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Opioid Abuse and Addiction

This page will clarify the difference between opiates and opioids, provide information on why opioids are addictive and how this can lead to misuse of both prescription and illicit opioids, signs and symptoms of opioid abuse and overdose, treatment options, and aftercare.

Opiates vs Opioids

Opioids are substances that interact with opioid receptors in the body’s central nervous system.1 They dull the senses and relieve pain.2 Opioid drugs are a group of drugs that includes opiates, which are natural derivatives of the poppy plant.2, 3 Types of opiates include:2, 3

Opioid is an umbrella term that includes natural opioids, semi-synthetic opioids derived from natural opioids, and synthetic opioids created in a laboratory.2, 3 Types of opioids include:2, 3

Prescription Opioids & Illicit Use

Opioid prescription bottle; prescription opioids are used to relieve pain, but are highly addictive.

Prescription opioids are used to relieve pain, but they can also cause feelings of relaxation or intense euphoria, especially when misused.3, 4, 5

In addition to blocking pain signals, opioids also release large amounts of dopamine. This release can strongly reinforce the act of taking the drug and may cause the user to want to repeat the experience.6

Opioids alter the brain’s natural reward system, making it difficult to stop using.5 Physical dependence often makes it even harder to quit using, as the user has to take the drug to avoid the severe negative effects that occur during withdrawal.5

A national study in 2018 estimated that among Americans aged 12 or older:7

  • About 10.3 million people (3.7%) had misused opioids in the last year.
  • About 9.9 million people (3.6%) had misused prescription opioids in the last year.
  • Approximately 808,000 people (0.3%) had used heroin in the last year.
  • Approximately 2 million people (0.7%) had an opioid use disorder.
  • About 1.7 million people (0.6%) had a painkiller use disorder.
  • Approximately 526,000 people (0.2%) had a heroin use disorder.

Hydrocodone was the most commonly misused prescription opioid, with about 5.5 million Americans aged 12 or older (2%) abusing it in 2018.7 Oxycodone was the second-most commonly misused prescription opioid, with approximately 3.4 million Americans aged 12 or older (1.2%) abusing it in 2018.7

Efforts to address the opioid epidemic have led to prescription opioids becoming less available, and people have turned to alternate routes to obtain them in some cases.8 People may buy prescription opioids from others, which can be very costly, while heroin has similar effects and can be cheaper and easier to access.6 In people who use heroin, 80% have a history of prescription opioid misuse.6, 8, 9  

Of the many different types of opioids, the following are most commonly used:10, 11, 12, 13, 14, 15

  • Codeine, a medication prescribed for mild to moderate pain or to treat coughing.
  • Fentanyl, prescribed to treat severe chronic pain or post-surgical pain. Fentanyl is sometimes used to cut illegal substances to make them seem stronger, often resulting in overdoses that can be fatal.
  • Heroin, an illegal drug derived from morphine, with no valid medical use. People can sniff, smoke, or inject heroin to get high.
  • Hydrocodone, prescribed to treat severe chronic pain.
  • Morphine, prescribed for moderate to severe pain.
  • Oxycodone, a prescription medication that treats moderate to severe pain.

Did you know that AAC is in-network with many insurance companies which means your treatment could be free depending on your policy.

Signs and Symptoms of Opioid Abuse

If you are concerned that someone you care about is misusing opioids, there are some signs to watch for. These include:4, 8, 17

  • Change in eating and sleeping habits.
  • Finishing a prescription early.
  • Having trouble completing usual tasks at home, school, or work.
  • Isolating or changing friends.
  • Mood swings.
  • Quitting hobbies.
  • Showing signs of intoxication, including constricted pupils, slurring, or nodding off.
  • Stealing money, medications, or valuables.
  • Taking more medication than prescribed, or for longer than prescribed.
  • Using prescribed medications in a different way than prescribed.
  • Visiting more than one doctor for prescriptions, going to urgent care or the hospital for extra medication, or getting illegal drugs.

If you think your loved one might be abusing opioids, talk to them. Share your concerns and be understanding. Be aware of the options for help and treatment that are available before you approach them. If you aren’t sure about treatment options, American Addiction Centers (AAC) operates a free hotline at that you can call 24/7 to connect to someone who can explain more to you.

