Opioids are a class of drugs primarily used to treat moderate to severe pain. They are naturally found in the opium poppy plant. Some opioid medications are made from the plant directly. Others are, however, made by scientists in laboratories.These drugs act on opioid receptors to produce different effects. Opioid receptors are found in the brain, spinal cord, and the gastrointestinal tract (gut). They are often referred to as narcotics.
Opioids can be prescription medications or street drugs. Those prescribed by healthcare professionals are often called “painkillers.” Examples are hydrocodone and oxycontin. On the contrary, street opioids do not come as a prescription. Heroin is an example of a street opioid.
Prescription opioids block pain signals between the brain and the body. They are typically used to treat moderate to severe pain. Though helpful, these medications also have side effects.
In addition to helping with pain, this substance can cause a “high.” This effect is known as euphoria. Unfortunately, some people use these drugs for this effect. Over time, addiction can become a problem. Dependence on opioids, therefore, makes overdoses a risk. As is well documented, the opioid epidemic remains a huge problem in the United States.
According to the Centers for Disease Control and Prevention (CDC), opioid overdose deaths remain an issue in the United States. Also, deaths from drug overdose are up among both men and women, all races, and adults of nearly all ages. In addition, research data shows the following:
Counties with higher opioid prescribing tend to have the following characteristics:
There are many different types of opioids. In general, most opioids fall under these two categories:
Opioids obtained from plants are called opiates. These come from the flowering opium poppy plant. Examples are opium, morphine, heroin, and codeine. This means that all opiates are opioids. On the contrary, not all opioids are opiates.
Did you know that your body also produces opioids? Your brain makes opioids known as endorphins. These chemicals are similar to morphine and activate the opioid receptors. As a result, they can help minimize discomfort.
In addition, endorphins also bring about feelings of happiness and general well-being. Because of this, they are sometimes referred to as the “feel-good hormones.”
To simplify this discussion, we will talk about opioids under these headings:
Most prescription opioids treat moderate to severe pain. Healthcare providers can prescribe these drugs. Even though they are helpful, side effects can occur. There is also the risk of tolerance, dependence, and addiction.
The adverse effects of opioid misuse apply not only to the individual but also to those around them. To a large extent, it affects family and friends. Also, society as a whole. In a way, these effects are similar to secondhand drinking.
There are many prescription opioids. These include:
The side effects of most of the prescription opioids tend to be similar. These effects are due to their similar actions on the body. They include:
There are many street names for prescription opioids. Because there are several different types of prescription opioids, the street names are numerous. The changes in the language for these substances help drug users evade the detection of their habitual use. By using these various slangs, people can, therefore, remain discreet and hide their habits from family and friends.
Some common slangs for some prescription opioids include:
Of course, these names depend on the type of prescription pill. For details of specific drugs, “Street Names of Drugs: How Many Do You Know” gives a good account.
Even though fentanyl is a prescription opioid, it needs a discussion of its own. This is because illegal production is rife. Also, deaths from fentanyl are in epidemic proportions. So, what is fentanyl? This drug is a synthetic opioid pain reliever. It is similar to morphine, but it is 50 to 100 times stronger. Fentanyl is a powerful prescription drug. It is also made and used illegally. The typical use of fentanyl is for severe pain, especially after surgery. In addition, it is helpful for severe cancer pain.
In some cases, fentanyl is used to treat people with chronic pain who are physically tolerant to other opioids. Tolerance occurs when you need a higher amount of a drug to get the desired effect. Thus, the longer you use an opioid, the more likely you are to become tolerant. Also, higher doses contribute to tolerance.Synthetic opioids are the most common drugs involved in overdose deaths in the United States. In 2017, 59.8 percent of deaths from opioids were due to fentanyl. This number is a considerable increase from 14.3 percent in 2010.Click To Tweet
Prescription fentanyl is marketed by names such as:
Many drugs have street names. By using these various slangs, people can remain discreet and hide their habits from family and friends. Illegal fentanyl has several street names. Some examples are:
Prescription fentanyl is given in the following ways:
On the other hand, illegal fentanyl is sold in the following ways:
Furthermore, drug dealers sometimes mix fentanyl with other drugs. For example, it can be combined with cocaine, methamphetamine, heroin, and ecstasy. Dealers make such mixtures as it takes only a tiny amount of fentanyl to produce a “high.” This makes it cheaper for them, hence increasing their profits.
Unfortunately, this trend is hazardous. There have been many overdoses and deaths as a result of this.
How does fentanyl affect the brain?
Just like other opioids, this drug works by binding to opioid receptors in the body. This reaction causes changes in the way the body perceives pain, and also emotions.
