Opiates are classified under highly potent pain killers that are prescribed to individuals who are unresponsive to over- the- counter analgesics like non- steroidal anti inflammatory drugs (aspirin, acetaminophen and others). Most opiates are derived from the processing and post- translational modification of opium plant (poppy seeds) and include morphine and codeine. There are also a large variety of opiates that are synthesized in the laboratory like hydrocodone, oxycodone and fentanyl to manage severe pain symptoms (like in palliative care of untreatable cancers). Likewise, there are also some illegal opiates that are used as recreational drugs (like heroin).
Mode of action of opiates and logical basis of opiate addiction
The brain controls all the primary activities and biological functions of human body. The remarkable degree of coordination is attributed to various neurochemicals (also known as neurotransmitters) that are released within the brain to influence the activity of receptors in order to elicit a response like control of a muscle activity or higher mental functions like processing of memory. Opiate receptors in brain are associated with the control of pain perception(1) that is controlled by endogenous pain neurotransmitters like endorphins. However, if an individual consumes exogenous (or oral) opiates in the form of drugs for considerable period of time, the internal production of opiates reduces significantly leading to degeneration or destruction of nerve cells that are responsible for producing endorphins (or endogenous opiates). This process initiates physical dependence on exogenous opiates since human brain has no internal source to stop the sensation of pain and discomfort. With continued intake, the receptors require even higher doses of exogenous opiates to control pain perception; thereby leading to opioid addiction.
Opioid addiction or psychological dependence on opioids is mainly associated with reward system of brain. Positive things in life like your favorite food, sex and fun related activities increase the release of dopamine in the brain that creates a state of well-being and euphoria. The reward system of the brain influences your lifestyle and habits to perform activities repeatedly that release dopamine in brain and induce a sense of pleasure and well-being. The same behavior promotes opioid addiction and psychological dependence. It is noteworthy that opioid addiction has been classified as a disease primarily because the long term intake leads to changes in the brain circuitry that leads to cravings even after the primary treatment.
Who is at risk of developing opioid addiction or dependence?
The patterns of opiate addiction are variable in different individuals and depend largely on the duration of use and indications. A lot of opiate users want to know a safe window during which opiates can be consumed without developing dependence. The answer to this question is complex and depends on various factors. Likewise, a lot of people usually start with prescription opiates to manage pain and gradually develop dependence. According to research and statistics presented by Mark Chaffin(3) certain risk factors increase the risk of opioid dependence in users; these are:
- History of certain psychiatric conditions like bipolar disorder, major depression, post- traumatic stress disorder
- Inherent genetic factors
- Stressful lifestyle (long working hours, poor social interactions)
- Nature of drug in use (short acting opiates causes addiction more readily than longer acting ones)
What are the signs to watch for in opiate users?
Opiate dependence or addiction is bad for a number of reasons. Not only it affects the general physical health (by interfering with your natural sleep pattern, gut motility) but it also increases the risk of sedation, respiratory depression and sudden death due to accidental over-dosage. Opiate dependence or addiction is a vicious cycle that involves acquisition of more and more opiates and ingesting higher doses to maintain euphoria. The process slowly and gradually compromise your productivity, personal and social life. As discussed previously, opiates are prescribed to manage pain symptoms in a variety of situations like post- surgical pain, inoperable cancers, chronic inflammation or infection involving renal stones, degenerative joint conditions or other similar situations. Here are a few signs that may help in diagnosing if you are developing opiate dependence.
- Are you experiencing an increase desire/ need to consume a higher dose of opioids over time?
- Have you ever experienced opioid withdrawal symptoms with delay in dose administration?
- Are you using a higher dose than what was initially prescribed to you?
- Are you experiencing any negative or undesirable effects with opioids?
- Are you experiencing any changes in your normal daily routine or personal/ professional and social life because of opioid intake?
- Do you often think about ways of getting more opioids?
- Have you made prior attempts to quitting opioid intake? Have you encountered difficulty in reducing your overall dose?
- If the answer to most of the listed questions is a YES, you may be addicted to opioids
What to do if you think you are addicted to opioids?
It is very important to think rationally and make decisions regarding your health and overall wellness of your family. First and fundamental step is acceptance (accepting that you have a problem and you need treatment). Second most important step is getting optimal support from your loved ones, family members or friends. A strong support group helps in maintaining compliance and preventing relapse. Third and most important step is getting professional help in the form of an expert team of healthcare providers who can manage the withdrawal symptoms and promote rapid opiate detox treatment. Additionally, it is also recommended to choose a center that can address the causes of your addiction and take measures to prevent relapse. Lastly, in order to prevent relapse, join support groups and involve yourself in positive and healthy activities. Seek treatment or medical help for psychological stressors or depressive symptoms and avoid the triggers (any positive memory associated with the experience of opiate use like certain friends, environment and circumstances that caused or promoted opiate addiction/ dependence in the first place).
References: 1. Wise, R. A. (1988). The neurobiology of craving: implications for the understanding and treatment of addiction. Journal of Abnormal Psychology, 97(2), 118. 2. Edlund, M. J., Steffick, D., Hudson, T., Harris, K. M., & Sullivan, M. (2007). Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain, 129(3), 355-362. 3. Chaffin, M., Kelleher, K., & Hollenberg, J. (1996). Onset of physical abuse and neglect: Psychiatric, substance abuse, and social risk factors from prospective community data. Child abuse & neglect, 20(3), 191-203.