The Opioid epidemic has been making the headlines for a while, depicting the serious nature of what is now termed as a public health crisis.
At least 175 people in America die from a drug overdose on a daily basis. Of the 175 deaths, Opioid overdose is responsible for over 115 of them, as stated by the National Institute on Drug Abuse. Essentially, Opioids are the leading cause of drug-related overdose deaths in America.
The Opioid overdose crisis has been significantly crippling the economic and social sectors of the United States. With the number of overdose deaths only increasing year after year, American’s life expectancy is declining. This, in turn, is negatively impacting the country’s level of productivity, as well as its labor force.
Sarah E. Wakeman, M.D., and Michael L. Barnett, M.D reveal startling statistics on the Opioid overdose crisis. According to them, there were over 42,000 Opioid Overdose deaths at the end of 2016. They continue to state that the above statistics represent a 28% increase of the Opioid overdose deaths that took place in 2015.
As stated by the Centers for Disease Control and Prevention, 2017 had over 49,000 Opioid-related deaths. It goes without saying; the number of deaths is only increasing at an alarming rate. The increase of medical treatment centers seems to be of no effect in treating the crisis at all.
What gives? What seems to be the problem and how can this epidemic be rightly dealt with? Let us start from the beginning.
The History of Opioids
According to the Dean of the University of Pittsburgh’s Graduate School of Public Health, Dr Donald Burke, the drug overdose epidemic has been around for four decades. The epidemic, even though seemingly new, has been a problem since the 1980s.
Dr. Donald Burke continues to state that the growth pattern of the epidemic has been a predictable one. Notably, this is in relation to drug- overdose deaths in general. How about Opioid overdose deaths?
The Opioid epidemic, as numerous research and studies, suggest, begun in the 1990s. This was when doctors and pharmaceutical companies started over-prescribing Opioids as painkillers. Of course, this was aided by pharmaceutical organizations that assured the medical sector of the non- addictive nature of Opioids.
The over prescriptions of the drug encouraged its use and abuse on a much larger scale. By the time State Laws restricted its use, a good number of American individuals were already addicted. Hence, addicted individuals sought ways to work around the Law restrictions opting for cheaper forms of Opioid drugs.
Despite the alternative forms of the drugs being cheaper, they are said to be a lot more dangerous. For instance, fentanyl, which is a synthetic Opioid, contributed to at least 30, 000 overdose deaths in 2017. Cheaper doesn’t necessarily mean safer.
According to Dr Donald Burke, there has been an increase in the use of cheaper forms of Opioids. Heroin and fentanyl rank as the top two widely used forms of Opioids.
Now, from the above statistics, what three major areas have we noted? According to the Centers for Disease Control and Prevention, there are three major factors that have contributed to the rise in Opioid overdose deaths. They include:
- Overprescribing Opioid drugs in the 1990s as we’ve noted above. Doctors overprescribed the drug under the incorrect observation that pain was not being adequately treated.
- The second factor resulted from an increase in heroin use, which led to an increase in heroin overdose deaths. CDC states that this factor began in the year 2010. Notably, the annual Opioid overdose deaths increased between the years 1999- 2010 at the alarming rate of 13.4%. The fact that heroin is only getting cheaper over time is a major concern.
- In 2013, there was a significant increase in the use of synthetic Opioids, which are not only cheaper but readily accessible.
By the time 2017 rolled around, the United States Department of Health and Human Services (HHS) acknowledged it as a public health emergency. The HHS, together with the National Institutes of Health (NIH), is working towards alleviating the epidemic through a Five- point strategy.
Through the implementation of their Five- point strategy, they hope to increase the accessibility of treatment centers and creating better ways/ practices of managing pain, among others.
To better understand this rising epidemic, let’s look at what Opioids are exactly.
The Opioid Drug Defined
Opioids were prescribed for the sole reason of providing pain relief. However, their use has evolved and changed, leading to serious and life-threatening consequences. Opioids are often classified as depressant drugs that aid in providing pain relief when needed. Additionally, they also stimulate feelings of pleasure and euphoria.
These drugs, in particular, interact with the central nervous system and influence the release and overproduction of certain neurotransmitters. For instance, they increase the overproduction and release of dopamine bringing about feelings of euphoria and heightened pleasure.
There are a good number of Opioids that range from prescription pain reliever and synthetic Opioids to heroin itself. Notably, even the legal pain reliever can cause harm if used for the wrong purposes.
- Heroin: Heroin if a cheaper Opioid that is readily and easily accessible. Hence, it is the most widely used and notably, ranks as the topmost addictive drug available. It is said to have ranked at an alarming 2.5 out of 3 On Nutt’s addiction scale.
Other than its highly addictive nature, heroin also ranks as one of the most dangerous drugs on the planet. Its high potency reveals a higher risk of causing death as compared to other drugs.
