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What Are Opioids and How Do They Work?

opioid epidemic

What Are Opioids?

Opioid is a broad term used to describe several natural substances which are all derived from the opium poppy plant that binds to specific opioid receptors in the brain cells.

Why Are Opioids Prescribed?

The drugs were originally designed to treat and manage pain as well as make surgery less painful for patients along with other medical issues. However, they have been commonly abused and used as recreational drugs because they give a euphoric experience, a feeling of elation, numbness to pain, trauma or anxiety and lowered inhibitions.

Opioid Abuse in the U.S.

How Many People Use Prescribed Opioids in the United States?

In the United States in the 1960s, about 80% of all patients going for treatment for abusing opioids were men. An estimated 39.4% of Medicaid insured and 27.7 % of privately insured women between the ages of 15 – 44 from 2008 to 2012 got an opioid prescription each year. As of 2010, the majority of patients going for treatment were women in the middle class, living in less urban or rural areas.

Even though the US accounts for just 5% of the total world population, it consumes 80% of the world’s supply of opioid medications. Over 259 million prescriptions were written for opioid medications in the United States in 2012 alone. It is estimated that over 115 people in the US die daily from overdosing on opioids.

Quick Note About the Opioid Crisis

• About 21 to 29% of patients who have an opioid prescription for chronic pain end up misusing them (Vowles KE., et al 2015)
• 8 – 12 % of patients with prescription develop opioid use disorder.
• A further 4 – 6 % of patients who misuse opioid prescriptions will eventually turn to Heroin.
• 80% of people who are now addicted to Heroin first misused prescription opioids.
• From July 2016 through September 2017 there was a 30% increase in opioid overdose in 52 areas in 45 states. (Centers for Disease Control and Prevention, 2017)
• There was a 54% increase in opioid overdose cases in 16 states within that time period. (Centers for Disease Control and Prevention, 2017)

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Types of Opioids

Some of the commonly prescribed opioids include;

• Codeine
• Fentanyl (Actiq, Duragesic, etc.)
• Hydrocodone (Hysingla ER, Zohydro ER)
• Hydrocodone/acetaminophen (Norco, Vicodin)
• Hydromorphone (Dilaudid)
• Meperidine (Demerol)
• Methadone (Dolophine, Methadose)
• Morphine (MS Contin, Morphabond)
• Naloxone
• Oxycodone (OxyContin)
• Oxycodone and acetaminophen (Percocet, Roxicet)

How Do Opioids Work?

When opioid medications are taken, they go directly to the bloodstream and are quickly attached to the opioid receptors in the brain cells, these cells then suppress the perception of pain and enhance the feeling of pleasure. Although opioids alter the perception of pain what they really do is numb it or block it. This action can lead to an increased sensitivity of pain which is called opioid-induced hyperalgesia.
Some other side effects and dangers of opioid abuse include:
• Heartburn
• Constipation
• Hypotension (low blood pressure)
• Dizziness
• Skin rash
• Blurred vision
• Muscle fatigue
• Nausea and vomiting
• Changes in appetite
• Drowsiness/heavy sedation

Opioid Use Disorder (What are the symptoms?)

Patients generally have a high probability of abusing or misusing opioids and becoming dependent on them. The fact that opioids have psychoactive properties which enables them to provide a euphoric feeling and relieve pain after binding with the brains cells makes it easy for them to be misused.

Opioid use disorder is the long-term (more than a week or two), compulsive, self- administration of opioids for non-medical reasons. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) opioid use disorder occurs when the pattern of use leads to medically significant impairments. In simple terms, if your answer is yes to two or more of the following questions;

• Do you take opioids in larger amounts?
• Do you take opioids longer than prescribed?
• Have you unsuccessfully tried to reduce your opioid usage?
• Do you spend time obtaining, using and recovering from opioids?
• Do you often crave opioids?
• Have failed to honor appointments in school, work, and home due to opioids?
• Have you given up on important social and recreational activities due to opioids?
• Do you continue to use Opioids despite having recurrent interpersonal and social issues due to them?
• Do you continue to use opioids in physically hazardous situations?
• Do you use opioids despite having a physical or mental disorder caused or worsened by them?
• Do you have a tolerance to opioids? (not a criterion when use is medically appropriate)
• Do you have opioid withdrawal symptoms?

Symptoms of Opioid Withdrawal

Some of the common symptoms of withdrawal to opioids include irritability and mood swings, nausea and vomiting, cold-like symptoms including runny/stuffy nose and fever, confusion, anxiety and depression, diarrhea, muscle aches and pains, appetite changes, rapid breathing, sleep disturbances, and tremors.

Symptoms of Opioid Overdose

Some of the symptoms include; extremely slow, labored respiration, unconsciousness, pale skin, nausea and vomiting, restricted pupils, limp body and cold, clammy skin, seizure, and death.

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