Opioid Addiction Treatment in 2020: The Ultimate Guide

Video Summary

What Are Opioids?

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.

 

Opioid Addiction Statistics

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:

• Two out of three drug overdose deaths involve an opioid.
• Overdose deaths from opioids have increased almost six times since 1999.
• Overdoses involving opioids killed more than 47,000 people in 2017. Also, 36% of those deaths involved prescription opioids.
• From 1999 to 2017, almost 218,000 people died in the United States from prescription opioid overdoses.
• Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.

 

Statistics for Opioid Overdose Waves

• More than 399,000 people died from opioid overdoses from 1999-2017.
• The first wave of deaths began with the increase in opioid prescriptions in the 1990s.
• The second wave began in 2010, with rapid increases in overdose deaths involving heroin.
• The third wave began in 2013, with increases in overdose deaths involving synthetic opioids. This was mostly due to illicitly manufactured fentanyl.
• There are 192 drug overdose deaths every day.
• Also, 70,237 drug overdose deaths occurred in the United States in 2017.
• Synthetic opioids are currently the main driver of drug overdose deaths.
• In 2017, opioids were involved in 67.8% of all drug overdose deaths.

 

Statistics by States in the U.S.

• The states with the highest rates of drug overdose deaths in 2017 were West Virginia, Ohio, Pennsylvania, the District of Columbia, and Kentucky.
• States with significant increases in drug overdose death rates from 2016 – 2017 are Alabama, Arizona, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, West Virginia, and Wisconsin.
• The fourth quarter of 2018 to the first quarter of 2019 showed a 7.2% decrease in opioid overdoses.

For every opioid overdose death, there are many more non-fatal overdoses. Ultimately, each of these comes with its own emotional and economic toll.Click To Tweet

 

Statistics on Opioid Prescribing Practices

• The overall opioid prescribing rate in the United States peaked and leveled off from 2010-2012.
• The prescribing rate has been declining since 2012. However, the amount of opioids prescribed per person is still around three times higher than it was in 1999.
• There was more than a 19% reduction in the annual prescribing rate from 2006-2017.
• The decline in opioid prescribing rates since 2012 suggests that healthcare providers have become more cautious in their opioid prescribing practices.
• In 2017, however, there were still almost 58 opioid prescriptions written for every 100 Americans.
• More than 17% of Americans had at least one opioid prescription filled.
• There was an average of 3.4 opioid prescriptions dispensed per patient.
• The average number of days per prescription continues to increase, with an average of 18 days in 2017.

 

Statistics on Variability in Opioid Prescriptions

Counties with higher opioid prescribing tend to have the following characteristics:

• Generally smaller cities or large towns
• A higher percentage of white residents
• More dentists and primary care physicians
• A higher number of people without health insurance
• More people without employment
• A higher number of residents who have diabetes, arthritis, or a disability

 

Statistics on Prescription Opioid Overdose Deaths

• About 46 people die every day from prescription opioid overdoses.
• In 2017, 35% of all opioid overdose deaths were due to prescription opioids.
• The most common drug prescription opioids resulting in deaths are methadone, oxycodone, and hydrocodone.
• There has been an increase in prescription opioid overdose deaths in people older than 65 years.
• In 2017, overdose rates from prescription opioids were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics.
• In 2017, the rate of overdose deaths from prescription opioids among men was 6.1 per 100,000. For women, it was 4.2 per 100,000.
• The highest overdose death rates from prescription opioids were in West Virginia, Maryland, Kentucky, and Utah.

 

Types of Opioids

There are many different types of opioids. In general, most opioids fall under these two categories:

• Natural opioids: Codeine, morphine, and heroin.
• Synthetic opioids: Examples include oxycodone, hydrocodone, fentanyl, hydromorphone, tramadol, and meperidine.