Over time, the brain adapts to the effects of this drug. More and more of this substance is needed to achieve the same effect. This is known as tolerance. As a result, dependence on fentanyl occurs. Continuous use leads to addiction, which can take over people’s lives.
Dependence on fentanyl can cause severe withdrawals if this drug is stopped. These symptoms include:
The withdrawal symptoms can be extremely uncomfortable. Hence, the difficulty in stopping fentanyl without medical supervision. This, therefore, stresses the importance of professional treatment.
Overdosing on fentanyl is relatively common. One of the reasons for this is because of the potency of this substance. In simple terms, this means fentanyl is a very powerful drug.
Also, to maximize profits, drug dealers mix it with other drugs. This means people end up taking fentanyl without even realizing it.
When people overdose on fentanyl, it can slow down their breathing. In addition to this, pinpoint pupils, coma, and even death can occur. Naloxone is a medicine that can quickly reverse the effects of fentanyl. Because of the quick action of naloxone, it is thus crucial to have it readily handy. Opioid users should have access but, also, family members and friends.
Detoxification is the first step in the treatment of opioid use disorders. Medication-Assisted Treatment (MAT) remains the gold standard for treating opioid use disorders long term.
MAT is an evidence-based treatment that involves the use of medications and behavioral therapy. Ultimately, the goal is to provide individualized whole-patient treatment.
There are three medications approved by the FDA for the treatment of opioid use disorders. These are buprenorphine, methadone, and naltrexone. In addition to medications and behavioral therapy, support from family and friends is essential to recovery.
For details on treatment, please refer to the section on Opioid Addiction Treatment below.
Heroin is a very addictive opioid. This rapidly acting opioid is classified as a Schedule I substance by the Drug Enforcement Administration (DEA). The reason for this is because of its extreme risk of addiction.
Heroin comes as a white powder, brown powder, or a black sticky substance known as black tar heroin. The use of this drug can quickly cause physical and psychological dependence.
It initially creates “a high” that users find attractive. Eventually, though, the high may not be as obvious. The withdrawals which follow not using can, however, be very uncomfortable. Because of this, people continue using to avoid the ensuing discomfort. For this reason, stopping “cold turkey” has very low success rates.
Common street names for heroin include:
Heroin is made from morphine, a natural substance from the opium poppy plant. This plant is common in Southwest Asia, Southeast Asia, Mexico, and South America.
People use this drug by injecting, snorting, sniffing, and smoking. As a way to make it work faster, some people burn the substance and inhale the fumes.
Also, injecting heroin directly into the blood (IV use) is another way people quickly gain its effects. This IV use, unfortunately, leads to many complications. Furthermore, there is a practice of mixing heroin and cocaine known as speedballing.
Even though purer heroin is now more common, most heroin from the streets is “cut” with other substances. These substances can be other drugs, starch, sugar, quinine, or even powdered milk. Drug dealers probably add these to heroin to increase their profit margins. Unfortunately, this puts users of such mixtures at risk. This danger is, therefore, yet another reason to stay away from this drug.
People who use heroin are aware of the adverse effects. Despite this, they continue to use it. Why is this?
Heroin enters the brain very quickly. Because of this, it is very addictive. People like the rush or intense high this drug produces. Heroin users report feeling a profound sense of happiness, peace, and relaxation. Also, some people describe a “slowing down” of the world and portray a dream-like state.
How do people become addicted to heroin?
Firstly, tolerance develops. Tolerance means you have to use more of the drug to get the same effects. Secondly, physical and psychological dependence occurs. This means that without heroin, people develop withdrawals. These are very uncomfortable. Because of this discomfort, users tend to continue using it. This continuous use, therefore, helps the cycle of addiction.
Addiction can occur very quickly. Many factors play into how quickly people become addicted. These include the dose of heroin, method of use, frequency, the individual, and circumstances around using.
The body breaks down heroin into morphine. This substance enters the brain very quickly. Morphine attaches to cells in the brain known as opioid receptors.
Consequently, this attachment causes the release of large amounts of a brain chemical called dopamine. This chemical is regarded as a feel-good chemical and produces feelings of happiness. Heroin has effects on brain cells involved in feelings of pain, pleasure, heart rate, sleeping, and breathing.
The duration depends on several factors. Firstly, the amount used is essential. Secondly, the method of using contributes to this. Also, your body metabolism can contribute to how long it stays in your system.
Ultimately, heroin and its byproducts (metabolites) can remain in your body for one to three days.
The use of heroin causes an extreme high, described as “a rush.” In addition to this, there are many other effects of this drug:
Heroin users do not always know the exact amount they use. The reason for this is because heroin is often “cut” with other substances. Also, the other ingredients are mostly unknown.
