healthy man after sub-acute medical detox

Opioid Addiction

Introduction

Perhaps you have heard of the opioid epidemic, which has made headlines in the United States over the past few years. Opioid use and abuse reached record highs over the past two decades, and efforts hava been made to control opioid use.

Why are these drugs so powerful and prevalent? First we must understand what opioid drugs are, how they work on the brain, why they are dangerous, and what types of treatments are available for opioid addiction.

What are Opioid Drugs?

Opioids are drugs that act on the opioid centers of the brain. There are two types of these drugs:

Opiate

Opiate refers specifically to drugs that are derived naturally from the opium poppy. The opium poppy produces big, colorful blooms and a large seed pod once the blooms have finished. Milky liquid seeps from the seed pods, and it is this liquid that contains opium.

The seed pod is scored to created opium, and the liquid can then seep out. After the liquid has dried into a gum-like substance, it is scraped off the seed pod and placed in open, wooden boxes to dry. It is then placed in bags or rolled into balls to be sold.1

Synthetic Opioids

Synthetic Opioids are opioid drugs that are made either partially or entirely from synthetic chemicals in a lab. Pharmaceutical companies have made these drugs for pain relief. Some of these drugs are made from opiates, while others are entirely synthetic.

History of Opium Use

Opium has been used as a pain reliever and sleep aid since ancient times. The first written reference to opium comes from Mesopotamia about 3400 B.C., where the ancient Sumerians referred to the opium poppy as hul gil, or the “joy plant.” This region of Mesopotamia is now located in Iraq and Kuwait.

Ancient Popularity

The use of opium spread from Mesopotamia to Persia and ancient Egypt. It was widely popular during the reign of King Tutankhamen about 1333 to 1324 B.C. Opium use also spread to ancient Greece. The Greek author Homer refers to opium in his epic work The Odyssey. Opium was used by ancient peoples to relieve pain, aid in sleep, and to help calm crying children. Some evidence also points to opium being used as an anesthetic during surgery.

Opium Comes to China

Opium was introduced to East Asia and China around the 6th or 7th centuries A.D. It was traded along the Silk Road, a trade route that connected Greece and Rome with central Asia, India, and China. During the 1700s, Great Britain conquered the region of India where opium poppies were grown and began using opium as a trade good to purchase tea, silk and porcelain from China. This trade led to widespread opium addiction in China. The Chinese ruling dynasties tried to reduce the use of opium. Two opium wars were also fought against Great Britain in the 1800s. These wars resulted in China losing its control of Hong Kong.

Harnessed for Medical Purposes

During the 1800s, scientists began studying opium for medical purposes. Morphine was first isolated from opium in 1803 and was used as a pain killer during the U.S. Civil War. About 400,000 soldiers became addicted to morphine as a result. Heroin, which was considered a safer drug, was isolated in 1874. Heroin was used as a substitute for morphine, as well as a cough suppressant until its addictive properties became apparent in the early 1900s.

Increasing opium use and problems with addiction during this period led to the eventual passage of the Harrison Narcotics Tax Act of 1914, the first major piece of legislation regulating opiates in the United States. Ten years later, the Anti-Heroin Act of 1924 made the production and sale of heroin illegal in the United States. The sale and use of opiates have been strictly regulated ever since.

Opium is currently produced legally for medical purposes in India, Turkey, and Australia, where two thousand tons of opium are produced annually. Illegal production of opium takes place in three other countries: Burma, Afghanistan, and Columbia. As of 2010, Afghanistan produced 90% of all illegal opium in the world.3

List of Opioid Drugs

This list gives an overview of the main types of opioid drugs. 4, 5 It includes brand and street names, and whether or not each drug is natural or synthetic. Also provided is its classification by the United States Drug Enforcement Agency, and the primary uses for each drug.

Opium

Brand Name: Paregoric Type: Natural (opiate)
Controlled Substance Classification: Schedule II
Uses: Paregoric is used legally to relieve diarrhea. Opium is used illegally in other instances. It can be smoked, injected, or taken in pill form. Sometimes combined with other drugs; it provides an initial euphoria followed by a relaxed state.
Street Names: Big O, Auntie Emma, Black Pill, Chinese Molasses, Midnight Oil, and Zero

Morphine

Brand Name: Kadian, MS-Contin, Oramorph SR, and MSIR Type: Natural (opiate)
Controlled Substance Classification: Schedule II. Some combination medications are Schedule III. Some related drugs containing morphine are Schedule I.
Uses: It is taken by injection, oral solution, pill form or suppository. It can be legally prescribed for control of severe pain.
Street Names: – Morpho, Dreamer, Mister Blue, First Line, God’s Drug, and Emsel

Heroin

Brand Name: None Type: Natural (opiate)
Controlled Substance Classification: Schedule I.
Uses: Illegal use only. Injected, smoked, or snorted for an initial high followed by a partially sedated state.
Street Names: Smack, Black Tar, Big H, Hell Dust, Thunder, and Chiva

