Opioid Addiction: Signs, Symptoms & Treatment Options

Opioid abuse and addiction over the past decade has been an inescapable scourge, claiming the lives of individuals and devastating families across the country. Indiscriminate of culture, socioeconomic status, religion, race, and location, opioid addiction has gripped the country by locking millions in its deadly stranglehold. What are opioids, how did they become such a problem, and what help is there to address opioid addiction? What are Opioids? What Are the Signs of Opioid Abuse? What Are the Real Dangers of Opioid Abuse? What Are the Signs of Opioid Addiction? Opioid Detox Options Opioid Addiction Treatment and Recovery

What are Opioids?

Opioids are a class of drugs, either partially or fully synthetic (man-made) which have analgesic, or painkilling properties and behave identically to natural opiates which are direct products of the opium poppy plant. Opioids are commonly known as prescription painkillers, prescribed for the treatment of mild to severe pain resulting from toothaches to terminal diseases. In addition to their analgesic properties, opioids can also provide intense euphoria for users which strongly contributes to their addictive nature. Grossly overprescribed and underestimated, opioids are strong and highly addictive drugs, despite their efficacy in easing sensations of pain.

History of Opioids: How Did We Get Here?

Although the opioid crisis has only recently been officially labeled an epidemic, widespread devastation from opioid abuse and addiction has been a problem since the late 1990's and early 2000's, following the introduction of a particularly potent form of oxycodone. Although heroin addiction had long been a continuous social issue since at least the 1960's, the emergence of oxycodone and the severity of its abuse spread far beyond the inner cities and made its way into rural and suburban communities. From there, with widespread ignorance of the strongly addictive nature of the drug, it continued to be prescribed, abused, and in short, time created a full-blown epidemic. Oxycodone was not the only prescription opioid to contribute to the crisis the United States now faces, however, it was this particular drug that gave fuel to the spark of opioid abuse which was already taking place.

Opioids may now have a negative stigma because of the epidemic, but there was cause for the development of these drugs as pain management options came to be in higher demand. The problem with opioids is the same as it is was with heroin before it was banned in 1924. The analgesic cough suppressant, heroin, was effective for its clinical purposes, but also lead to high levels of addiction which were accompanied by high crime and troubling overdose death rates.  Similarly, opioids are effective painkillers, but the devastating effects of their abuse often turn out to be unequal to their analgesic benefits.

Since the opioid epidemic began, there has been a mass awakening in the United States. Due to the misinformation about the abuse potential of many opioids on the market, countless people assumed that their prescription painkiller was safer than heroin simply because of the prescription label. That erroneous belief had devastating consequences, especially as abuse continued to grow and spread throughout the nation. There were two deadly consequences of this mindset:

  1. As people continued to believe they were safely abusing their opioid painkillers, the overdose death rates involving any opioid skyrocketed nearly fivefold from 2000 through 2016.1
  2. With rising costs and growing restrictions on prescription opioids, an influx of heroin and other illicit opioids, like illegally made fentanyl provided a cheaper and more intense high than painkillers which resulted in even more opioid-related overdose deaths.

Today, focus on the opioid epidemic is plentiful and many doctors are more discerning with their prescribing practices, but the damage has been done. Anyone in the market for an opioid painkiller can get it from a doctor, a friend, relative, or a street-level dealer. And many who became addicted to opioids since the onset of the epidemic have already moved on to heroin.

While all hope is not lost, the rapid spread and complete devastation of the opioid epidemic is solid evidence of the powerful effects of opioid addiction. Virtually every other story of a heroin addict today, started with a prescription opioid.

Signs of Opioid Abuse

Undoubtedly, people do not go from taking opioid prescriptions as directed, to heroin addicts overnight. There is a process to becoming an opioid addict and an integral part of that process is opioid abuse. It is not always easy to identify when opioid abuse is beginning to happen, especially for those who have been taking their prescription as directed. Opioid abuse can be subtle at the start for those with legitimate prescriptions. Additionally, abuse of these drugs is so common that many people view it to be almost as acceptable as alcohol consumption. The following are some scenarios in which opioid abuse takes place, from its subtle beginnings to full-blown chronic abuse.

Taking extra opioids without doctor's approval for any reason, including

  • breakthrough pain
  • periods of high stress
  • difficulty getting to sleep
  • easing anxiety
  • new injuries or ailments
  • doubling a dose due to an earlier missed dose

Taking opioids with other depressant drugs, such as

  • alcohol
  • benzodiazepines like Xanax, Klonopin, Valium, Ativan
  • certain club drugs such as ketamine, GHB, Rohypnol

Taking opioids via unintended administrations, like

  • crushing and snorting pills
  • diluting pills in water, and injecting them intravenously
  • crushing opioid pills, and mixing them with any other drug or solvent like alcohol

Taking opioids without a prescription by obtaining them through illicit means like

  • buying opioids from street level dealers
  • obtaining opioids from friends
  • stealing opioids from family members or others
  • ordering opioids from dark web marketplaces
  • doctor shopping to obtain multiple prescriptions for opioids

Engaging in dangerous and criminal drug-seeking behaviors, including

  • fraudulent actions like stealing prescription pads and forging doctors' signatures
  • intentionally injuring oneself to obtain more opioid prescriptions
  • seeking out stronger opioids than prescribed
  • participating in illegal actions to get money for opioids
  • seeking street opiates like heroin or illicit fentanyl

Opioid abuse may start as one extra pill here or there, but abuse is a slippery slope. Opioids produce a euphoric feeling by releasing higher than normal amounts of dopamine in the reward center of the brain. As such, repeated and higher opioid dosages for more intense euphoria go hand in hand with any degree of abuse of these drugs. Unfortunately, what may seem like an innocent extra pill can turn into two extra pills, then five or six a day, and so on down the rabbit hole of opioid abuse. One of the most dangerous aspects of opioid abuse is growing tolerance which comes with taking higher and more frequent doses. As tolerance grows, the brain becomes acclimated to the presence of opioids and dependence begins to develop. Once dependence develops, a whole new host of dangers present themselves, many of which can change lives and create terrible traumas in the lives of addicts and their loved ones.

