Opioids, sometimes called narcotics, are a class of drugs that include legal prescription medications, the illegal drug heroin, and synthetic substances such as fentanyl. Opioids are commonly prescribed by medical providers to reduce pain, including pain associated with cancer or following a surgery (i.e., severe acute pain). Opioids can negatively affect the reward center in the brain, leading users to need more and more over time. As a result, these drugs can be highly addictive.
Natural opioids are derived directly from the opium poppy plant. Natural opiates include morphine, codeine and thebaine.
Semi-synthetic (man-made) opioids are created in labs from natural opiates. Semi-synthetic opioids include hydromorphone (Dilaudid® and Exalgo®), hydrocodone (Vicodin®), oxycodone (OxyContin® and Percocet®), oxymorphone (Opana®), and heroin, which is made from morphine.
Synthetic opioids are produced entirely by people in a lab. Examples of synthetic opioids include fentanyl, carfentanil, methadone, tramadol and more.
“Opioid use disorder causes measurable changes in the brain. It’s a real thing that you can see,” says Dr. Caleb Banta-Green, principal research scientist with the University of Washington’s Alcohol and Drug Abuse Institute. “It’s a biological condition that’s driving behavior. While it looks like a person making bad choices over and over, it’s really about the brain being hijacked by the drug.”
Opioids attach to proteins, called opioid receptors, on nerve cells in the brain, spinal cord, gut and other parts of the body. By attaching to receptors, opioids block pain signals or “messages” from reaching the brain, which then curbs the feeling of pain. That is why opioid medications are often prescribed for severe acute pain, including pain associated with cancer or surgery. While opioids can effectively relieve pain, they do carry some risks and can be highly addictive.
Along with reducing pain, opioids increase pleasure by releasing dopamine, one of the “feel good chemicals” in the brain. Research has shown that the drugs most used by humans (e.g., opiates, alcohol, nicotine, amphetamines and cocaine) create a neurochemical reaction that significantly increase the amount of dopamine that is released by neurons in the brain’s reward center. This dopamine overflow results in the feeling of being “high.” The body eventually adjusts to the pain-blocking properties and abundance of dopamine, which means a larger dose is needed to get the same level of pain control or high. Your brain becomes hard-wired to seek opioids to maintain its new normal, which is labeled as dependence.
Dependence is not the same as addiction.
Dependence occurs when the brain adapts to the effects of a drug and develops tolerance. In other words, an individual will require a higher dose of the drug to feel “normal.” If the drug were to be stopped, the body would begin to go through withdrawal. Opioids, even when used as directed by a doctor, can cause dependence. Luckily, dependence can be easily managed and resolved. Talk to you doctor about slowly lowering the dose of, or “tapering,” your medication.
Misuse of opioids can lead to addiction, a disease that interferes with normal functioning. A person who has an addiction is physically unable to stop taking the drug, even when that drug is causing negative consequences. “Addiction affects the parts of the brain responsible for decision-making and self-control, so a person suffering from addiction will continue to use the drug despite serious life consequences, such as losing a job, getting arrested, or suffering an overdose.” Opioid addiction is not a moral failing, but a chronic disease. Finding the right treatment options and services are crucial.
A similarity to heart conditions, cancers, and other chronic diseases is the random nature of how addiction can happen. Some individuals may have had adverse experiences in childhood or adulthood that caused emotional and/or physical trauma, resulting in an increased risk for developing a substance use disorder. Others may be born genetically geared to like or feel “normal” when taking opioids. The tricky part is you will not know if you fall into the latter category until you try an opioid for the first time.
Moodiness, irritability, anger, aggressive behavior
Depression, poor personal hygiene
Incoherence, forgetfulness, slurred speech
Significant changes in weight
Clumsiness, poor balance, lack of coordination
Rapid speech, uncharacteristic talkativeness, restlessness
Irresponsibility, recklessness, bad judgment, secrecy
Thefts or sudden requests for money
Change in social interactions, new friends replace old friends, fights with family members and friends, not participating in family functions
Problems at work/school, such as decreased effort, discipline issues, poor grades or unexplained absences
Among people who used heroin in the last three months, 53% reported that they had been previously “hooked on” prescription-type opioids.
Misusing and abusing opioid prescriptions can lead to an addiction and increases the risk of overdose.
Improperly using your own prescription is called “prescription misuse,” and when that prescription is for opioids, this practice can be very dangerous. Examples of prescription misuse include:
Examples of prescription abuse include:
“Opioid pain medication for acute pain should be taken at the lowest dose possible and for the shortest time possible to make the pain manageable. A patient who tries to take sufficient medicine to get rid of the pain completely or continues the medication until the pain is gone completely puts themselves at risk for prolonged opioid use disorder.”
––Dr. Howard Leibrand, Health Officer for Skagit County and addiction medicine physician with Ideal Option