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:

1. Prescription Opioids (e.g., hydrocodone, oxycodone)
2. Fentanyl
3. Heroin
4. Purple Heroin
5. Carfentanil

 

1. Prescription Opioids

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:

• Hydrocodone  (Hysingla, Zohydro ER)
• Hydrocodone/Acetaminophen (Lorcet, Lortab, Norco, Vicodin)
• Hydromorphone (Dilaudid, Exalgo)
• Meperidine (Demerol)
• Methadone (Dolophine, Methadose)
• Morphine (Kadian, MS Contin, Morphabond, Astramorph, Avinza, Ora-Morph SR)
• Oxycodone (OxyContin, Oxaydo, Oxecta, Roxicodone)
• Oxycodone/Acetaminophen (Percocet, Roxicet, Endocet)
• Oxycodone/Naloxone (Targiniq ER)
• Oxymorphone (Opana)
• Codeine
• Fentanyl (Actiq, Duragesic, Fentora, Abstral, Onsolis)

 

Side Effects of Prescription Opioids

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:

• Drowsiness
• Nausea
• Vomiting
• Confusion
• Dry mouth
• Constipation
• Excessive sweating
• Difficulty urinating
• Psychosis
• Itching
• Difficulty breathing
• Slow heart rate
• Low blood pressure
• Muscle stiffness
• Seizures
• Irregular heartbeat

 

Street Names of Prescription Opioids

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:

• Stop signs
• Biscuits
• Mrs. O
• Blue Heaven
• Roxy
• Oxy
• Percs
• Hillbilly Heroin
• M-30s
• Kickers
• Buttons
• Ercs
• Greenies
• Blueberries

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.

 

2. Fentanyl

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:

• Actiq
• Duragesic
• Fentora
• Abstral
• Onsolis

 

Street Names of Fentanyl

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:

• Tango and Cash
• Murder 8
• TNT
• Friend
• Jackpot
• Goodfella
• China White
• China Girl
• Apache
• Great Bear
• Friend
• Dance Fever
• Percopop
• King Ivory
• He-Man

 

How is Fentanyl Used?

Prescription fentanyl is given in the following ways:

1. As a shot
2. A patch on your skin
3. Lozenges that are similar to cough drops

On the other hand, illegal fentanyl is sold in the following ways:

1. As a powder
2. Dropped onto blotter paper
3. In eye droppers
4. Put in nasal sprays
5. As pills

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.

 

Fentanyl Addiction

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:

• Difficulty sleeping
• Mood swings
• Nausea
• Vomiting
• Muscle aches
• Tearing
• Runny nose
• Dilation of the pupils
• Diarrhea
• Yawning
• Fever
• Bone pain
• Cold flashes with goosebumps
• Severe cravings

The withdrawal symptoms can be extremely uncomfortable. Hence, the difficulty in stopping fentanyl without medical supervision. This, therefore, stresses the importance of professional treatment.

 

Side Effects of Fentanyl

• Drowsiness
• Nausea
• Vomiting
• Confusion
• Dry mouth
• Constipation
• Excessive sweating
• Difficulty urinating
• Psychosis
• Itching
• Difficulty breathing
• Slow heart rate
• Low blood pressure
• Muscle stiffness
• Seizures
• Irregular heartbeat

 

Fentanyl Overdose

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.

 

Treatment of Fentanyl Addiction

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.

 

3. Heroin

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.

 

Street Names for Heroin

Common street names for heroin include:

• Smack
• Black Tar
• Big H
• H
• Hell Dust
• Horse
• Negra
• Thunder
• Chiva
• Mexican Brown
• China White

 

Origin and Use of Heroin

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.

 

Heroin Addiction

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.

 

How long does heroin stay in your system?

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.