Consequently, overdoses and complications are frequent. The death rate from heroin overdose is high. Unfortunately, deaths from heroin and other opioids continue to increase. The effects of heroin overdose include:
Detoxification is the first step in the treatment of opioid use disorders. Medication-Assisted Treatment (MAT) remains the gold standard for treating opioid use disorders long term.
MAT is an evidence-based treatment that involves the use of medications and behavioral therapy. Ultimately, the goal is to provide individualized whole-patient treatment.There are three medications approved by the FDA for the treatment of opioid use disorders. These are buprenorphine, methadone, and naltrexone.Click To Tweet
In addition to medications and behavioral therapy, support from family and friends is essential to recovery. For details on treatment, please refer to the section on Opioid Addiction Treatment below.
Purple heroin is a combination of heroin and carfentanil or fentanyl. This mixture is relatively new on the drug scene. Unfortunately, there have been complications and deaths from using this substance.
Fentanyl is a powerful drug. Did you know, however, that carfentanil is even much stronger than fentanyl? Veterinarians use carfentanil for enormous animals like elephants, rhinos, and gorillas. That is, indeed, how strong it is.
According to the Drug Enforcement Administration (DEA), carfentanil is about 100 times stronger than fentanyl. It is also 5,000 times stronger than heroin and 10,000 times stronger than morphine! That is mind-boggling.
There is documentation of many overdose deaths from abusing purple heroin. Unfortunately, this number continues to grow.
Common street names for purple heroin are:
Overdoses are common with purple heroin. It is also more likely that people will overdose on purp than on heroin. This likelihood is because of the potency of fentanyl and carfentanil.
Overdose symptoms can present as:
Combining heroin with carfentanil or fentanyl is one thing. However, mixing them up in unknown amounts is another issue altogether.
People using purp don’t know the exact amount of the ingredients in the drug. As a result, this makes taking purple heroin similar to playing Russian roulette. Thus, the high number of deaths from this drug.
The best way to stay safe from the effects of purple heroin is to abstain. Staying away is, however, easier said than done for people who have an addiction to this drug. Because addiction is a brain disease, stopping drug use is more complicated than the moral angle suggests.
As a result of this, consideration of other techniques is crucial. Harm reduction for purple heroin is one of such modalities to consider.
The Community Drug Strategy is a Canadian initiative. This organization aims to improve health and also address drug-related issues. As a way to be safer, these are some of their recommendations:
The above advice is in keeping with harm reduction. Again, it is best to abstain from purple heroin and other drugs. However, for people who use, caution must be utilized. The aim is to avoid life-threatening complications from using purple heroin.
To clarify, abstinence or safer alternatives should be the goal. Medication-Assisted Treatment remains a gold standard for treating opioid use disorders.
In the United States, the ingredients of purple heroin are all controlled substances:
Detoxification is the first step in the treatment of opioid use disorders. Medication-Assisted Treatment (MAT) remains the gold standard for treating opioid use disorders long term.MAT is an evidence-based treatment that involves the use of medications and behavioral therapy. Ultimately, the goal is to provide individualized whole-patient treatment.Click To Tweet
There are three medications approved by the FDA for the treatment of opioid use disorders. These are buprenorphine, methadone, and naltrexone.
In addition to medications and behavioral therapy, support from family and friends is essential to recovery.
For details on treatment, please refer to the section on Opioid Addiction Treatment below. In summary, though, a comprehensive treatment approach is key.
Is carfentanil dangerous? Yes, it is! Very dangerous. Carfentanil is about a hundred times stronger than fentanyl. It is also thousands of times stronger than heroin.
This potency means very tiny doses can be hazardous. An amount as small as a grain of salt (about 20 mcg) can be fatal. Hence, the need to be very careful with this substance.
Carfentanil is a synthetic opioid first made in 1974. It is a very potent drug. Because of this, veterinarians use carfentanil to put huge animals to sleep. It can knock out an elephant quite quickly! The brand name for this drug is “Wildnil.” Due to its potency, it is a component of some tranquilizer darts.
In 2016, Time wrote an article titled “Heroin is Being Laced With a Terrifying New Substance: What to Know About Carfentanil.” This article reported over 300 overdoses and multiple deaths related to this drug.
Carfentanil is probably added to heroin because it is cheaper than heroin. It is also easier to get and make than heroin. Furthermore, carfentanil has no smell or taste. This property makes it impossible to tell if your drug has carfentanil in it. It comes as liquid, blotter, powder, and pill.
Carfentanil can get to the brain very quickly. This ability is because of how easily it crosses the blood-brain-barrier. It thus works fast, but it is also short-acting.
