The Use And Misuse Of Prescribed Opioids And The Risk Of Subsequent Addiction

What’s The Difference Between Opiates & Opioids?

An opioid is a term that was originally used to differentiate synthetic opiates from pure opiates. Opioids were applied to semi-synthetic and synthetic drugs of the opiate class of medicines. Now the term opiates and opioids are used interchangeably to describe any opiate-based drug or medication synthesised to mimic its effects.

For ease of understanding in this article, we will use the term “opioid” for both terms.

What Are Prescription Opioids?

Oxycodone pills spilling out of a bottle

Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made by scientists in labs using the same chemical structure.

Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea.

Opioids can also make people feel very relaxed and “high” which is why they are sometimes used for non-medical reasons.

This can be dangerous because opioids can be highly addictive and overdoses and death are common.

Heroin is one of the world’s most dangerous opioids, and is never used as a medicine in the United States or in the United Kingdom but is sold on the streets illegally.

What Are Common Prescription Opioids?

  • Hydrocodone
  • Oxymorphone
  • Morphine
  • Codeine
  • Fentanyl
  • Tramadol

How Do People Misuse Prescription Opioids?

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by a GP or Doctor, but they can be misused. People misuse prescription opioids by:

  • Taking the medicine in a way or dose other than prescribed (injected, snorted ect)
  • Taking someone else’s prescription medicine
  • Taking the medicine for the effect it causes-to get high than for pain
  • “Shop around” with different GP’s or Doctors to get multiple prescriptions for the same medication within a very short period of time

When misusing a prescription opioid, a person can swallow the medicine in its normal form. Sometimes people crush pills or open capsules, dissolve the powder in water & inject the liquid into a vein.

Some also snort the powder. Liquids opioids such as oral morphine (oramorph) can also be injected straight out of the bottle and into their veins.

How Do Prescription Opioids Affect The Brain?

Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord and other organs in the body, especially those involved in feelings of pain and pleasure.

When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience.

What Are Some Possible Effects Of Prescription Opioids On The Brain & Body?

In the short term, opioids can relieve pain and make people feel relaxed and happy. However, opioids can also have harmful effects, including:

  • Drowsiness
  • Confusion
  • Nausea
  • Constipation
  • Euphoria
  • Slowed breathing
  • Slowed heart rate
  • Changes in heart beat/function
  • Damage to veins and arteries
  • Risk of blood clots
  • Respiratory/cardiac arrest
  • Reduced level of consciousness

Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can have short and long term psychological and neurological effects, including coma, permanent brain damage, or death. Researchers are also investigating the long-term effects of opioid addiction on the brain, including whether damage can be reversed.

What Are The Other Health Effects Of Opioid Medications?

Older adults are at higher risk of accidental misuse or abuse because they typically have multiple prescriptions and chronic diseases, increasing the risk of drug-drug and drug-disease interactions, as well as a slowed metabolism that affects the breakdown of drugs and confusion as to whether they have taken their dose and then end up taking two doses accidentally.

Sharing drug injection equipment and having impaired judgment from drug use can increase the risk of contracting infectious diseases such as HIV, blood borne viruses and sexually transmitted diseases from unprotected sex.

Likewise, pregnant women who use prescribed opioids or street heroin, can also cause their unborn baby to also become addicted to the opioids before its even born. Once it’s born, the baby must then detox on top of its struggles after just being delivered.

Also, the developing fetus prior to being born may also develop abnormally or grow up with physical or mental handicaps, learning difficulties or disabilities.

Prescription Opioids & Heroin

Prescription opioids and heroin are chemically similar and can produce a similar high. In some places, heroin is cheaper and easier to get than prescription opioids, so some people switch to using heroin instead.

Data from 2011 showed that an estimated 4 to 6% who misuse prescription opioids switch to heroin and about 80% of people who used heroin first misused prescription opioids.

More recent data suggest that prescription opioids are frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported prescription opioids as the first opioid they used regularly to get high, swapping to heroin when their tolerance increased and access to prescribed opioids got more difficult to get as their Doctors became aware of their addiction and prescription misuse.

This suggests that prescription opioid misuse is just one factor leading to heroin use.

An investigation by BBC News has found:

  • More than two million working age people in England are estimated to have taken a prescription painkiller that was not prescribed for them in 2016-17.
  • GPs in England prescribed 23.8 million opioid-based painkillers in 2017, the equivalent of 2,700 items every hour.
  • This was 10 million more prescriptions than in 2007.
  • The prescribing rate of opioid painkillers in parts of northern England is four times higher than in London.