Opioid Overdose Symptoms

An opioid overdose can occur whether a person is using a prescription medication or illicit drugs.6 An opioid overdose can be life-threatening.6 One of the side effects of opioids is slowed breathing; when a person overdoses, breathing can stop, reducing oxygen to the brain, which can result in a coma, irreversible brain damage, or death.6, 17

Opioid overdoses are causing significant deaths in the United States, as these statistics from 2018 show:9, 18, 19, 20

  • There were 128 deaths attributed to opioid overdoses each day.
  • Of the 67,367 overdose deaths that occurred, 46,802 (69.5%) involved an opioid.
  • Of all opioid-related overdose deaths (31,355), two-thirds were attributed to synthetic opioids.
  • Nearly one-third of opioid-involved overdose deaths (14,975 deaths) were due to prescription opioids.
  • There were 14,996 deaths due to heroin.

Recognizing Signs of Overdose

If someone is experiencing an overdose, it is important to recognize the signs so you can get help. Signs that a person has overdosed on opioids include:3, 21, 22

  1. Unconsciousness or inability to awaken.
  2. Breathing difficulty (choking sounds or gurgling/snoring noises from someone who can’t be awakened) or slow or shallow breathing.
  3. Pinpoint pupils and/or fingernails or lips turning blue/purple.

You can help someone experiencing an opioid overdose. You should immediately call 911 for assistance6 to ensure that the person receives medical attention as soon as possible.

If you have Naloxone available, you should administer it immediately.6 This medication blocks the effects of opioids and works quickly to counteract an overdose.6 The effects of Naloxone will last only for a short time; it is important to make sure that the person still receives medical attention because the effects of the Naloxone could wear off before the opioid does.

If the person is not breathing, a 911 operator may talk you through CPR procedures until help arrives. It is also essential to be honest with responders about what drugs have been taken. They will take the person who overdosed to the hospital for further treatment and monitoring to be sure that the person doesn’t return to an overdose state once the Naloxone wears off.

Treatment Options for Opioid Addiction

People with an opioid use disorder (OUD) can be treated with medications combined with behavioral counseling. The first step of treatment is dealing with the uncomfortable process of opioid withdrawal. For someone who is physically dependent on opioids, symptoms of withdrawal may appear within 6 hours to a couple of days, depending on what type of opioids have been used.17

Symptoms may include:17, 23

  • Abdominal cramps.
  • Anxiety.
  • Cravings.
  • Depression.
  • Diarrhea.
  • Enlarged pupils.
  • Excessive yawning.
  • Fever.
  • Goosebumps and chills.
  • Increased sensitivity to pain.
  • Insomnia.
  • Irritability.
  • Muscle and bone pain.
  • Nausea.
  • Runny nose.
  • Sweating.
  • Tearing eyes.
  • Vomiting.

While opioid withdrawal can be painful and uncomfortable, it generally is not life-threatening.23 A medical detox allows medical staff to monitor for potentially dangerous and uncomfortable complications that can develop quickly, lower the risk of relapse, and ensure the safety of the individual during withdrawal.23 In addition, medications can be provided to reduce symptoms of withdrawal. This is known as medication-assisted treatment.23

Opioid withdrawal is generally managed with either methadone or buprenorphine, both of which reduce symptoms of withdrawal and reduce cravings to allow the person to detoxify comfortably and safely.4, 6, 16, 27 Because detox doesn’t address the underlying causes of addiction, behavioral counseling is strongly recommended. This may include inpatient or outpatient treatment, where counseling is provided, along with additional medication-assisted treatment if needed.16

AAC takes addiction seriously and approaches treatment with a whole-body approach. Treatment plans take into account not just substance use, but also mental health, physical health, social concerns, and anything else that may be going on. These plans evolve throughout the program as you progress in recovery.

Treatment is provided through a combination of various types of groups using different counseling techniques to address coping skills, trauma, grief, anger management, communication skills, and relapse prevention. Individual counseling and psychiatric care are also provided as needed.

AAC operates 8 facilities across the United States, making access to treatment easy no matter where you live. These facilities provide a continuum of care, from medical detox to inpatient treatment to outpatient services, to meet all your recovery needs. For more information about AAC’s services and how they can help you on the road to recovery give us a call or provide your contact information below and we’ll call you at your earliest convince.