When an opioid is taken, it travels through the blood and gets into the brain. This chemical then attaches to specific receptors called opioid receptors. Also, opioids bind to receptors in the spinal cord and gut.
The chemical response of this drug binding to receptors in the brain decreases the body’s perception of pain. Opioids are used to treat moderate to severe pain that does not respond well to other pain medications.
The brain produces a chemical called dopamine. Because opioids target the brain’s reward system, they increase dopamine in the brain. The overstimulation of this system causes the high that comes with using these drugs. Due to this feeling, there is a tendency for people to continue to use to experience this euphoria.
The brain’s reward center is responsible for the reactions to intense pleasure. Opioids, like all drugs of abuse, triggers the release of dopamine in excess amounts. The amounts released are far beyond what is needed to provide pleasure in typical situations.
Opioids are most commonly used to treat moderate to severe pain. The origin of such pain may be following surgery or trauma. In some cases, pain may be due to chronic conditions like arthritis or even cancer.
Other than pain, opioids are also used for treating other conditions. Codeine was once the “gold standard” in cough suppressants. Not so much currently, though. Loperamide is an opioid for treating diarrhea due to irritable bowel syndrome. Opioids may also help with shortness of breath in advanced cases of cancer and other terminal conditions.
Opioid use leads to tolerance over time. Tolerance means you need an increase in the amount of opioids to achieve the same effect. It also infers that the effect decreases with continued use of the same amount of the drug. This makes the brain function more or less normally when the drug is present. On the other hand, there is abnormal functioning when the drug is absent.
Continuous use may lead to dependence. This occurs when the body adapts to the presence of opioids. As a result, withdrawal symptoms develop when the drug is decreased or stopped. Addiction may also occur. Addiction is defined as the compulsive and uncontrollable use of drugs despite adverse consequences.
Initially, people who abuse opioids may experience a high and pleasure. Regular use of this drug, however, causes the effect to diminish. At this point, people continue to use to avoid withdrawal symptoms.
To make a diagnosis of an opioid use disorder, specific criteria have to be met. According to the DSM-5, there must be a problematic use of opioids, causing significant impairment or distress. The DSM-5 requires at least two of such of impairments that occur within 12 months. These impairments or difficulty include:
How can you tell if you or a loved one is struggling with opioid addiction? It is important to note that someone struggling with opioid use disorder may develop symptoms slowly. Over time, however, it becomes more evident that they need help.
Common signs of opioid addiction include:
Several factors determine how long opioids stay in your system. Also, because there are many different types of opioids, the length of stay will vary somewhat. However, the following factors generally affect the duration of most opioids:
In general, detection of opioids in the body is as follows:
Note, though, that these are all averages. The half-lives vary from one opioid to another. Besides, opioids build up in fatty tissues after long-term use. Thus, these averages tend to be longer in heavy, chronic users.
Does eating poppy seeds cause a false positive urine screen for opioids? This question is a genuine concern for a lot of people. The answer to this question is, yes, it can.
Poppy seeds do not contain morphine. However, the seeds can become coated by opium extract during harvesting. Consequently, the poppy seeds end up with some opium. Such poppy seeds may end up on muffins or bagels.
Eating pastries with poppy seeds can cause the urine to test positive for morphine and codeine. Indeed, they can be found in urine samples for as long as two days after eating foods containing poppy seeds. When large amounts of the seeds are consumed, opiates may last up to 60 hours in the urine.
Previously, there were many false-positive tests from eating poppy seeds. However, since they contain low amounts of opioids, many current tests now have a higher threshold to avoid false positives.
An opioid overdose occurs when an individual takes high doses of opioids. This can lead to slowing or stopping of breathing. Consequently, this may lead to death.
Opioid overdoses are relatively common. An overdose can occur for a few reasons. Examples are when someone accidentally takes an extra dose, intentionally misuses a prescription opioid, or mixes opioids with other medications. Also, alcohol and over the counter medications may be involved.
In some cases, people take medications meant for someone else. For example, children may overdose if they accidentally take their parents’ medications.
Prescription opioid overdose deaths often involve benzodiazepines. These are medications that help with anxiety, sleep, and seizures. Examples are Xanax, Ativan, and Valium.The combination of benzodiazepines and opioids can cause difficulty breathing, thus, leading to coma or death. So, avoid mixing these medications.Click To Tweet
Overdosing on opioids is life-threatening. This situation requires immediate emergency attention. For this reason, it is important to be able to recognize the signs.
The chance of survival is dependent on how quickly the person receives emergency treatment. Consider the following actions:
Naloxone is a medication that can treat an opioid overdose when given immediately. It is an opioid antagonist with FDA approval for opioid overdose. This drug is a lifesaver. In view of this, it is readily available to individuals who use opioids. In addition, friends and family members can easily get this medication.