This rise in opioid overdose deaths can be outlined in three distinct waves.

  1. The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.
  2. The second wave began in 2010, with rapid increases in overdose deaths involving heroin.
  3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.

Can I Take Prescription Opioids If I’m Pregnant?

As we mentioned earlier, if a woman uses prescription opioids when she’s pregnant, the baby could develop dependence and have withdrawal symptoms after birth. This is called neonatal abstinence syndrome (NAS), which can be treated/eased with medicines.

Opioid use during pregnancy can also lead to miscarriage and low birth weight, among with other mental and physical disabilities.

It can be difficult for a person with an opioid addiction to quit, but pregnant women who seek treatment have better outcomes than those who quit abruptly. Methadone and buprenorphine are the standard of care to treat opioid-dependent pregnant women.

Methadone or buprenorphine maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the adverse outcomes associated with untreated opioid addiction.

If a woman is unable to quit before becoming pregnant, treatment with methadone or buprenorphine during pregnancy improves the chances of having a healthier baby with a lower risk of developing abnormalities or disabilities at birth.

In general, it is important to closely monitor women who are trying to quit drug use during pregnancy and to provide treatment as needed. You can find contact information for groups, charities and organisations who can help with opioid addictions on our help and support page here.

Tolerance Vs. Dependence Vs. Addiction

Long-term use of prescription opioids, even as prescribed by a Doctor, can cause some people to develop the following:

Tolerance: which means that they need higher and/or more frequent doses of the drug to get the desired effects.

Drug dependence: occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug.

Drug addiction: is a chronic disease characterised by compulsive or uncontrollable drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes result in harmful behaviors by those who misuse drugs, whether they are prescription or illicit street drugs.

Can A Person Overdose On Prescription Opioids?

Yes, a person can overdose on prescription opioids just as they can with street drugs. An opioid overdose occurs when a person uses enough of the drug to produce life-threatening symptoms or death.

When people overdose on an opioid medication or drug, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, which can result in coma, permanent brain damage or death.

How Can An Opioid Overdose Be Treated?

If you suspect someone has overdosed, the most important step to take is to call 999 (or your emergency number depending on your country of origin) so he or she can receive immediate medical attention.

Once medical personnel arrive, they will administer naloxone. Naloxone is a medicine that can treat an opioid overdose when given right away. It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs. Naloxone is available as an injectable (needle) solution, a hand-held auto-injector (EVZIO®) and a nasal spray (NARCAN® Nasal Spray).

Naloxone Nasal Spray

Some US states have passed laws that allow pharmacists to dispense naloxone without a personal prescription. This allows friends, family and others in the community to use the auto-injector and nasal spray versions of naloxone to save someone who is overdosing.

Naloxone Injectable Kit

In the UK, you can contact your nearest community based drug and alcohol service who will provide you with free training and issuing of your own naloxone kit for free. you can find your nearest on our help and support page here.

Read more about naloxone on the Naloxone UK website here.

Can The Use Of Prescription Opioids Lead To Addiction?

Yes, repeated misuse of prescription opioids or street drugs such as heroin can lead to a substance use disorder (SUD), a medical illness which ranges from mild to severe and from temporary to chronic.

Addiction is the most severe form of an SUD. An SUD develops when continued misuse of the drug changes the way the brain works and causes physical and mental health problems and failure to meet responsibilities at work, school, or home among many other negative consequences. You can find out more about the science of addiction and how medicated assisted treatment works here.

People addicted to an opioid medication or street opioids who stop using the drug can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. These symptoms can include:

  • Muscle aches and pains
  • Sleep problems
  • Diarrhoea and vomiting
  • Cold/hot flashes with goose bumps
  • Uncontrollable restless leg and body movements
  • Severe cravings
  • Headaches
  • Low mood and irritability

These symptoms can be extremely uncomfortable and are the reason many people find it so difficult to stop using opioids.

There are medicines to help with the withdrawal process, including lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms that was approved by the U.S. Food and Drug Administration (FDA) in 2018. The FDA has also approved sale of a device, NSS-2 Bridge, that can help ease withdrawal symptoms. The NSS-2 Bridge is a small electrical nerve stimulator placed behind the person’s ear, that can be used for up to five days during the acute withdrawal phase.