Codeine

Brand Name: Tuzistra XR, Tylenol-Codeine No. 3, Robitussin AC, Type: Natural (opiate)
Controlled Substance Classification: Schedule II. Some combination medications are Schedule III or Schedule V, depending on the amount of codeine in the combination.
Uses: Legally used as a pain reliever and a cough suppressant. Taken in tablet or syrup form.
Street Names: Captain Cody, Schoolboy, Lean, Sizzurp, and Purple Drank

Fentanyl

Brand Name: Actiq, Abstral, Onsolis, and Fentora Type: Synthetic
Controlled Substance Classification: Schedule II. Some related fentanyl drugs are Schedule I.
Uses: Legally used to treat breakthrough pain in cancer patients. Only used when other pain relievers are ineffective. Used illegally for its intense, short-term high. Taken as a lozenge, tablet, or on a patch.
Street Names: Poison, China Girl, Great Bear, Dance Fever, He-Man, and Tango & Cash

Hydromorphone

Brand Name: Dilaudid, and Exalgo Type: Synthetic
Controlled Substance Classification: Schedule II
Uses: Legally used to treat severe, chronic pain. It is taken in a tablet, oral solution, suppository, and injectable forms. Used illegally for its effect on relaxation, and anxiety-reducing properties.
Street Names: Smack, Black Tar, Big H, Hell Dust, Thunder, and Chiva

Methadone

Brand Name: Methadose, and Dolphine Type: Sythentic
Controlled Substance Classification: Schedule II.
Uses: Legally used to offset the effects of opioid withdrawal for people in treatment for opioid addiction.
Street Names: Chocolate Chip Cookies, Fizzies, Water, Salvia, Pastora, and Amidone

Hydrocodone

Brand Name: Anexia, Dicodid, Hycodan, Lorcet, and Norco Type: Sythentic
Controlled Substance Classification: Schedule II.
Uses: Legally used to treat severe pain and upper respiratory infections. Used illegally to treat pain and to prevent the symptoms of withdrawal from pain medications.
Street Names: Hydro, Norco, Vikes, and Watson 387

Oxycodone

Brand Name: Oxycontin, Xtampza ER, and Roxicodone Type: Natural and Synthetic
Controlled Substance Classification: Schedule II.
Uses: Legally used to treat severe pain. Illegally used for a high and numbing effect. Usually taken in pill form.
Street Names: Kicker, Percs, Hillbilly Heroin, OC, 512s, and Blue

Oxymorphone

Brand Name: Opana and Opana Type: Synthetic
Controlled Substance Classification: Schedule II.
Uses: Legally used to treat severe pain. Illegally used for the high it produces. Taken in pill form, injection, or by snorting.
Street Names: Blue Heaven, Mrs. O, Octagons, Oranges, The O Bomb, Pink, Pink Lady

Buprenorphine

Brand Name: Bunavail and Zubsolv Type: Synthetic
Controlled Substance Classification: Schedule III.
Uses: Used to treat opioid addiction. It is administered as a sublingual tablet or film (under the tongue). Some people buy buprenorphine illegally to treat addiction.
Street Names: Bupe, Sub, Subbies, and Orange Guy

Tapentadol

Brand Name: Nucynta and Nucynta ER Type: Synthetic
Controlled Substance Classification: Schedule II.
Uses: Used to treat severe pain, especially nerve pain resulting from diabetes. Taken in tablet form.
Street Names: None

Tramadol

Brand Name: Conzip and Ultracet Type: Synthetic
Controlled Substance Classification: Schedule IV.
Uses: Legally used to treat moderate pain and to improve mood. Less potent than other opioid medications. Taken in tablet and capsule form.
Street Names: Trammies, Chill Pills, and Ultra

Meperidine

Brand Name: Demerol Type: Synthetic
Controlled Substance Classification: Schedule II.
Uses: Legally used to treat severe pain. Taken in tablet or syrup form. People may abuse the drug by taking larger amounts as they build a tolerance.
Street Names: Demmies and Pain Killer

How Do Opioids Work?

Opioids drugs, both synthetic medications and natural drugs, work by binding to the opioid receptors of nerves in the brain, spinal cord, and other parts of the body. The body naturally produces chemicals for this purpose, providing some natural pain relief. Opioid medications multiply the pain-relieving effect, much more than natural versions of the drug. This makes these drugs highly effective in relieving severe, long-term pain. Opioid medications are often prescribed to relieve pain after surgery and to relieve pain from chronic conditions such as cancer.

Recent research has revealed that opioid drugs not only bind to opioid receptors, but also to receptors in other structures of the brain. This may account for the side effects that these medications cause.6 Studying the actions of opioid medications may help researchers develop safer pain medications that do not have this extra binding action. The result would be pain relief that is less addictive with a lower risk of overdose.

Use and Abuse

According to the 2018 National Survey on Drug Use and Health (NSDUH), about 10.3 million people age 12 and over misused opioid drugs over the past year. This included people who used heroin as well as opioid pain-relieving medications. The number of people who misused opioid drugs accounted for about 3.7 percent of the adult population in the United States.7 9.9 million people misused opioid and opiate pain medications, while 808,000 misused heroin.