This medication blocks opioid receptors in the brain. As a result, it reverses the toxic effects of the overdose. Naloxone administration is by:
Naloxone is readily available from healthcare providers. In some states, pharmacists can dispense naloxone without a prescription. Hence, friends, family, and others can administer this drug in emergencies. The auto-injector (Evzio) and nasal spray (Narcan) versions of naloxone are easy to use.
Training for naloxone administration is available. So, people with opioid use disorder should get this training and carry this life-saver with them. In addition, friends and family should consider having this emergency medication available. Ultimately, it is people around who rescue overdose victims.
The following groups of people will benefit from carrying naloxone:
Note that some people may require multiple naloxone doses. Overdosing on stronger opioids like fentanyl makes this even more likely. In such cases, dosing every two to three minutes may be necessary.
Furthermore, it is essential to monitor people who receive naloxone closely. The recommendation is to observe for up to two hours after the last dose of naloxone. This is because breathing can still slow or even stop afterward.
Because naloxone blocks opioid receptors, it can cause symptoms of opioid withdrawal. Naloxone also has side effects:
Opioid addiction is a chronic brain disease. In a way, it is similar to other medical conditions like high blood pressure and diabetes. What this means is that there is no cure. Opioid addiction can, however, be managed, and people with addiction can recover.
Treatment using safe and proven methods can lead to a healthy, positive life. This healthy way of life is known as recovery. Several studies have been done to find out the most effective choice for opioid addiction treatment. Medications, along with behavioral therapies, are the gold standard for treating this disorder.
Unlike stopping heavy alcohol use, quitting opioids is not particularly risky. Withdrawal from alcohol and benzodiazepines can be fatal. This is, however, not the case with opioids. Still, opioid withdrawals can be extremely uncomfortable.
Opioid addiction treatment can occur in several different settings. The place of treatment will depend on the medications, the person’s situation, home environment, and other factors. There are three primary treatment settings:
Addiction is a chronic disease. Given this, it is essential to note that the treatment will be ongoing. In addition, avoiding persons, places, and situations that can lead to relapse is crucial. Relapse means using a substance again after a period of not using.
In general, opioid addiction treatment involves the following:
Medically assisted detoxification is commonly known as detox. It is only the first stage of addiction treatment. By itself, it does little to change long-term drug abuse. Thus, the need for comprehensive treatment to maintain sobriety.
Detox helps to manage the symptoms of withdrawal safely. This treatment is a crucial step in the process of recovery. Opioid withdrawal refers to a wide range of symptoms that occur after stopping the use of opioid medications. These symptoms can last up to 10 days. In most cases, however, opioid withdrawals last between three to five days.
Withdrawals from opioids can be extremely uncomfortable without proper management. It is rarely life-threatening, though. Using medications to treat withdrawals is generally known as withdrawal management or detoxification. Also, some people refer to it as detox.
The success rates for opioid addiction treatment are much higher when detoxification is done. Quitting “cold turkey” is less successful and is usually very uncomfortable. Albeit challenging, some people have success stopping without any medical intervention. This is, however, not recommended.
Commonly used medications for opioid detox are buprenorphine and clonidine. These medications help make withdrawal symptoms more manageable. They also make detox safer and more successful. Note, however, that opioid-dependent people can start methadone maintenance immediately. They do not require withdrawal management. Similarly, buprenorphine maintenance requires an induction and stabilization initially. After this, an individual can go on a maintenance dose.
Codeine phosphate is sometimes used for detox. It does not affect 2-10 percent of people, however. It tends to be an option when there is breathing difficulty and liver damage. In addition, Lofexidine has FDA approval for treating opioid withdrawal symptoms. It is a non-opioid medication.
Also, the NSS-2 Bridge device is a small electrical nerve stimulator for opioid withdrawals. The placement of this device is behind the person’s ear. It eases symptoms for up to five days during the acute withdrawal phase. Some studies have shown the benefits of this device.
In addition to the above treatments, other medicines may be prescribed for sleep, nausea, vomiting, and anxiety.
Medication-Assisted Treatment (MAT) is an evidence-based treatment approach that involves the use of medications with counseling and behavioral therapies to treat substance use disorders. The goal of Medication-Assisted Treatment is to provide a “whole-patient” approach to treatment.
Note that withdrawal management alone does not treat opioid addiction adequately. Many people relapse after having just detox. Hence, the need for comprehensive treatment to ensure recovery.Maintenance medication in combination with counseling and other support is the recommended treatment for opioid addiction. Click To Tweet
What are maintenance medications? These are medications on a consistent schedule for people with addiction. There are three main choices for medications to treat opioid addiction. These are buprenorphine, naltrexone, and methadone.