Other medicines such as methadone and naltrexone and buprenorphine are also available.

If you are experiencing withdrawal symptoms from opioids, you can reduce the intensity and length of time you experience them by following some simple tips, tricks and techniques in our previous article about overcoming withdrawal symptoms here.

What Type Of Treatments Can People Get For Their Addiction To Prescription Opioids?

A range of treatments including medicines and behavioural therapies have been proven to be effective in helping people with opioid addiction.

Two medicines, buprenorphine and methadone, work by binding to the same opioid receptors in the brain as the opioid medicines, reducing cravings and withdrawal symptoms.

Another medicine, naltrexone, blocks opioid receptors and prevents opioid drugs from having an effect.

Behavioural therapies for addiction to prescription opioids help people modify their attitudes and behaviours related to drug use, increase healthy life skills and persist with other forms of treatment, such as medication assisted treatment (MAT). You can learn more about the science of addiction and how MAT medicines work in our previous article here.

Some examples include, cognitive behavioural therapy (CBT) which helps modify the patient’s drug use expectations and behaviours, and also effectively manage triggers and stress by providing better alternative coping strategies, tricks and techniques to cope with life without drugs or alcohol.

Multi-dimensional family therapy, developed for adolescents with drug use problems, addresses a range of personal and family influences on one’s drug use patterns and is designed to improve overall functioning.

These behavioural treatment approaches have proven effective, especially when used along with medicines. Likewise, one to one counselling, group therapies and fellowship meetings, hypnotherapy, auricular acupuncture and others can also play a huge role in an individual’s recovery. You can find out more about accessing these services through your local drug and alcohol service on our help and support page here or we also provide counselling, hypnotherapy and auricular acupuncture. You can find out more about this here.

When Should I Speak To My Doctor Or GP About My Use Of Opioids?

If you meet any of the criteria below, even if it’s just one on the list, it’s absolutely vital that you get in touch and see your GP or Doctor as quickly as physically possible as it may indicate that you are becoming physically or psychologically dependent on opioids:

  1. You have been on opioids for more than 6 weeks continually.
  2. You have needed to get your dosage increased either more than twice
  3. You also take other types of opioid such as other prescribed opioids such as morphine or OxyContin or street drugs such as heroin.
  4. You use opioids to make you feel good instead of for their prescribed reason
  5. You get them from someone else, other than your Doctor
  6. You get them from more than one Doctor
  7. You don’t use them as your supposed to, such as sniffing instead of swallowing them or injecting liquids instead of swallowing them
  8. You feel unwell when you don’t have them
  9. You give them away to others or sell them
  10. You use them to attempt suicide, including attempting to overdose.

Points To Remember

  • Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea.
  • Opioids aren’t best suited to treat neuropathic pain (nerve pain) and other medicines such as Pregabalin or Gabapentin should be used instead. However, talk to your GP or Doctor as to the best medication for you.
  • People misuse prescription opioids by taking the medicine in a way other than prescribed, taking someone else’s prescription, taking the medicine to get high or have been on them for so long that they have developed a physical and psychological dependency on them. When misusing a prescription opioid, a person may swallow, inject or snort the drug.
  • Opioids bind to and activate opioid receptors on cells located in the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure and can strongly reinforce the act of taking the drug, making the user want to repeat the experience.
  • People who use prescription opioids can feel relaxed and happy but also experience drowsiness, confusion, nausea, constipation and slowed breathing.
  • Prescription opioids have effects similar to heroin. While prescription opioid misuse is a risk factor for starting heroin use, only a small fraction of people who misuse opioid pain killers switch to heroin, but it is a real and definite possibility if the dependency isn’t dealt with and overcome quickly enough at an early stage. The sooner you access treatment, the quicker and easier your recovery will be.
  • A person can overdose on prescription opioids. Naloxone is a medicine that can treat an opioid overdose when given right away.
  • Prescription opioid use, even when used as prescribed by a doctor can lead to a substance use disorder, which takes the form of addiction in severe cases. Withdrawal symptoms include muscle aches and restless legs, sleep problems/insomnia, diarrhoea and vomiting and severe cravings.
  • A range of treatments including medicines and behavioural therapies are effective in helping people with an opioid use disorder.

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Published by Drink ’n’ Drugs

Providing useful, relevant, up to date information and support for those suffering from active addiction or those who are in recovery.

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