Heroin is an illegal drug; hence, it is often purchased illegally. Illegally obtained substances are not quality controlled and the chances of them being contaminated or laced are high. This makes heroin even more dangerous and harmful.
Additionally, heroin use poses another risk to their users. Recent research confirms that this drug increases the chances of contracting a host sexually transmitted diseases, as well as HIV.
- Synthetic Opioids: Fentanyl and Carfentanyl are two forms of synthetic Opioids. These drugs are known to imitate the effects that would be brought about by using natural opioids.
Fentanyl is often compared to morphine in terms of similarities. Yet, in terms of potency, it has been found to be over 50 times more potent than morphine.
Regardless, this particular drug is also used in its prescription form to treat serious cases of pain. For patients that have developed a tolerance against natural Opioids, Fentanyl is also used on them in its prescription form.
- Prescription Opioid drugs/ Opioid painkillers: These are legally accessible drugs that often prescribed by healthcare providers to treat pain. Legally prescribed Opioids range from oxycodone and oxymorphone to codeine and methadone, among many others.
Unfortunately, Opioid painkillers are often abused and misused. The fact that medical practitioners are wrongly prescribing them doesn’t help either. The recreational use of legal Opioids still leads to death as well as other serious consequences.
Now, how do Opioids work and interact with the brain? What makes them highly addictive?
The Addictive Nature of Opioid Drugs
As previously mentioned, Heroin is the topmost addictive drug in the entire world. Yet, how can one define addiction? What is an addiction exactly?
An addiction, as described by the addictioncenter.com, is often characterized by compulsive behavior. A person is said to be addicted, he or she repeatedly uses the drug or indulges in the activity regardless of its harmful effects.
The American Association of Addiction Medicine has a better definition of the term addiction. According to them, addiction is a chronic disease that affects that affect the brain’s motivation and reward system, as well as memory capabilities, just to name a few. The use of certain drug substances causes the above circuits to dysfunction affecting a person’s behavior.
An individual that is addicted to a substance finds it hard to abstain from using it. Instead, he or she uses the drug to survive and function properly. Once a person becomes dependent on a drug, they grow to become tolerant to it. At this point, the user is lily to increase their dose so as to feel the effects of the drug.
The more an individual uses the drug, the more likely he is going to get addicted to it. If a person finds it hard to stop using the drug, they are said to have developed an addiction. They often experience withdrawal symptoms once they try to stop which can be highly uncomfortable.
That being said, this still begs the question, why are opioids so addictive?
The brain is a complex organ in the body and is responsible for a great number of functions. It is made of cells known as neurons that control the flow of information. The flow of information often involves three major systems in the body. The information is sent to and from among the spinal cord, the brain and the peripheral nervous system, which is the rest of the body.
The information is often sent in the form of signals through the use of neurotransmitters. That said, heroin, which is a chemical substance, resembles a normal neurotransmitter due to its chemical structure. Its similarity to a natural neurotransmitter allows it to bind to a neuron before activating it.
The neuron will then send the wrong informational signal to the brain, the spinal cord and the peripheral nervous system. This can lead to an increase in the release of certain neurotransmitters such as dopamine, heightening the feelings of pleasure and euphoria.
Below are some of the areas in the brain that are affected by Opioid consumption:
- The brain stem: The brain stem is said to control vital bodily functions such as breathing and heart rate. These functions are not only vital but are life- sustaining. However, Opioids are known to damage it or cause it to function incorrectly.
For example, Opioids can slow down a person’s heartbeat or interfere with breathing. If not dealt with, this can lead to unconsciousness or even death.
- The prefrontal cortex: This part of the brain controls a person’s ability to think, make decisions, solve problems and execute sound judgments. An individual that has consumed drugs overtime, or Opioids to be more specific, often damages this part. Hence, he is unable to perform the aforementioned functions properly.
- The basal ganglia: this part is responsible for the pleasurable feelings that come with engaging certain activities. It is also commonly referred to as the reward circuit.
Opioids tend to over-stimulate the reward circuit, leading to the overproduction of endorphins and dopamine. Endorphins and dopamine are known to control our emotions, and in large amounts, can lead to euphoria.
Dopamine is specifically known to cause us to repeat pleasurable activities. This could explain the repetitive nature of drug users.
However, over time, the circuit gets used to the drug, making it harder and harder to reap the effects. For the user to experience the effects, he or she will have to increase the use of the drug. This is why drug users and addicts tend to seek out more of the drug.
Moreover, the reward circuit will lose its sensitivity and only the drug can bring about these emotions. This is why drug abusers and addicts lose interest in activities that they once found pleasure in.
- The extended amygdala: This part of the brain is known for controlling feelings of anxiety and unease. Since Opioids are depressants, they tend to relax and calm a person’s muscle and bring relief. However, an extended use of such drugs can cause the opposite effect when one tries to stop. In other words, the person tends to experience anxiety, unease and other uncomfortable symptoms when the drug is not present in the body.