Everyone’s condition is different. Thus, the best option will depend on the person, situation, and environment. This decision is made between the person and the clinician. It is, therefore, essential to be open with your treatment professionals.
Buprenorphine is used in medication-assisted treatment to treat opioid use disorder. It was approved by the Food and Drug Administration (FDA) in 2002.
This medication is the first medication for opioid addiction that can be prescribed in an office setting. On the contrary, methadone requires a highly structured clinic. Thus, buprenorphine significantly increases access to treatment.
Under the Drug Addiction Treatment Act of 2000 (DATA 2000), U.S physicians and mid-level practitioners can offer buprenorphine for opioid addiction. Such professionals have to qualify and get an X-license to prescribe. Settings for such prescriptions include offices, community hospitals, health departments, and correctional facilities.
Buprenorphine prescription is always done as part of a comprehensive treatment plan that includes counseling and social support programs. The following buprenorphine products have FDA approval for opioid addiction:
In addition, some buprenorphine products also come as generics. The dose of buprenorphine depends on the type. Most of the tablets and films are given once or twice a day. Sublocate injection is administered under the skin (subcutaneously) once a month. Probuphine is a skin implant that lasts for six months.
Buprenorphine is a partial opioid agonist. This means that it has similar actions to opioids. Thus, it produces effects such as feeling a “high” or breathing difficulties. However, these effects are weaker than full opioid agonists such as methadone and heroin.
The use of buprenorphine is NOT replacing one addiction with another. This medication can lower the potential for misuse of opioids. It also decreases the effects of physical dependence on opioids, such as withdrawals and cravings. Furthermore, it increases safety in cases of overdose.
The effects of buprenorphine increase with each dose until it gets to moderate doses. At this point, it levels out. Thus, further increases do not yield any effects. This “ceiling effect” lowers the risk of misuse, dependence, and side effects.
The side effects of this medication are similar to those of opioids. These include:
Due to the opioid effects of buprenorphine, some people misuse it. As a result of this, naloxone is a component of some buprenorphine products. Suboxone, Zubsolv, and Bunavail all contain this compound.
Naloxone is an antagonist (or blocker) at opioid receptors. It has no effect when products containing it are taken as prescribed. However, if someone with opioid dependence injects a product containing naloxone, severe withdrawal symptoms will occur. Thus, this combination decreases the likelihood of misuse and diversion.
It is not advisable to take buprenorphine with alcohol, other illicit drugs, sleep medications, or drugs that slow breathing. This is to avoid the possibility of overdose or death. So, care should be taken after buprenorphine administration.
Buprenorphine treatment requires a diagnosis of opioid use disorder. This treatment occurs in three phases:
Note, though, that not all clinicians can prescribe buprenorphine. So, it is vital to find a healthcare provider with the certification to prescribe this medication. Many certified prescribers can be found in the Buprenorphine Practitioner Locator.
Methadone use for opioid addiction spans several decades. It is helpful as medication-assisted treatment for opioid use disorder. The goal of methadone is to sustain long-term success. This, therefore, helps people live healthier and more fulfilling lives.
The brand names of methadone include Diskets, Dolophine, and Methadose.
Methadone acts on the opioid receptors in the brain. It, thus, decreases opioid cravings and withdrawals. This drug is taken once a day. It is available as liquid, tablets, powder, and diskettes.
Medication-assisted treatment involves medications, counseling, and social support. Similarly, the prescription of methadone is part of a comprehensive treatment plan.
Methadone prescriptions come with tight regulations. It is available only via SAMHSA-certified opioid treatment programs.
Again, just like with buprenorphine, the length of treatment with methadone is variable. According to the National Institute on Drug Abuse (NIDA), the duration of methadone treatment should be a minimum of 12 months. Even though this minimum is recommended, many people take methadone for several years.
Methadone is safe when taken as prescribed. It has a very long half-life. Because of this, it stays in the body long after the effects wear off. Thus, it is essential to avoid medications that can cause an overdose. Sharing a list of your other medications with your healthcare provider is vital.
Naltrexone is a medication used to treat opioid and alcohol use disorders. It has approval by the FDA for use in medication-assisted treatment. The most common prescription is the pill form. Brand names for the tablets are ReVia and Depade. It, however, also comes as an injectable – Vivitrol.
Naltrexone tablet dosing is usually 50mg daily. Higher doses are sometimes necessary. Vivitrol, the injectable extended-release form, is dosed as 380mg monthly.
Unlike buprenorphine and methadone, naltrexone prescriptions are more readily available. Any healthcare provider licensed to prescribe can write scripts for naltrexone.
