, individual, family, peer and environmental factors. However, it has been suggested that these causes operate through genetics. For example, certain temperamental qualities appear to effect the development of opioid addiction in particular, novelty seeking and impulsivity. Yet temperament is considered to be inherited and the specific qualities one displays inborn. Another example would be related to how peers influence the development of the addiction in others. While peer influence has been hypothesized to be a strong causal factor, it has long been recognized that we select our environment and are drawn to relate to certain types of people. These tendencies are believed to be the result of an interaction between heredity and environment.
- Lack of Adaptive Coping Mechanisms – One theory about the cause of opioid addiction involves individuals who cannot regulate their emotions in particular with regard to negative mood states. Thus, if they lack coping mechanisms to help them decrease negative moods, they may search for another way to elevate their mood. Often through peers, they try opioids and after experiencing the positive mood or even euphoria that results become addicted very quickly.
- Modeling – One way we learn behaviors is through observing others. If we are raised in a family that does not model positive ways to handle stress and instead uses narcotics to avoid feelings of distress, we may grow up believing that is a viable and preferable manner to use when experiencing stressful situations or relationships.
- Physiological Predispositions and Stress – Each of us is born with certain physiological characteristics that predispose us to develop certain problems or disorders and not to develop others. Thus, one hypothesis suggests that people who are predisposed to suffer from an opioid addiction may or may not go on to actually develop that addiction if exposed to numerous stressors throughout their lifetime.
- Repeated Rewards Experienced in the Brain – Our brains are hard wired to make sure that we repeat life sustaining activities such as eating and drinking by pairing them with pleasure. Similarly, using an opioid results in extreme pleasure, influencing the person to want to repeat the experience. Before long, our brain interprets the use of the opioid as a life sustaining activity due to the same neural circuit that is created between real life sustaining activities and pleasure.
Signs and Symptoms of Opioid Use
- Opioids are taken over a longer period of time or at a higher dose than intended
- The individual continues to attempt to cut down on the amount used but is unsuccessful
- The individual spends a lot of time trying to get, use or come down from the opioid
- The individual craves the drug
- Opioid use begins to interfere with the individual’s ability to fulfill responsibilities in various areas of life
- Despite recognition that opioid use is damaging relationships or leading to serious interpersonal problems the individual keeps using them
- Opioid use leads to the individual abandoning important activities in their life
- The individual continues to use the drug even in situations when it can be dangerous
- Despite being aware that a pre-existing psychological or physical problem is being made worse by the drug, the individual continues to take it
- The development of tolerance:
- The individual needs more of the drug to achieve the desired effect
- The effect of the drug continues to diminish over time when the individual maintains the same dose
- The development of withdrawal:
- Withdrawal symptoms result in cessation of the drug including negative mood, nausea or vomiting, muscle pain, sweating, runny nose and tearing
- Opioids are taken specifically to prevent or avoid the negative symptoms of withdrawal
Effects of Opioid Use
There are a number of effects that result from the use of opioids. These include:
- Feeling tire, fatigued and sedated
- Constipation
- Euphoria
- Constricted pupils leading to decreased sight in dim or darkened conditions
- Nausea and vomiting
- Chest pain
- Decreased respiration and trouble breathing
- Death
- Physical and psychological addiction
- Development of the belief that the drug is needed to act “normally” or decrease shyness so the person feels comfortable in social interactions