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Overview: Opiates
Opiates are narcotic pain relief medications. Some of the most popular opiates include Oxycontin, Percocet, and Vicodin. The difference between an opiate and an opioid is minimal and mainly has to do with opiates being sourced from poppies (naturally) and opioids being sourced from derivatives of the active chemical in opiates.
Opiates are made of natural substances, while opioids include both the natural and synthetic forms.
Opiates are a pain management tool. When used correctly under a doctor’s supervision they are safe and effective. But according to the National Institutes of Health (NIH), these drugs are also some of the most abused of all prescription medications.
Research shows opiate abuse is on the rise and is now considered one of the nation’s biggest health problems. According to the Substance Abuse and Mental Health Services Administration:
- 1.6% of the U.S. population aged 12 or older reported current nonmedical use of prescription pain relievers in 2014.
- Three years prior, in 2011, 40 percent of all emergency room visits for nonmedical use of pharmaceuticals involved prescription opiates.
Types of Opiates
There are three opiate classifications: natural, synthetic, and semi-synthetic.
Natural opiates come from poppies and are considered the least harmful type of opiate. However, they still have a high risk of abuse and addiction and can trigger respiratory depression in high doses. Natural opiates include:
Synthetic opiates are man-made in labs but have a chemical structure similar to natural opiates. Their effects are also similar to natural opiates. Synthetic opiates include:
Semi-synthetic opiates derive from natural opiates and are prescription narcotics. This category includes heroin. Heroin is an illegal narcotic but it is derived from morphine. Other semi-synthetic opiates include:
- Oxycodone
- Oxymorphone
- Meperidine
- Hydrocodone
- Hydromorphone
In some cases, opiates are paired with other medications to achieve the desired result. This is because they have a weaker potency. For instance, codeine is considered the weakest opiate and is usually paired with ibuprofen or acetaminophen when used for pain relief. Oxycodone, hydrocodone, and Oxycontin also fall into this category.
More potent opiates are “strong opiates” and include methadone, fentanyl, and morphine.
Side Effects of Opiates
It’s possible to experience side effects whether you are using opiates according to a doctor’s prescription or you are abusing them. One of the most common side effects is constipation.
Opiates interfere with normal elimination because they prevent contraction making bowel movements difficult. Opiate users can develop rock-hard stools that eventually block the bowels and cause bowel rupture, sepsis, and death.
Opiate users should increase their fiber intake, exercise, and drink a lot of water to counteract the effect of the medication.
Other side effects of opiates include:
- Itching
- Sedation
- Dizziness
- Fatigue
- Depression
- Tremors
- Anxiousness
- Insomnia
- Upset stomach
- Dry mouth
- Pupil contraction
- Coma
- Hallucination
- Sweating
- Delirium
- Confusion
- Extreme irritability
- Muscle pain and spasms
- Severe side effects include:
- Circulatory collapse
- Severe respiratory depression
- Cardiac arrest
Side effects vary based on dosage amount, method of how the drug was used, and previous opiate exposure.
Overdose Symptoms
Overdose is a concern when someone is using opiates. A single dose higher than recommended by a doctor can be fatal.
Symptoms of overdose include:
- Shallow breathing
- Pinpoint pupils
- Convulsions
- Coma
- Nervous system changes
- Decreased vital signs
- Cold or clammy skin, or bluish lips
Opiate Addiction
Opiates are highly addictive. They work by attaching to opioid receptors found in the brain, gastrointestinal tract, spinal cord, and other parts of the body. This causes a reduction in the perception of pain and a euphoric feeling of well-being.
Ongoing use of opiates eventually inhibits the product of the body’s endorphins, known as “feel good” chemicals. As tolerance develops, the body needs higher doses of the drug to achieve the same response, which leads to addiction. Tolerance also increases the risk of overdose.
Opiate addiction symptoms include:
- Using large amounts of a drug or for longer periods than intended or prescribed
- Unsuccessful effort to cut down or control the use of the drug
- Excessive time and effort invested in getting, using and recovering from the use of the drug
- Intense cravings for the drug
- Neglecting obligations at work, school, or home
- Continued use despite problems caused by the usage
- Continued use despite the risk of harm, including overdose
- Continued use despite awareness of the problem
Prescription opiate use is also linked to heroin use. This is because a person addicted to prescription opiates who is no longer able to get his or her drug of choice by prescription will turn to heroin to satisfy the addiction. There is evidence that the rise in prescription pain relief medication has led to a rise in heroin addiction.
Opiate Withdrawal
Someone addicted to or dependent on opiates will experience withdrawal if he or she stops using the drug. Opiate withdrawal symptoms are unpleasant and increase the risk of relapse. Opiate withdrawal can also be dangerous. Anyone addicted or dependent on opiates should consider medically supervised detoxification.
Symptoms of opiate withdrawal are similar to extreme flu symptoms and also include:
- Intense cravings
- Aches
- Involuntary muscle movements
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Chills
- Dilated pupils
- High blood pressure
- Seizures
- Rapid heart rate
- Irritability
- Agitation
- Anxiety
- Restlessness
- Inability to experience pleasure
- Yawning
Severe symptoms tend to ease within a few days, but full opiate withdrawal can last several weeks. Cravings and milder symptoms can last for months.
Nausea and vomiting are two of the most intense symptoms associated with withdrawal. Vomiting can lead to secondary complications including aspiration pneumonia. This occurs when vomited material is accidentally breathed into the lungs.
Diarrhea is another potentially dangerous opiate withdrawal symptom that can lead to dehydration and electrolyte imbalance, which can cause heart health and circulatory issues.
Addiction Treatment Options
Over-the-counter medications coupled with rest and plenty of fluids can ease the symptoms of mild withdrawal.
Intense withdrawal symptoms might require hospitalization and prescription medications. Certain medications, such as clonidine, are only available in an inpatient setting. Clonidine reduces withdrawal symptoms by as much as 75 percent and eases:
- Anxiety
- Cramping
- Restlessness
- Muscle aches
- Runny nose
- Sweating
- Tears
Suboxone is another pharmaceutical treatment for opiate addiction. It’s a blend of buprenorphine, a milder opioid, and naloxone, an opioid blocker. The use of Suboxone makes it possible to gradually decrease opioid addiction and prevents some of the most unpleasant withdrawal symptoms, including constipation.
Methadone is for long-term maintenance pharmaceutical treatment. It’s a powerful opioid, but reduced in a controlled manner has less risk for overdose and other complications of opiate use. Methadone treats heroin addiction.
Rapid detoxification is rarely used to treat opioid addiction.
In addition to medically supervised detoxification, people addicted to opiates often participate in counseling, behavioral therapy, and 12-step programs.