Abstaining from any opioids at least 7-10 days before taking naltrexone is necessary. This helps to avoid precipitated withdrawals. It is, therefore, important to get a proper timeline before treatment.
Naltrexone blocks the opioid receptors in the brain. As a result, it stops opioids from working. This action removes the ability to get high from using drugs like heroin, codeine, and morphine.
Due to the way naltrexone works, it may not stop all drug cravings. It is, however, a good option for preventing relapse.
On the contrary, medications like buprenorphine and methadone activate the opioid receptors. They are, therefore, better at suppressing cravings.
One massive advantage of naltrexone, though, is that there is no abuse and diversion potential. Also, for those who relapse while on naltrexone, it prevents the feeling of getting high.
Discontinuing naltrexone can lead to a decrease in tolerance to opioids. This can cause an increase in sensitivity to opioids. This means lower doses of opioids have more effects on them than previously. Thus, doses of opioids that were previously tolerated can lead to an overdose. People must be aware of this.
Again, as with other MAT medications, naltrexone is usually part of a comprehensive treatment plan. Counseling and social support are vital components of success.
There is no specialized training for healthcare providers to prescribe naltrexone or Vivitrol. Detox from opioids must, however, be done before administration. At least 7-10 days should be given before treatment starts.Naltrexone decreases cravings. It also minimizes the feeling of intoxication if people drink on it. Note, though, that it is not advisable to drink on this medication. In addition, naltrexone is not addictive.Click To Tweet
Research shows long-term naltrexone beyond three months to be most effective. It can also be used indefinitely. The duration of treatment will depend on the individual and personal circumstances.
So, which of the various medications is your best choice? Picking a medication for opioid addiction depends on a few factors. Firstly, it depends on the individual. Secondly, the circumstances and environment play a huge role. In addition, the choice of medication is made together with a healthcare provider.
A NIDA study comparing the effectiveness of these two medications is available. It compares buprenorphine/naloxone and extended-release naltrexone (Vivitrol) in treating opioid use disorder. This study shows that both medications are similarly effective once treatment is initiated.
Because naltrexone requires full detoxification, initiating treatment among active opioid users was more difficult. However, once detox was complete, naltrexone had similar effectiveness as the buprenorphine/naloxone combination.
Behavioral therapy is an essential component of treatment. In addition to medications, counseling is recommended for patients with opioid addiction. Counseling helps people modify their attitudes and behaviors related to opioid use. Also, it increases a healthy lifestyle and helps with taking medications regularly.
Counseling also helps people address personal, social, or other issues that can contribute to their addiction. For example, improving self-worth, stressful situations at home or work, and spending time in the same environment.
Behavioral therapies are quite useful in opioid addiction. This usefulness is especially evident when combined with medications. Such therapies include cognitive-behavioral therapy, motivational enhancement, and contingency-management interventions.
Cognitive-behavioral therapy is a type of counseling that helps people understand the thoughts and feelings that influence their behaviors. In this case, these behaviors are those that cause their addiction to opioids.
Contingency management interventions refer to providing incentives in exchange for treatment engagement and being able to maintain abstinence.
Motivational enhancement therapy attempts to initiate a change in behavior. It does this by encouraging people to resolve their doubts about stopping the use of opioids. Furthermore, it also helps individuals engage in treatment.
These behavioral treatment approaches have proven effective, especially when used along with medicines. Given this, it is essential to have this as a component of treatment.
In 2018, the FDA cleared a mobile medical application (app) for opioid use disorder. The reSET-O app is a prescription cognitive behavioral therapy. It is helpful for treatment together with treatment that includes buprenorphine and contingency management. It, thus, helps increase retention in outpatient treatment programs.
In addition to counseling, support groups are beneficial. They usually consist of other people who are also in recovery. These groups help people share their personal experiences. Support groups provide community encouragement to assist in the recovery process. Examples of such groups are Narcotics Anonymous and Pills Anonymous.
For people who use opioids and other drugs, recovery is ongoing. Cravings may develop from time to time, even after treatment. Support groups can provide emotional guidance and encouragement when cravings become intense.
Support groups exist not just for people in recovery, but also their friends and family. Remember, addiction affects people around those who use drugs. So, collective help goes a long way to help recovery.
Coping with addiction is tough. Despite proper treatment, maintaining sobriety can be quite tasking. It is, therefore, vital to have good social support. Growing and strengthening ties with family and friends go a long way to help with recovery.
Family and friends play a crucial role in recovery. Moreso, when they are engaging. They should try and learn as much as possible about addiction to improve the chances of maintaining recovery.
