Back in 2017, the US Department of Health and Human Services declared opioids a Public Health Emergency due to the emergence of the opioid epidemic and the prevalence of increased opioid addiction.
36 million people abuse opiates and opioids worldwide, from OTC medication and prescription painkillers to illicit narcotics like heroin and synthetic opioids like fentanyl, according to the UN World Drug Report.
In the United States, both alcohol use disorder and substance use disorder increased significantly from 2019 to 2020, per SAMHSA’s most recent National Survey on Drug Use and Health (NSDUH 2020). Fortunately, there was a decrease in those with opioid use disorder, falling from 2 million adults in the US in 2019 to 1.6 million. However, that doesn’t mean that opioid addiction isn’t a problem.
While doctors are prescribing fewer prescriptions for opioid pain relievers, and the number of people with opioid use disorder is declining, this in no way means the opioid epidemic is over. Indeed, the growing menace of fentanyl is at least partially responsible for a 30% increase in fatal drug overdoses in the US, according to this CDC report.
What Are Opioids?
Opioids are a class of drug that stimulate the opioid receptors in your brain. Opioids can be natural or synthetic, and they can be categorized as follows:
- Endogenous opioids: Endogenous opioids like endorphins occur naturally in the human body.
- Opium alkaloids: Codeine and morphine are both isolated from the seeds of the opium poppy.
- Semi-synthetic opioids: Heroin and oxycodone are both considered semi-synthetic opioids. These are modified variants of opium alkaloids.
- Synthetic opioids: Methadone and fentanyl are examples of fully synthetic opioids. These drugs have similar properties to semi-synthetic opioids, but they are entirely manmade.
Opioids have a powerful mechanism of action reducing the amount of pain signals your body sends to your brain. This class of drug also influences the way your body responds to pain. Pain relief, then, is the primary purpose of opioids, but the rewarding and euphoric effects means opioids have a strong potential for abuse and addiction. As opioids interact with your brain’s natural opioid receptors, as well as on nerve cells throughout your body, your perception of pain is blunted.
While opioids are highly effective for the purposes of pain relief, they can also induce confusion, drowsiness, and severe nausea, in addition to euphoric effects. In high doses, opioids can also depress respiration to dangerous levels.
Opioids are prescribed for the treatment of acute post-surgery pain. They are also routinely prescribed for the management of chronic pain, the root cause of the opioid epidemic, and mercifully in decline.
Are Opioids Depressants?
Opioids act on your central nervous system (CNS) by directly impacting the brainstem’s respiratory center. This serves to decrease breathing rate and slow the overall activity of the CNS.
As mentioned above, high doses of opioids in any form can lead to this system completely shutting down, with breathing stopping. When opioid overdose occurs, it is typically triggered by respiratory depression due to the impact of opioids on the CNS.
If you take more than one CND depressant, this further increases the effects on your CNS with regard to respiratory depression. If you combine even a moderate dose of opioids with a substance like alcohol or sleeping pills, you could easily overdose, potentially with lethal consequences.
This risk is increased in older adults. Seniors often have multiple prescriptions, intensifying the likelihood of an adverse or harmful drug interaction.
Examples of Opioids
These are some of the most prescribed opioids for pain relief:
- Vicodin (hydrocodone)
- OxyContin (oxycodone)
Codeine and morphine have been used for centuries for the purposes of pain relief, although both also have the potential for abuse. The medication at the heart of the opioid epidemic in its early phase, OxyContin was flagged as a nationwide issue back in the early 2000s.
While prescribing practices have tightened up and fewer people are using opioid painkillers, the same does not apply to synthetic opioids. Common examples include:
Fentanyl is up to 100 times stronger than morphine. Heroin is up to 5 times stronger than morphine, so it is unsurprising that the DEA considers fentanyl the most pressing threat to the United States in terms of synthetic opioids.
Carfentanil is an analog of fentanyl that’s up to 10,000 times more potent than morphine. Typically prescribed to manage the most severe pain, this drug also finds its way onto the black market. Although opioids are safe if used short-term and exactly as directed, this does not always apply. Any form of opioid misuse can easily lead to tolerance and then addiction by way of opioid use disorder.
How Do Opioids Work?
When you take opioids, they travel through the bloodstream and then enter the brain and the rest of the body. On this journey, opioids bind to the opioid receptors in your spinal cord, and digestive tract.
This binding reduces neurotransmitters like glutamate. These are responsible for relaying pain signals, while at the same time triggering the dopamine reward system and dopamine neurons. Resultantly, you feel an intense euphoria that subsides into a state of relaxation lasting several hours.
As well as relieving pain by blocking pain messages, opioids can also act within your brain to alter the way you experience pain.
How Long Do Opioids Stay in Your System?
The following variables all influence how long opioids stay in your system:
- Amount of opioids taken
- Regularity of dose
- Speed of your metabolism
- Route of administration
- Presence of other substances
- Medical conditions impacting drug elimination
While all opioids exert a similar effect on the opioid receptors in your body, the duration of effects differs.