Opioid Support and Aftercare

Support and aftercare following treatment for opioid use disorder are important. This often includes long-term maintenance medications to support sobriety, such as methadone, buprenorphine, or naltrexone.24 Each of these medications works differently, but they all achieve the same goal of treating OUD by helping a person to  maintain sobriety by increasing the likelihood of a person staying in treatment and improving recovery outcomes.24 Methadone can be used long-term to reduce opioid cravings and block the effects of any opioids that are taken. It activates the same areas of the brain as other opioids but does not cause euphoria or a high.24 Since methadone is long-acting, it needs to be taken only once a day, allowing people to function normally while on this medication.16 Suboxone is a combination of buprenorphine, a weak opioid, and naloxone, an opioid blocker.16 When Suboxone is taken as prescribed, only the buprenorphine has an effect. If taken differently than prescribed, such as injected, the naloxone will dominate, and it will induce severe withdrawal symptoms.16 Suboxone functions similarly to methadone in that it lessens cravings and works effectively when taken properly.24 Naltrexone, an opioid blocker, works by ensuring that any opioids that may have been taken will not have any effect.24 This can help reduce the likelihood that a person will relapse.24 However, since this medication works only if it is taken daily, it was formulated as a monthly injection, which studies have shown to be more effective.16, 24

Additionally, continued attendance at individual therapy and family counseling can be especially helpful as people learn to navigate a new, sober life. Life outside of treatment can come with stressors and temptations; it can be an adjustment period for the family as well. Attending therapy can help to provide support.

Many people find that attending mutual-help groups is a great way to develop a sober support group and maintain sobriety after completing treatment.

There are many different types of support groups, including organizations designed for people in recovery from addiction in general and specifically OUD. Here are some examples:

  • AAC’s Free Online Support Group — these virtual 12-step meetings are held throughout the week so that you can attend from the comfort of your own home. These meetings are independent of AAC.
  • AAC’s Alumni Group — this is a free, supportive group of graduates of AAC programs across the country. These groups allow everyone to give and receive support, no matter where they are in their recovery journey.
  • Narcotics Anonymous (NA) — NA is a fellowship based on the 12-step Alcoholics Anonymous (AA) model. Meetings are held across the world and online. They cost nothing to attend and don’t involve religious beliefs.
  • Pills Anonymous (PA) — PA is an offshoot of AA/NA and focuses on people who have experienced an addiction to pills of any sort.
  • Heroin Anonymous (HA) — HA is another offshoot of AA/NA and focuses on people who have experienced an addiction to heroin.
  • Al-Anon and Alateen — Al-Anon is an offshoot of AA designed for people who have a loved one who struggles with or had struggled with addiction. Alateen is geared for young people who have someone close to them with an addiction.
  • Secular Organizations for Sobriety is a peer support group that provides an alternative to 12-step programs.
  • SMART Recovery — Another alternative to 12-step programs, this program is based on scientific evidence and peer support.

Prescription opioid misuse and illicit opioid use is a major issue in U.S. There are warning signs to be aware of to tell if someone you care about is abusing opioids. Opioid overdose is dangerous and can be fatal, but if you are aware of the signs, it can be treated. A wide range of treatment options for OUD are available, and recovery is achievable. Having the right support is important to a strong recovery. There’s plenty of help available all you need to do is call a treatment center or join a support to start and continue your recovery.

 

Sources:

  1. National Institute on Drug Abuse. Opioids.
  2. Centers for Disease Control and Prevention. (2020). Commonly used terms.
  3. Drug Enforcement Administration. (2017). Drugs of abuse.
  4. National Institute on Drug Abuse. Opioid Overdose Crisis.
  5. S. Department of Health and Human Services. (2018). Facing addiction in America: The Surgeon General’s spotlight on opioids.
  6. National Institute on Drug Abuse. (2020). DrugFacts prescription opioids.
  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. Rockville, MD: Center for Behavioral Health Statistics and Quality.
  8. National Institute on Drug Abuse. (2018). Prescription opioids and heroin research report.
  9. National Institute on Drug Abuse. (2020). Opioid overdose crisis.
  10. National Institute on Drug Abuse. (2018). Opioid facts for teens.
  11. S. National Library of Medicine. (2018). Codeine.
  12. National Institute on Drug Abuse. (2019). DrugFacts fentanyl.
  13. S. National Library of Medicine. (2019). Hydrocodone.
  14. S. National Library of Medicine. (2019). Morphine.
  15. S. National Library of Medicine. (2019). Oxycodone.
  16. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (Third edition).
  17. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
  18. Centers for Disease Control and Prevention. (2020). Drug overdose deaths.
  19. Centers for Disease Control and Prevention. (2020). Data overview.
  20. National Institute on Drug Abuse. (2020). Overdose death rates.
  21. Centers for Disease Control and Prevention. (2017). Opioid overdose.
  22. Substance Abuse and Mental Health Services Administration. (2018). Opioid Overdose Prevention Toolkit.
  23. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  24. National Institute on Drug Abuse. (2018). Medications used to treat opioid use disorder research report.
Last Updated on August 13, 2020
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Ryan Kelley, NREMT
Industry Expert
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS).
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