 

Side Effects of Heroin

The use of heroin causes an extreme high, described as “a rush.” In addition to this, there are many other effects of this drug:

• Drowsiness
• Nausea
• Vomiting
• Dry mouth
• Skin itching
• Warm flushing of the skin
• Heavy feeling in the arms and legs
• Confusion
• Difficulty sleeping
• Sexual problems
• Irregular menses
• Constipation
• Constriction of the pupils
• Lung issues like pneumonia
• Depression
• Heart disease
• Collapsed veins from injecting
• Damaged nose tissue from snorting
• Damage to other body organs like the kidneys, liver, and brain
• HIV and hepatitis from sharing needles

 

Heroin Overdose

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:

• Slow and shallow breathing
• Blue lips and fingernails
• Clammy skin
• Seizures
• Coma
• Death

 

Statistics for Heroin Overdose

• In recent years, there has been an increase in heroin use among men and women, most age groups, and all income levels.
• Some of the most significant increases have been in women, people with private insurance, and individuals with higher incomes.
• In 2017, nearly 494,000 people in the United States reported using heroin in the past year.
• In 2015, 81,326 heroin-related poisonings were reported in emergency rooms.
• From 2010 to 2017, there was a five-fold increase in heroin-related overdoses.
• In 2017, over 15,000 people died from drug overdoses involving heroin.
• From 2016-2017, heroin overdose death rates remained stable.

 

Treatment of Heroin Addiction

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.

 

4. Purple Heroin

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:

• Purple
• Purp

 

Purple Heroin Overdose

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:

• Drowsiness
• Slow breathing
• Slurred speech
• Poor attention and memory
• Confusion
• Blue lips and nails
• Seizures
• Coma
• Death

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.

 

Avoiding Complications from Purple Heroin

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:

• Have naloxone (Narcan) ready.
• Use it with other people, but NOT at the same time. Never use drugs alone. Better still, DO NOT use drugs.
• Start with smaller amounts than usual.
• An overdose occurs quickly.
• Call 911 if you suspect the person is overdosing.
• Stay with the person until help arrives.

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.

 

Legal Status of Purple Heroin

In the United States, the ingredients of purple heroin are all controlled substances:

• Heroin: Schedule I under the U.S. Controlled Substances Act
• Fentanyl: Schedule II under the U.S. Controlled Substances Act
• Carfentanil: Schedule II under the U.S. Controlled Substances Act

 

Treatment of Purple Heroin Addiction

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.

 

5. Carfentanil

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.

 

How Do Opioids Work?

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 Dependence

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.

 

DSM-5 Criteria for Opioid Use Disorder

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:

 

Signs of Opioid Addiction

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:

• Inability to control the use of opioids
• Intense cravings
• Changes in sleep habits
• Loss of weight
• Drowsiness
• Poor self-care and hygiene
• Frequent flu-like symptoms
• Decreased sex drive
• Changes in habits
• New financial problems
• Isolating from family and friends
• Stealing from family, friends, or work

 

How Long Do Opioids Stay in Your System?

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:

• Type of opioid
• The dose of the opioid
• Type of ingestion
• The individual’s metabolism
• Body mass and weight
• Body fat content
• Age
• Kidney and liver function
• Quality of the drug
• Level of hydration
• The presence of other drugs in the body

In general, detection of opioids in the body is as follows:

• Urine: 2-7 days
• Saliva: 1-3 days
• Blood: 1-3 days
• Hair: Up to 90 days

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.

 

How Long do Poppy Seeds Stay in Your System?

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.

 

Opioid Overdose

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

 

Signs of Opioid Overdose

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.

• Loss of consciousness
• Breathing is very slow, shallow, or absent
• Unable to talk, even though awake
• Unresponsive
• Vomiting
• Choking sounds
• A snore-like gurgling noise
• Skin tone turns bluish purple, grayish or ashen
• Fingernails and lips turn blue or purplish black
• Pulse is slow, erratic, or absent
• The body is very limp
• The face is clammy and pale

 

Treating Opioid Overdose

The chance of survival is dependent on how quickly the person receives emergency treatment. Consider the following actions:

1. Dial 911 immediately.
2. Begin CPR if the person is no longer breathing or if breathing is very shallow. This is best done by someone who has training.
3. It is crucial for family and friends to be aware of overdose signs and treatment.
4. Administer Naloxone if available.

 

Naloxone

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.

 

How Does Naloxone Work?