People, places, events, and situations associated with opioids may contribute to relapse. Thus, individuals need to avoid such triggers. In some cases, these may be unavoidable. The ability to use coping mechanisms to stop cravings becomes crucial. This also requires support from family and friends. In essence, support from people around the person struggling with opioid addiction is essential for recovery.
Detox, medication-assisted treatment, counseling, and support are helpful for opioid addiction treatment. In addition to these, it is essential to treat underlying mental health disorders. The importance of this should never be underplayed.
Treatment for depression, anxiety, post-traumatic stress disorder, bipolar disorder, ADHD, and other mental conditions must be considered. It is well known that many individuals self-medicate with drugs. Thus, the need to treat these conditions to prevent a relapse and maintain recovery.
There are different classes of medications that help with various mental disorders. Some of these include antidepressants, anti-anxiety medications, mood stabilizers, and antipsychotics. Transcranial Magnetic Stimulation (TMS) is an FDA approved non-drug treatment for depression.
The National Institute of Drug Abuse (NIDA) produced a research-based guide. This guide highlights the principles of effective treatment. These include:
Following the treatment of opioid use disorder, cravings can still occur. In fact, this is a real struggle for many. It is also a reason for multiple relapses.
So, what are opioid cravings? These are physical compulsions or urges to use opioids. The prominent symptom of cravings is the overpowering desire to use the drug.
This drive causes individuals to focus on acquiring the drug. It also leads to a psychological want for the positive effects of the substance.Cravings are normal and can last for long periods, often causing people to relapse. Cravings may be experienced during the acute withdrawal period and may also occur weeks, months, or even years after use.Click To Tweet
In general, though, they tend to decrease in strength and frequency over time. Cravings may last for minutes to even hours but usually will go away eventually, until the next episode.
Cravings do not indicate that there is a problem. It does not mean that you are unable to manage your desires or that you are weak. A previously published article describes cravings as coming in waves – they build up, reach a peak, and then subside.
Relapse triggers are things, people, places, or situations that an individual who struggles with drugs or alcohol associates with the reward of getting high. These triggers may lead to intense cravings.
Ultimately, the goal is to stop or control these cravings. So, how do you do this?
The key to limiting relapse is to manage relapse triggers and cravings.
Often, the talk is about how to stop opioids. Let us not forget, though, that in some cases, people use prescription opioids due to chronic pain. So, what happens when they stop these medications?
Perhaps, alternative treatments for chronic pain may help them continue to stay away from their prescription medications. Indeed, there are quite a few of such treatments.
Ultimately, individuals who suffer from chronic pain should consult with a pain specialist. Even though there are many alternative treatments, pain treatment is specific to each individual. Due to many possible reasons, what works for one person may not work for another. Hence the need for a proper evaluation by a professional.
Opioids are a class of drugs primarily used to treat moderate to severe pain. They are naturally found in the opium poppy plant. Even though they help treat medical conditions, they also have adverse effects. In addition to several possible side effects, addiction to this drug is rife. As a result, opioid overdoses and deaths remain an epidemic in the United States.
Opioids attach to specific sites in the brain known as opioid receptors. This reaction causes a decrease in the body’s perception of pain. Also, opioids can cause an overstimulation of the reward system – also called the pleasure center. This leads to the release of very high amounts of dopamine. Unfortunately, tolerance, dependence, and addiction can develop as a result.
Signs of opioid addiction include the inability to control the use of opioids, intense cravings, drowsiness, new financial problems, and isolating. Furthermore, there is also the risk of overdose and death. Naloxone (Narcan) is a medication that can reverse an opioid overdose. It, however, needs to be given immediately after an individual overdoses.
Due to the many adverse effects of opioid use disorder, it is essential to obtain proper treatment. Management can be done as an inpatient or outpatient. Regardless of the setting of choice, the first step is withdrawal management. This is also called detoxification (detox). Medication-Assisted Treatment (MAT) is the gold standard for opioid addiction.
MAT involves the use of medications with counseling and behavioral therapies. Other than medications and counseling, support from family, friends, and groups is crucial. Also, it is essential to treat underlying mental illness. Self-medication with illicit substances is a common occurrence in people with mental disorders.
The opioid crisis remains a scourge in the United States. Even though it remains a public health crisis, there have been some positive changes in the right direction. This, however, needs to continue with everyone on board. Collectively, we can make a change!
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The entire content of AddictionBlueprint, including content on drugs and alcohol, medications, therapies, facilities, spotlights, recommendations, and other features is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. This does not constitute a physician-patient relationship. Please seek the advice of your physician or other qualified health providers regarding your addiction, mental and medical issues.
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As far as I know, since the mid-1990s, the frequency of use of opioids (painkillers) has increased significantly in some countries.
That is correct. There are slight variations from one country to another.
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