The amount of time it takes for your body to metabolize a drug and to remove half the original dose is clinically labeled its half-life. To remove a drug fully from the body usually takes five half-lives. The half-life of opioids varies according to the following types:
- Long-acting opioids
- Short-acting opioids
Long-acting opioids can be effective for minimizing pain for long periods. This type of opioid is often prescribed to improve functioning and provide pain relief. Additionally, long-acting opioids can also provide relief for both anxiety and insomnia. With less potential for abuse than short-acting opioids, long-acting opioids can improve ongoing pain control, too.
It is advisable to start with low doses of long-acting opioids, increasing the dosage if necessary.
Morphine is a long-acting opioid that’s cheaper than oxycodone or hydrocodone, and also less commonly diverted and abused.
In cases of breakthrough pain – acute pain not controlled by current medication – long-acting and short-acting opioids are often prescribed in combination, leading to an improved response to pain management.
The Opioid Crisis
The roots of the opioid epidemic date back to the late 1990s. Pharmaceutical companies like Purdue Pharma strongly reassured the medical community that not only were opioids not addictive, but also that they should be more widely prescribed.
From here, amid a flurry of aggressive advertising and incentivizing from big pharma, healthcare providers across the US started prescribing opioids liberally for the treatment of chronic pain. Previously, opioids were almost exclusively prescribed for the treatment of severe chronic pain in cancer patients at the end of life.
This blizzard of prescriptions led to widespread misuse and abuse of opioids. Soon, it became abundantly clear that opioids were strongly habit-forming and powerfully addictive.
Declaring the opioid epidemic a national health emergency in 2017, HHS announced a multi-pronged strategy for combating the opioid epidemic.
Looking back, we can see that opioid addiction and the opioid epidemic unfolded in the United States over the following distinct phases:
- Prescription opioid pain reliever
- Synthetic opioids like fentanyl
As outlined above, some people use all classes of opioids, meaning there are effectively three crises rolled into one.
The debate over what caused the opioid epidemic ended with Purdue Pharma pleading guilty to their role in this nationwide crisis.
The Rise of Synthetic Opioids
Synthetic opioid is a term used for either well-known man-made opiates or for newer, less-researched drugs mirroring the effects of opiates.
All these drugs are completely synthesized in labs. We get natural opioids, on the other hand, from the seed pods of Asian opium poppies. Synthetic opioids target the same receptors in your brain as natural opioids – codeine or morphine, for instance.
All synthetic opioids deliver powerful pain-relieving effects and an accompanying euphoria and sense of sedation.
There are some synthetic opioids approved for use in medical applications. Fentanyl, for example, has been used to treat chronic pain for decades. If used in tiny amounts in a controlled setting, fentanyl is incredibly effective.
Many synthetic opioids, though, have no approved medical applications. These include:
Increasingly, drug suppliers are cutting both heroin and cocaine with fentanyl. It is a cheap bulking agent that also increases the potency of the drug, resulting in many overdoses when unsuspecting users take the same amount of heroin as normal, but with deadly consequences.
Since the mid-2010s, we have seen a sharp increase in the trafficking and misuse of many substances similar in structure to fentanyl.
Synthetic opioids are abused in the same way as prescription opioid painkillers or street heroin. Abuse follows similar patterns, but the strength of fentanyl and other synthetic opioids increased the risk of fatal overdose.
Opioid Abuse in Teens
Opioids are still commonly prescribed for pain management, so teens looking to experiment with drugs may find it easier and more affordable to access prescription painkillers than illicit drugs. If you have teens in the house and you also have an opioid prescription, ensure that this remains locked away and out of reach.
For anyone who feels their teenager is already abusing opioids, it is worth immediately opening a frank and ongoing dialogue. Educate your son or daughter about the proven dangers of opioid abuse.
It is also worth underscoring to your teen that opioids interact adversely with many other substances, alcohol in particular. This study shows that 70% of teens taking opioids for recreational purposes also use alcohol or other drugs, dramatically increasing the risk of fatal overdose.
Opioid Addiction Statistics
- Over 70,000 US citizens died from drug overdoses in 2019, up to over 100,000 in 2020.
- In 2019, 2 million adults in the US had opioid use disorder, a figure that’s reduced to 1.6 million over from 2019 to 2020.
- 10 million people abused prescription opioids in 2019. 1.6 million of these abused this class of medication for the first time.
- Of the 50,000 people who try heroin for the first time each year, some resort to this addictive drug after being unable to refill opioid prescriptions or being unable to afford opioid prescriptions.
- Almost 30% of those prescribed opioids for the treatment of chronic pain misuse this medication.
- More than 10% of those prescribed opioids for the treatment of chronic pain eventually develop opioid use disorder.
- In the United States, nearly 15,000 people overdosed on heroin in 2020.
- IN the same year, 48,000 deaths were attributable to overdose on synthetic opioids (aside from methadone).
- Up to 6% of people misusing prescription opioids begin using heroin. 80% of all people who use heroin first misused opioid painkillers.
Opioid Addiction Help
If you need help fighting an opioid addiction, our team at The District Recovery Center can provide you with the tools and assistance you need to achieve long-term sobriety. Call our experts today to learn more about how we can help you fight opioid addiction and the problems associated like opioid withdrawal, overdose, and more.