This medication blocks opioid receptors in the brain. As a result, it reverses the toxic effects of the overdose. Naloxone administration is by:

• Intranasal spray (into the nose)
• Intramuscular injection (into the muscle)
• Subcutaneous (under the skin)
• Intravenous (into the veins)

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.

 

Who Needs Naloxone?

The following groups of people will benefit from carrying naloxone:

• People with active opioid addiction.
• Those who take high doses of opioids for long-term treatment of chronic pain.
• People who take certain extended-release or long-acting opioids.
• Those receiving rotating opioid medication regimens.
• Following discharge from emergency care after an opioid overdose.
• People completing mandatory opioid detoxification or abstinence programs.

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.

 

Side Effects of Naloxone

Because naloxone blocks opioid receptors, it can cause symptoms of opioid withdrawal. Naloxone also has side effects:

• Rapid heartbeat
• High blood pressure
• Low blood pressure
• Nausea
• Vomiting
• Tremors
• Excessive sweating
• Difficulty breathing
• Cardiac arrest
• Seizures
• Severe opioid withdrawal

 

Opioid Addiction Treatment

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:

1. Outpatient
2. Intensive outpatient or partial hospitalization
3. Residential addiction treatment or hospital 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.

 

Components of Opioid Addiction Treatment

In general, opioid addiction treatment involves the following:

1. Medically Assisted Detoxification (Detox)
2. Medication-Assisted Treatment
3. Counseling/Behavioral Therapy
4. Support groups
5. Support from family and friends
6. Treating underlying mental illness

 

1. Medically Assisted Detoxification (Detox)

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.

 

Medications for Opioid Withdrawals

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.

 

2. Medication-Assisted Treatment

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

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:

• Suboxone tablet and film (contains buprenorphine and naloxone)
• Zubsolv sublingual tablet (contains buprenorphine and naloxone)
• Bunavail buccal film (contains buprenorphine and naloxone)
• Subutex sublingual tablet (contains buprenorphine)
• Sublocade injection (contains buprenorphine)
• Probuphine subdermal implant (contains buprenorphine)

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.

 

How Does Buprenorphine Work?

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.

 

Side Effects of Buprenorphine

The side effects of this medication are similar to those of opioids. These include:

• Drowsiness
• Nausea
• Vomiting
• Headache
• Confusion
• Dry mouth
• Constipation
• Excessive sweating
• Difficulty urinating
• Anxiety
• Depression
• Psychosis
• Itching
• Difficulty breathing
• Slow heart rate
• Low blood pressure
• Muscle stiffness
• Seizures
• Irregular heartbeat

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.

 

Treatment with Buprenorphine

Buprenorphine treatment requires a diagnosis of opioid use disorder. This treatment occurs in three phases:

1. The Induction Phase: This takes place in a certified treatment center or physician’s office. It involves medically monitoring the startup of treatment. Buprenorphine is given in the early stages of opioid withdrawals. On average, this is usually about 12 hours from the last opioid ingestion. The opioid-dependent person must be in mild withdrawals. This is because buprenorphine can cause acute withdrawals if not in the early stages of withdrawal.
2. The Stabilization Phase: This follows the induction phase. It commences after significantly reducing the use of the problem drug. Also, there are minimal or no side effects on buprenorphine treatment. Adjusting the dose of buprenorphine may be necessary for this phase.
3. The Maintenance Phase: In this stage, the individual is doing quite well on a specific dose of buprenorphine. The length of the maintenance phase is variable. It depends on the person and the circumstances. It may be for several months, years, or could be indefinite.

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

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.

 

How Does Methadone Work?

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.

 

Side Effects of Methadone

• Breathing difficulties
• Low blood pressure
• Irregular heartbeat
• Cardiac arrest
• Seizures
• Constipation
• Lightheadedness
• Nausea/vomiting
• Excessive sweating
• Abnormal sperms
• Hallucinations
• Confusion

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 (and Vivitrol)

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.

 

How Does Naltrexone Work?

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.

