Opiates are powerful narcotics that include drugs like heroin and fentanyl. With a high potential for abuse, opiate addiction can lead to fatal overdose. To overcome addiction, medications may be used during treatment to ease withdrawal symptoms and manage dependence.
In 2015, about 20 million people suffered from a substance use disorder (SUD). Out of those 20 million, 2 million were addicted to prescription painkillers, while another half a million were addicted to heroin.
Heroin and prescription painkillers are opiates, the main culprit for the rise in drug-related deaths.
2015 recorded over 20,000 overdose deaths caused by prescription painkillers, and another near 13,000 related to heroin.
It’s estimated that more than 90 Americans die every day from an opiate-related overdose.
And human life isn’t the only cost; the estimated economic price it costs the United States is almost $80 billion, factoring in the costs of healthcare, addiction treatment, and the overall loss of productivity.
Opiate abuse and addiction continue to grow worse, and in 2017 the Trump administration declared it a public health emergency.
This epidemic affects millions of people, and understanding opiates is a reasonable starting point for battling addiction and finding the right treatment.
What Are Opiates?
Opiates are the natural substances derived from opium, which is extracted from the poppy plant.
Opiates are routinely used to treat severe pain after surgery or intense trauma.
Often used as a standard of care to offer patients pain relief, opiates produce sedation, reduce anxiety, and create a strong sense of well-being that is euphoric or feels good.
Because opiates produce feelings of euphoria, they are highly addictive. Most opiates rank as DEA schedule II drugs, meaning they have a high potential for abuse, but some medicinal value.
Heroin, an illicit opiate, is a DEA schedule I drug, meaning it has a high potential for abuse, but no known medicinal value.
Opiates may also be referred to as narcotics, which means any drug derived from opium, including synthetic substitutes (opioids).
Many people receive prescriptions for opiates to relieve pain, and some speculate this is a major cause for the country’s current crisis. Nearly a third of all people prescribed opiates, or opioids, end up misusing them for nonmedical purposes.
What’s more, it’s estimated about a tenth of all people prescribed painkillers will develop a substance use disorder (SUD) relating to opiates or opioids.
There are many prescription drugs that contain opiates. Here’s a list of commonly abused opiates and opioids:
- Darvocet (propoxyphene)
- Demerol (meperidine)
- Dilaudid (hydromorphone)
- Oxycontin (oxycodone)
There is some confusion regarding the terminology of opiates and opioids. Although they’re both narcotics, what’s the difference?
Opiates VS Opioids
While technically different terms, opiates, and opioids are generally used interchangeably.
Both opiates and opioids are used to treat pain, can be used illicitly, and can lead to abuse and addiction.
However, the one major difference is how the drug is made.
In the simplest terms, opiates are the natural substances derived from opium and include morphine, heroin, and codeine.
Opioids, conversely, are unnatural and produced in a lab, or “synthesized.” This is why people refer to opioids as synthetic or chemically manufactured.
Common opioids include prescription drugs such as Vicodin, Demerol, and Oxycontin.
Both opiates and opioids are narcotics, produce the same effects, and have a high potential for abuse.
More and more journalists and media correspondents refer to narcotics as opioids, even though they are also referring to other natural opiates. For the purposes of substance abuse information and treatment, this article will use the term opiate to describe all narcotics, opioids included.
Regardless of the term opiate or opioid, there are several signs and symptoms of narcotic, or opiate abuse.
Signs And Symptoms Of Opiate Abuse
Opiates work by acting on areas of the brain that respond to pleasure and pain. Once a person begins abusing opiates, they may need the drug to feel pleasure or happiness.
Typical signs of drug-seeking behavior include compulsively using drugs, showing impaired judgment relating to drugs, continuing to use drugs despite obvious harm, and constantly craving drugs.
This abusive pattern of drug-seeking behavior is likely to lead to addiction, and someone on this path may have a hard time with relationships, money management, and other responsibilities at home, school, or work.
Someone who abuses opiates is likely to show several physical and behavioral signs of misuse. A person abusing opiates may:
- act impulsively
- engage in risky activities, like having unprotected sex or driving under the influence
- go to various doctors in search of prescriptions (doctor shopping)
- experience dramatic mood swings
- have “pinpoint” pupils
- experience sleeping problems, or fall asleep at odd times
- withdrawal from social activities they usually enjoy
A person abusing opiates is also likely to experience more side effects. Many of these side effects may occur shortly after the drug is taken. Side effects may include:
- blurred vision
- impaired judgment
- itchy skin
- hallucinations (hearing or seeing things that aren’t there)
- loss of appetite
- slowed breathing
Long-term opiate abuse can cause serious and long-lasting health effects. When a person abuses opiates over time, they are likely to put vital organs at risk, and experience psychological issues like depression, anxiety, and difficulty thinking and concentrating.
Other long-term effects may include emotional instability, liver damage, brain damage, and severe constipation.
While the signs and symptoms of opiate abuse are troubling, opiate addiction will likely lead to further dangers and health risks.
The Dangers Of Opiate Addiction
Overdose is perhaps the greatest danger a person faces when they suffer from opiate addiction.
Opiates and opioids are responsible for thousands and thousands of deaths every year, and overdose is likely the result of taking too much, mixing with other drugs, or not knowing exactly what is being taken.