The percentage of people who have misused these drugs has declined over the past few years.

The highest rates of misuse among adults occurred in the age 18 to 25 category. This age group also experienced the greatest decline in opioid misuse. Most adults who misused opioid drugs reported misusing them to relieve pain. The most commonly misused opioid medication reported in 2018 was hydrocodone.

Health Risks of Opioids

While each opioid drug has its own side effects, all of these drugs have some dangerous health risks in common. These risks are particularly apparent in cases of opioid overdose. Signs of overdose include:

Drowsiness or loss of consciousness

Small, constricted pupils

Pale, cold, clammy skin

Body goes limp

Slow, shallow breathing

Choking or gurgling sounds

Blue or purple fingernails and lips

Slow or stopped hearbeat

If an overdose of an opioid drug is suspected, it’s vitally important for emergency medical care to occur immediately. Naloxone ( Narcan) is a medication that can be used to stop the effects of an overdose. Naloxone is an opioid antagonist, meaning it has the opposite effect on the body that opioid drugs do. Because of this, Naloxone can reverse an overdose quickly if administered in time.

Dependence and Addiction

A second health risk that all opioids have in common is the risk of dependence and addiction. Opioid drugs build up a tolerance in the body very quickly. Tolerance is when more of the drug is needed for the same effect. People who take opioid drugs regularly build tolerance and develop dependence, requiring medications to ward off the symptoms of withdrawal. Symptoms of withdrawal include:

Fast heartbeat

Fast breathing or shortness of breath

Irritability 

Restlessness 

Insomnia 

Sweating

Chills

Joint pain and muscle cramps

Widened pupils, causing sensitivity to light

Seizure 

Nausea and vomiting

If you or someone you love is struggling with withdrawal from opioids, seek medical help as soon as possible to manage symptoms.

Treatment for Opioid Addiction

A person who has become addicted to opioid drugs cannot quit on their own but must go through a medically managed detoxification process. Detox occurs in an inpatient rehabilitation setting, where withdrawal symptoms can be managed by trained personnel to prevent complications such as respiratory distress, heart attack, or seizures. One should never attempt to go through detox on their own at home, as severe withdrawal symptoms may occur as a result.

Once detox is completed, treatment for addiction may begin. Commonly used treatment techniques for addiction include:

Medications

Medications are frequently used to assist in recovery from opioid addiction. The primary medications used to treat opioid use disorder are:

Methadone: A synthetic medication that acts on the same receptors of the brain as opioids, but for a longer time at a lower intensity. Methadone reduces cravings and relieves withdrawal symptoms. Methadone is only available through specially licensed treatment programs for opioid addiction.

Buprenorphine: Another synthetic medication that acts on the same receptors of the brain as opioids. Buprenorphine is not as highly regulated as methadone, so it is more readily available in a larger number of treatment programs. Buprenorphine can also be prescribed through outpatient rehabilitation programs.

Naltrexone: Makes opioids ineffective by blocking their access to the opioid receptors in the body. It is especially effective for people who have trouble remembering to take other medications.

Behavioral Treatments

Behavioral treatments are provided through either inpatient or outpatient treatment programs. These treatments focus on changing the patterns of thinking and behaviors that lead to drug abuse. Techniques used during behavioral treatment include:

Cognitive Behavioral Therapy: One-on-one counseling helps to identify the thought processes that lead to drug use. Counseling gives strategies to help change negative thought processes and supports the development of drug-free patterns of thinking.

Contingency Management: This type of treatment provides rewards for abstaining from drug use. Contingency programs usually involve vouchers that can be exchanged for prizes or items of monetary value.

Marital and Family Counseling: The inclusion of family members in the rehabilitation process can be vital in supporting long-term recovery. Family counseling helps to repair relationships between the person and family members that were damaged by opioids.

Get Help for Opioid Addiction

Opioids have been around for many years, but they are just as dangerous and addictive as they have always been. While opioids may be used for some pain relief, the risk of overdose and addiction is very high. People who take opioid medications should do so under the strict supervision of a doctor. If you or someone you love has developed an opioid use disorder, medical help can end opioid dependence in a safe and effective manner.


Resources

  1. Cannabis, Coca, & Poppy: Nature’s Addictive Plants.” DEA Museum, Drug Enforcement Administration, 2008.
  2. History.com Editors. “Heroin, Morphine and Opiates.” History.com, A&E Television Networks, 12 June 2017.
  3. “Cannabis, Coca, & Poppy: Nature’s Addictive Plants.” DEA Museum, Drug Enforcement Administration, 2008,
  4. Drug Facts.” DEA, United States Drug Enforcement Administration, 2019.
  5. Drugs, Herbs and Supplements.” MedlinePlus, U.S. National Library of Medicine, 28 Apr. 2015.
  6. How Opioid Drugs Activate Receptors.” National Institutes of Health, U.S. Department of Health and Human Services, 5 June 2018.
  7. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19 5068, NSDUH Series H 54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from 
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100% Free and Confidential.
1 (866) 338-6925