Side Effects of Naltrexone

• Difficulty sleeping
• Nausea
• Vomiting
• Diarrhea
• Anxiety
• Headaches
• Abdominal pain
• Body pain
• Rash
• Dizziness
• Fatigue
• Loss of appetite
• Constipation
• Liver damage
• Depression
• Suicidality
• Injection site reactions from Vivitrol

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.

 

 

Buprenorphine or Naltrexone? Which one works better?

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.

 

3. Counseling/Behavioral Therapy

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.

 

4. Support Groups

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.

 

5. Support From Family and Friends

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.

 

6. Treating Underlying Mental Illness

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.

 

Principles of Effective Opioid Addiction Treatment

The National Institute of Drug Abuse (NIDA) produced a research-based guide. This guide highlights the principles of effective treatment. These include:

1. Addiction is a complex but treatable disease that affects brain function and behavior.
2. No single treatment is appropriate for everyone.
3. Treatment needs to be readily available.
4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
5. Remaining in treatment for an adequate time is critical.
6. Behavioral therapies – including individual, family, or group counseling – are the most commonly used forms of drug abuse treatment.
7. Medications are an essential element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
9. Many drug-addicted individuals also have other mental disorders
10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
11. Treatment does not need to be voluntary to be effective.
12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B, and C, tuberculosis, and other infectious diseases. Such programs should also provide targeted risk-reduction counseling, linking patients to treatment if necessary.

 

How to Stop Opioid Cravings

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?

 

12 Ways to Stop Opioid Cravings

The key to limiting relapse is to manage relapse triggers and cravings.