(Many overdose deaths are related to fentanyl, a powerful opiate often laced with or substituted for heroin, sometimes unknown to the person taking it.)
If a person is overdosing it should be treated as a medical emergency, and 9-1-1 should be contacted immediately.
Overdose is common for drugs like heroin and fentanyl. Symptoms of overdose are likely to include:
- blue lips and fingernails
- cold skin
- damp skin
- gurgling noises
- slowed breathing
If someone is having an opiate overdose, they may look pale and feel clammy, be unconscious or difficult to wake up and be limp in the body.
The lethal effects of an overdose can be reversed with Narcan (naloxone), so it’s imperative to call for help right away.
When suffering from addiction, people may inject opiates to feel the effects quicker. This can be dangerous because sharing the use of intravenous needles, for drugs like heroin and morphine, can accelerate the spread of HIV.
Opiates are also very dangerous when combined with other drugs or medications. Mixing opiates with substances like benzodiazepines (Xanax, Valium), alcohol, and barbiturates can be deadly because of their combined effect of slowing down breathing.
When people die from drug overdoses, it’s usually because their breathing is slowed, or depressed, to a point where it cuts out entirely.
Stopping use of opiates can be incredibly difficult for some because, if addicted, they’ve likely developed a dependence to opiates.
Opiate dependence is likely to occur after prolonged use. How long it takes a person to develop a dependence depends on their history of substance abuse and which opiate they abuse.
Dependence means a person will experience a period of sickness once they stop taking the drug.
When a person stops taking an opiate or quits “cold turkey,” the body needs time to adjust and recover. It’s this period of adjustment where a person experiences painful and uncomfortable physical and psychological symptoms known as withdrawal.
Due to the severity and discomfort of withdrawal symptoms, it can be very difficult for a person to quit “cold turkey” on their own, without assistance.
While symptoms of withdrawal onset depend on the person, their level of abuse and the particular opiate painkiller addiction abused are factors. For opiates, there will likely be some symptoms that occur early on, and others that may set in later.
Early symptoms of opiate withdrawal may include:
- involuntary limb movement
- muscle pain
- a runny nose
- trouble sleeping
As these symptoms persist, a person may appear on edge and restless. These symptoms can occur as soon as 6-8 hours after last use.
Some later symptoms of opiate withdrawal are likely to include:
- abdominal cramping
- cold flashes
- dilated pupils
Although none of these symptoms are life-threatening, they can be so uncomfortable that a person may turn to use more drugs in hopes of alleviating the discomfort.
It can be dangerous for a person to go through opiate withdrawal on their own. While quitting “cold turkey” without help or treatment is possible, it can be incredibly difficult and likely to lead to further drug use.
If a person does attempt the withdrawal process on their own, they’ll need a lot of support from family or friends, a stable environment, and medicine to ease the discomfort.
However, a far more effective route for dealing with the painful symptoms of opiate withdrawal is entering a facility, inpatient treatment center, or hospital to receive proper care during the detoxification process.
Detoxification is the process by which the body rids itself of harmful toxins.
An opiate detoxification, or detox, can be difficult for a person to endure on their own, and if withdrawal symptoms are severe, they may need a medically supervised detoxification.
A medically supervised detoxification must take place in a hospital or medical setting. During a medically supervised detox, staff can monitor symptoms as well as administer medication when necessary.
This can be useful for the early treatment of opiate dependence and addiction because there are several medications available to help deal with symptoms of withdrawal.
While detox is a necessary step towards recovery, it’s not a cure for addiction
Effective treatment for opiate addiction likely includes medication-assisted treatment (MAT) combined with a host of behavioral therapies.
Treatment For Opiate Painkiller Addiction
Medication-assisted treatment (MAT) includes the use of various medicines to combat drug cravings and painful symptoms of opiate withdrawal.
There are at least three effective medications approved to help treat opiate addiction. These medications include:
- Buprenorphine – used to treat withdrawal symptoms and decrease the time of detox. Also effective for long-term maintenance of addiction to help with drug cravings, dependence, and opiate misuse.
- Clonidine – used to alleviate symptoms of withdrawal and helps reduce anxiety, sweating, muscle aches and pain, cramping, and runny nose.
- Methadone – used for long-term maintenance to help with opiate dependence and other drug cravings. Methadone is likely administered to help reduce withdrawal symptoms and drug cravings and is then gradually decreased over time.
MAT aims to help people stay in recovery long enough to complete thorough treatment. It has shown to decrease opiate use, criminal activity, overdose death, and the spread of HIV and disease.
MAT is likely most effective at an inpatient treatment center because the center may offer behavioral therapies to coincide with medication.
Behavioral therapies used in conjunction with MAT is likely the most effective course of action for those suffering from opiate addiction.
Behavioral therapies aim to change a person’s thinking and attitudes towards drugs and may include one on one counseling, support groups, and other intensive therapies like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).
American Society of Addiction Medicine – Opioid Addiction 2016 Facts and Figures
NIDA –Opioid Overdose Crisis
DEA – Narcotics
State of Oregon – Opiate vs Opioid
US National Library of Medicine – The Doctor’s Dilemma: opiate analgesics and chronic pain
MedlinePlus –Opioid Abuse and Addiction
MedlinePlus –Opiate and opioid withdrawal