Opioid addiction is a complex disorder, and anyone that uses it is at the risk of developing it. If you or your loved is addicted to the drug, you are advised to seek medical and professional help. Below are a few symptoms that often accompany Opioid addiction.
Signs and Symptoms of Opioid Addiction
Notably, signs and symptoms of Opioid addiction differ from one person to the other. This is because certain factors, such as the length of use, tend to dictate the symptoms a person exhibits. They include:
- Insomnia and other sleep-related problems
- Anxiety and depression
- Demonstrates an inability to make sound decisions
- Impaired judgments
- Poor problem-solving skills
- Memory problems
- The person demonstrates a short- attention span
- He or she finds it hard concentrating or focusing on one specific thing
- Addicts often demonstrate suicidal tendencies
- Neglecting academic or professional responsibilities or
- Poor performance when it comes to school or/and work
- Poor personal hygiene
- Lack of interest in activities and hobbies
- Withdrawal from social settings
- Stealing and engaging in other illegal activities
- Financial instability and bankruptcy
- Broken families and damaged relationships
- Gastrointestinal problems and issues
- Visual acuity and so forth
- Neonatal abstinence syndrome (NAS): If a woman takes Opioids while pregnant, there are chances that the baby will develop of Neonatal abstinence syndrome (NAS). This is when the baby is not only addicted to the drug itself but also exhibits withdrawal symptoms as well.
Can Opioid Addiction Be Treated
Opioid addiction is treatable. The first step has to start with the addict; he or she has to be willing to seek treatment. It is important to note that trying to stop the addiction without seeking professional help might not work.
Willpower will not get you through the addiction, or completely heal you from it. If you opt to do this, you will only relapse numerous times and get greatly discouraged. Moreover, you are also likely to experience withdrawal symptoms that will make it harder to stay away from the drug.
Withdrawal symptoms are often uncomfortable and can range from mental to physical discomforts. They include the following:
- Body aches
- Uncontrollable and involuntary shaking
- Abdominal pain
- Aggressiveness and irritability
- Strong cravings for the drug
That being said, the type of treatment a person receives varies. Certain factors should always be considered. They include:
- Duration of drug misuse and abuse
- If an individual suffers from any other disorder. For example, if an Opioid addict also suffers from alcohol use disorder, the type of treatment he will receive will be different. Particularly, a more serious and lengthier type of treatment.
- If the Opioid addict suffers from a mental disorder, he or she will receive a different type of treatment as well.
So, what are the treatment options that are available for Opioids addicts?
This type of treatment is suitable for those that wish to still maintain their everyday lives. In other words, an addict can get required treatment from the comforts of his home. This type of treatment is, however, not as effective as the other treatment plans.
The patient receiving treatment can easily relapse due to external factors, such as peers.
The Inpatient treatment plan is the exact opposite of the outpatient one. This type of treatment requires the addict to stay within the treatment center for observation and treatment. The care and help the addict reserves is available around the clock, making this treatment plan more effective.
The environment often provided is often strict and controlled. This helps keep external factors and pressures that may lead to a relapse at bay.
Residential is very similar to the Inpatient type of treatment plan. However, the housing provided is often short- term. Yet, the patient will receive reliable treatment from professionals in a controlled environment.
This type of treatment is also known to be effective.
However, do not underestimate the value of long-term treatment. The longer the treatment, the more likely the patient will recover from his addictions. Hence, look for a treatment plan that offers long-term treatment in a controlled and strict environment.
According to the National Institute on Drug Abuse, the major treatment for prescription Opioid addiction is known as medication-assisted treatment (MAT). Hence, if the person in need of treatment is specifically addicted to prescription Opioids, ensure that the treatment plan includes the medication-assisted treatment.
The individual under treatment is advised to never share his medicine with any of his peers. Stick to the instructions given and provided by the medical professional. Treatment drugs differ from person to person, since addiction cases are likely to be different.
Signs and symptoms of an Opioid Drug Overdose
We already know the signs and symptoms that indicate Opioid addiction. Yet, how can one tell if a loved one is having a drug overdose? Notably, Opioid overdoses are known to slow a person’s breathing rate and ultimately lead to death.
If you know that you or a loved one is addicted to Opioids, it is imperative that you remain aware of these symptoms. Below are symptoms that often indicate that someone is having an Opioid overdose:
- The person’s body goes completely limp
- He/she starts vomiting profusely
- Having trouble breathing, or breathing is slowing down
- The person’s face is pale
- Is unable to speak
- The person is making weird gurgling sounds
- If the lips are purple/blue in color
- If the fingernails have changed color, either purple or blue in color
In conclusion, it is very easy to get addicted to Opioids. Those that have already started using them are likely to get addicted to them quickly. The best form of prevention and treatment is abstinence from the substance itself.
Doctors are urged to look for other forms of other pain-relieving drugs, other than Opioids. HHS has joined in this fight and is seeking better alternatives and practices to treating pain.