What You Don’t Know Unless You’ve Been There: Opioids

In our series about drug addiction, “What You Don’t Know Unless You’ve Been There,” Addiction.com writer Fran Kritz talks to recovering addicts and healthcare professionals who treat those in active addiction to share what it’s really like to live with all kinds of addiction.

Whether they occur naturally or are made in a lab, opiate drugs are known as opioids. These include morphine, codeine and oxycodone, says the National Institute on Drug Abuse. When an opiate enters the brain it is converted to morphine (if it isn’t morphine to begin with, of course) and then binds to opioid receptors in the brain that are associated with profoundly pleasurable feelings of pain relief and what brain scientists call “reward.”

That’s why people get a euphoric rush when using opioids, which also include heroin, says Marci Ouellette, RN, director of nursing at Mountainside, a substance abuse treatment center in Canaan, Connecticut. This class of drugs also decreases anxiety and pain and, like heroin, gives the user a feeling of detachment from the world along with extreme pleasure. Here are a few things to know about what it’s really like to live with an opiate addiction or care for those who do:

Your risk of overdose or brain damage from an opioid is very real. Deaths from prescription painkillers have quadrupled since 1999, killing more than 16,000 people in the U.S. in 2013, according to the Centers for Disease Control. And nearly two million Americans age 12 or older either abused or were dependent on opioids in the same year. Opioid receptors are located in the brain stem, which also controls the autonomic nervous system — responsible for blood pressure, respiration and alertness. High doses of opiates depress these functions and can lead to a fatal overdose or brain damage from a lack of oxygen to the brain if breathing decreases enough, explains Ouellette.

Different pills mean different risks. Not only are there a variety of opioids, they come in different prescription strengths, which can cause both fluctuating highs and varying levels of danger. “Some people think prescription opiates are safe because they are prescribed,” notes Ouellette. That’s not always the case, though, and it can be very difficult to convert the strength and timing (some pills are extended-release, while others are fast-acting) of various medications without risking serious side effects, or worse. That said, if you take the drug as directed by a physician for a short period of time for acute pain relief and/or switch to over-the-counter pain relief if your doctor tells you to, these medications typically do not lead to addiction in most people.

What starts out as seeking relief can quickly turn into chasing the high. Often, those who begin taking Vicodin, Percocet or Oxycontin to ease a chronic backache or pain from an injury end up loving the buzz these meds give. They may take an extra pill and tell themselves they’re hurting more that day, to justify the extra dose. “Soon,” says Ouellette, “an extra pill a day can become several extra a day and addiction can follow. ” After all, many millions of Americans are in need of pain relief, and striking a balance can be very tricky to navigate. “Some people have pain that needs to be managed — pain is a part of their life and it can certainly be that prescription opiate pain relievers are the best choice, or the only choice,” Ouellette says. But, she adds, oftentimes, there are other methods of relief that can be used in conjunction with medication to help, such as yoga and meditation.

Opioids can hurt your body in myriad ways. While these pain relievers are mostly meant to be taken orally, they’re often crushed and snorted to obtain a quicker high, says Ouellette. This can do damage to the nasal airways, the back of the mouth and throat and the lower respiratory airways, to the point of deteriorating these tissues. The damage may irreversible and could require surgery.

Your doctor may not know how to prescribe opiates properly or how to recognize and treat addiction. Connie, 38, who works at a supermarket in her hometown of Minneapolis, was addicted to opiates and other substances for years before going into recovery in 2014. She was first put on opiates for pain relief in the third grade, when she had knee surgery, and then again in fifth grade for thyroid surgery. She became addicted to the drugs back then — a situation made worse by her parents, who were substance abusers and perhaps not aware of what was happening to their daughter. If you’re living with chronic pain, Connie suggests telling your doctor that you want to try other approaches — exercise, massage, nonprescription relief — before trying opiate painkillers. “Doctors will cut you off if they find you’re abusing opiates, but they’re often the ones who prescribed them in the first place,” she notes.

Opioids may be expensive, but cheaper heroin brings its own big risks. “Many addicts get to a point where they can no longer afford to keep buying the pills,” Ouellette notes. “Since heroin is so much less expensive, oftentimes they switch to heroin in a quest for the same high for less money.” At that point you’re dealing with a whole new set of dangers, namely additives and adulterants to heroin that can be lethal and the risk of blood borne diseases such as HIV if needles used to inject heroin are shared.

Withdrawal is often devastating. Edwin Salsitz, MD, an addiction medicine specialist in the chemical dependency division of Mount Sinai Beth Israel Medical Center, in New York City, says that addiction experts have a saying: “Opiate withdrawal won’t kill a person, but the person withdrawing wishes it would.” Connie concurs that leaving the drugs behind is no easy feat: “Even though I’m now off opiates, I don’t know how to tell people to come off them; it’s something you have to do for yourself. Nobody else can want this for you,” she says. “You have to chase recovery the way you chased the drugs.”

Your loved ones may need to save you from an overdose. Dr. Salsitz says that anyone addicted to opioids should have a family member or significant other learn how to administer naloxone (brand name: Narcan), a drug that reverses an overdose from opiates or heroin/opioids. “It can save you,” he says plainly. Doctors can prescribe naloxone and in some states pharmacists can dispense it directly, without a doctor’s prescription, he adds.

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One Response to What You Don’t Know Unless You’ve Been There: Opioids

  1. anjay September 25, 2015 at 8:57 pm #

    This is great info for those who do not understand Substance Abuse Disorder. I recommend it to everyone.

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