1. Identify and avoid your triggers: The first step to stopping your cravings is learning to identify and avoid them. Being aware of your emotional triggers, social triggers, pattern triggers, and, also, withdrawals will go a long way in your ability to avoid these triggers. Planning ahead of time to avoid triggers is essential. This may be as simple as driving home on a different route to avoid the restaurant or bar which you associate with your opioid use. You can also keep things in check at social gatherings by attending with a friend or family member who holds you accountable. Some people, places, objects, situations, and feelings which serve as triggers may, however, be unavoidable. In cases like this, it, therefore, becomes necessary to come up with strategies to deal with cravings that may arise from these triggers.
2. Mindfulness: Mindfulness is a mental state achieved by focusing your awareness on the present moment, while calmly acknowledging and accepting your feelings, thoughts, and bodily sensations. It refers to the ability to be fully present, aware of where you are and what you are doing, and not overly reactive or overwhelmed by what is going on around you. Mindfulness is a therapeutic technique that we all have. It is, thus, available to us in every moment if we take the time to appreciate it. A  2015 study showed that mindfulness could decrease cravings in people who use addictive substances by as much as 20% in the short-term and probably even more over an extended period. So, learn to practice mindfulness!
3. Distractions: Distractions are an excellent way to overcome opioid cravings. It can be especially helpful when you cannot avoid the triggers. Examples of such distractions may be reaching out to someone for social support, going for a run, engaging in work, playing video games, listening to music, watching a movie, taking a relaxing bath, cleaning, and mowing the lawn. It may be helpful to make a list of distractions that help with your cravings. This, therefore, means you can quickly refer to your list and pick on something to distract yourself when the cravings are present. Lists are helpful as this can make a call to action much faster. The short duration it may take to think up and decide on a distraction may be all that is needed to succumb to the cravings and relapse on opioids.
4. Urge surfing: The urge that comes with opioid cravings can be a huge struggle. It may be more beneficial to surf the urge, rather than trying to stop it altogether. Urge surfing is a mindfulness technique that helps with accepting a craving for what it is rather than resisting and struggling with it. One way to do this is to stop and acknowledge a craving when it comes on.  This means accepting that the cravings are there and riding them out, rather than trying to push them away. They will eventually pass. They always do. Many urges disappear in about 10-20 minutes if you can remove yourself from the trigger for the cravings. So, being able to surf the urge is crucial.
5. Reach out to others: Calling and speaking with a friend, family member, sponsor, or therapist may help you cope with your cravings. Support groups like Narcotics Anonymous (NA), Alcoholics Anonymous (AA), and several others are helpful. They encourage having a sponsor whom you can talk to one on one when the cravings are present. Attending support group meetings can also be very helpful as it connects you with other people who have the same struggles. This can go a long way in helping with your conflicting desire to use drugs and your commitment to stay sober. Drug helplines are available, and these numbers can be obtained online for your area. These helplines have trained counselors and volunteers who understand the process of addiction and recovery and who may have been through it as well. Also, churches and other religious bodies usually have people with a capacity for compassion. This may be helpful even you are not religious. It may be that you had used opioids in the past to drown emotional and physical turmoil. You, however, need to look at things differently and work through the various issues you may have. Professional counseling will help you deal with the inevitable stressors of life.
6. Express your feelings: Expressing your feelings sounds simple, but the benefits of this can be huge. There are many ways to do this, all of which can help with the cravings. Simple forms of expressing yourself, such as painting, dancing, singing, drumming, writing, and journaling, are helpful. Your ability to immerse yourself in your feelings, rather than trying to escape drug urges can have huge benefits. Although simple, it can be a truly transformative experience.
7. Cognitive-Behavioral Therapy (CBT): CBT is a form of therapy that aids in developing a positive skillset in recovery. It helps people understand the relationship between thoughts, emotions, and behaviors. It provides techniques to help with cravings when they arise. Redirection, visualization, and distraction are some of the methods that can be used to cope with cravings. Redirecting your attention to something else may be a way to deal with cravings. Some people can distract themselves with some thought or activity until the craving passes. Imagining yourself in a relaxing and soothing environment may help you relax during a craving. Such visualization techniques are quite helpful.CBT techniques help with negative thinking and cognitive distortions. During drug craving, a common cognitive distortion an individual may experience is catastrophizing. This may lead people to experience thoughts like: “There is no way I can do this if I don’t use this drug. I have to use a little to make it through this.” CBT techniques can help with such negative thoughts and help you think through your craving more rationally. This form of therapy can help people deal with their stressors, identify and change their behaviors. Also, their way of thinking that may lead to negative consequences. It helps obtain motivation to change and cultivate ideas to avoid using drugs and alcohol.
8. Get a hobby and job: Hobbies and new interests may provide an excellent way of creating a distraction during drug cravings. Boredom and loneliness may precipitate cravings as the mind attempts to fill a void or space in someone who no longer uses opioids. A hobby helps to provide an alternative to engage people and avoid the use of drugs. In some cases, people may have lost their jobs due to opioid use. This creates a lot of free time and a lack of structure, which could make relapse more likely. The ability to occupy your time with a job not only takes away boredom but also gives you a sense of self and fulfillment. This feeling thus helps with your recovery process.
9. Using self-talk and recalling negative consequences: You can resist the urge to use opioids by talking yourself out of it. The adverse effects of using should be a constant reminder of the need to stay away from these drugs. A written down list of the reasons for quitting has been found helpful by several people, and you may benefit from such a list as well. Reading through such a list can remind you of the things you previously experienced, which you would rather not go through again. Also, challenging your thoughts when cravings arise is an excellent way to help rationalize yourself away from the urge to use opioids.
10. Exercise: Good self-care, such as regularly exercising, has been shown to help improve physical health and emotional well-being. This can help make you more resilient and better able to deal with cravings when they arise. Exercise also has the added benefit of boosting the release of endorphins, sometimes referred to as the “feel-good hormones.” Most forms of exercise will help you get through your cravings. Aerobic activities tend to help more with the release of endorphins. Examples are walking, running, cycling, swimming, tennis, and basketball.
11. Medication-Assisted Treatment (MAT): 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 is to provide a “whole-patient” approach to treatment. MAT is often called the gold standard of addiction treatment. Three medications are approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid addiction. These drugs are methadone, buprenorphine, and naltrexone.
12. Transcutaneous Electrical Acupoint Stimulation (TEAS): Positive results have been obtained using Transcutaneous Electrical Acupoint Stimulation for the treatment of opioid withdrawals. Some studies have shown reductions in cravings by TEAS treatment. The Bridge Device has an indication from the U.S. Food and Drug Administration (FDA) for use in helping reduce the symptoms of opioid withdrawal. It is the first non-pharmacological, non-implantable medical device available for opioid withdrawal. Housed in a small device that fits discreetly behind the ear, it claims to reduce the symptoms of opioid withdrawals by sending gentle electrical impulses to the brain.

 

Alternative Management of Chronic Pain

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.

• Weight Loss: Weight can contribute to many chronic pain conditions. Moreso, on the joints of the lower body. Thus, losing some weight can yield a significant improvement in pain. In some cases, such weight loss may be enough to get off medications.
• Exercise: In addition to contributing to weight loss, exercise has many other benefits. Studies show an overall sense of mental and physical well being in people who exercise regularly. Of course, exercising has to be done within the limits of your condition. You do not want to hurt yourself even more.
• Cold and heat: Depending on your condition, one or both of these can be helpful. In some cases, alternate use of both can have significant benefits. They can help to decrease pain, reduce inflammation, and relieve muscle spasms.
• Occupational Therapy (OT) and Physical Therapy (PT): These require the services of professionals. Physical therapy aims to ease pain and help you function, move, and live better. Occupational therapy improves your activities of daily living (ADL), such as taking a bath and eating. It helps you develop, recover, improve, and maintain skills for daily living and working.
• Ultrasound: This treatment uses sound waves and vibration to deliver heat and energy to parts of the body. The goal is to reduce pain and, as such, speed up healing.
• Cold laser therapy: In this form of therapy, low-intensity laser therapy stimulates healing and decreases pain using low levels of light. The level of light is so small that it is not even enough to heat your body’s tissues. Hence, the name cold laser therapy.
• Transcutaneous electrical nerve stimulation (TENS): TENS is a pain treatment that applies low voltage electric current to the body. It is done with a TENS unit, a small battery-operated device.
• Iontophoresis: This is a technique that uses an electric current to deliver a medicine or other chemical through the skin. Consequently, this decreases inflammation, and thus, pain.
• Mind-body techniques: These are relaxation techniques that help relax the mind and body. Some examples are breathing exercises, mindfulness, and meditation. Albeit simple, these can be quite effective.
• Biofeedback: It is a non-drug treatment in which people learn to control bodily processes that are typically involuntary. This includes processes like muscle tension, heart rate, and pain perception.
• Acupuncture: This is a practice that entails stimulating specific points on the body. It involves using needles to penetrate the skin. It treats various health conditions, including pain.
• Chiropractic care: A chiropractor performs adjustments to the spine or other parts of the body. The goal of these manipulations is to correct alignment problems, ease pain, and help the body heal itself. It can, thus, be quite beneficial for some individuals.
• Psychotherapy: Cognitive-behavioral therapy (CBT) is helpful for people with chronic pain. CBT helps people understand their thoughts and feelings. It can, therefore, help reframe negative thinking patterns that relate to ongoing pain.
• Yoga: This is helpful for chronic pain conditions due to low back pain, headaches, and fibromyalgia. Yoga is a group of physical, mental, and spiritual practices. Its purpose is to foster harmony in the body, mind, and environment. Thus, it can be beneficial for chronic pain.
• Pain-relieving devices: There are many devices which help to support aching joints, and minimize aches. Some examples include shoe orthotics, braces, splints, inversion table, back stretchers, and compression sleeves.
• Topical pain relievers: Some pain relief medications come as skin creams and ointments. These penetrate the skin and help with decreasing pain. Many of them come as over-the-counter medications.
• Other non-opioid medications: gabapentin, pregabalin, and corticosteroid injections. Also, over-the-counter drugs such as ibuprofen and naproxen.

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.

 

Conclusion

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.