What Are The Real Dangers of Opioid Abuse?

Opioid abuse is more than taking extra opioids or using unintended courses of administration for the drugs. Opioid abuse is essentially training the brain and body to acclimate to and begin to depend upon opioids for normal function. The process of becoming dependent on opioids leads to riskier and more dangerous behavior in efforts to continue abusing the drugs and seeking a more intense high. Additionally, as users keep chasing the ultimate opioid high, the effects of the drugs become more intense and that can be very dangerous, resulting in overdose and death.

Effects of Opioid Abuse

When opioids are abused, their effects can be overwhelming and cause a plethora of depressive symptoms which can become deadly in overdose situations. Some of the most common effects of opioid abuse and overdose include the following:

  • extreme euphoria
  • constricted (pinpoint) pupils
  • nausea
  • vomiting
  • drowsiness
  • slowed or irregular heart rate
  • shallow breathing
  • nodding (short periods of falling in and out of consciousness)
  • slurred speech
  • low blood pressure
  • heavy limbs
  • itching

These effects of opioid abuse can become very dangerous and even deadly when the system becomes overwhelmed by the drugs. This can lead to severely depressed breathing which is the most common cause of death in opioid overdose.

In addition to the physical dangers of overdose with opioid abuse, there are lifestyle changes and risks which are inherent to drug-seeking behavior and growing tolerance. It should be made very clear; chronic opioid abuse will increase tolerance. Tolerance is not the same as addiction, but it is a hallmark characteristic along the path to addiction.2

Higher Tolerance, Higher Doses

As the brain becomes more acclimated to opioids and their effects, a user will need higher and more frequent doses of the drug in order to achieve the same effect. As this happens, not only does tolerance grow into deeper levels of dependence, but the risks of overdose also increase significantly. This is especially common if withdrawal symptoms begin to occur. Desperate to feel better, many opioid abusers will take whatever opioids they can get which can be far too much and lead to a dangerous or deadly overdose.

New Opioids

As tolerance grows to one particular type of opioid, for example, a 30mg dose of a prescription painkiller, users begin to look for stronger doses, especially as opioids on hand are depleted faster by taking several pills for greater effect. Different strengths and different formulations of opioids may have varying and unexpected effects, also significantly increasing overdose and complication risks. The most disturbing trend in the opioid epidemic has been the introduction of fentanyl, produced illicitly and mixed in with heroin sold by street dealers. 2018 Research shows that nearly half (45.9%) of all opioid-related overdose deaths in 2016 involved fentanyl.3

Dysfunction

Opioid abuse may start as an extra pill before bed, but often evolves into an extra pill because work was stressful or bringing a pill to work because of there is a big presentation, maybe even taking a pill before commuting to calm traffic anxiety. When these kinds of developing excuses are creating dangerous and risky opioid intoxication, dysfunction begins to present as a part of life. Traffic accidents, loss of employment, confrontation and tension with others, are all growing risks of continued opioid abuse.

Decisions and Judgement

As opioid abuse continues, judgment begins to sway toward the continuation of abuse rather than seeking help to reverse it. Cloudy decision-making and thought processes are a big part of drug abuse, especially as it progresses closer to addiction. Individuals who are determined to experience a more intense high will take outrageous risks to achieve that goal. These risks include things like

  • accepting and using drugs with which the individual is not familiar
  • combining various drugs without knowledge of potential dangers and effects
  • intentionally inflicting harm to oneself in efforts to obtain stronger and more dangerous combinations of prescription drugs

Eventual Opioid Addiction

The most inevitable and consequential effect of opioid abuse is eventual addiction. The time it takes to become fully addicted to opioids depends strongly on individual circumstances, but the reality of addiction looms around the corner for every individual engaging in opioid abuse. Once addiction takes hold, opioid abuse is no longer solely for the enjoyment of a high, but more often to avoid withdrawal symptoms and maintain some sense of personal normalcy.

The full scope of dangers and risks associated with opioid abuse have no real limits. The effects of opioid abuse have been felt all across the United States, upending the sanity and stability of millions of families and relationships. Personal health and wellbeing are constantly in jeopardy as continued opioid abuse never strays far from the possibility of a deadly overdose.

What Are The Signs of Opioid Addiction?

Once opioid abuse has developed into an addiction, a whole new set of standards begin to apply to life. Whereas opioid abuse may have been for purposes of coping with a stressful time here or there, wanting to feel euphoric and have fun, or even sensation-seeking, opioid addiction raises the stakes to what can feel like life or death. Opioid addiction is literal dependence on opioids in order for the brain to function with any sense of normalcy. When opioid addiction has developed, the brain has become accustomed to the effects of opioids and makes adjustments from normal functions to accommodate constant effects of opioids. At this point, opioid-addicted individuals need to maintain opioids in their system in order to avoid withdrawal symptoms. Although they are not life threatening, opioid withdrawal symptoms are among the scariest and most undesirable set of consequences addicts may encounter.  The behaviors resulting from addiction are often unmistakable, as addiction does not give an individual a choice of abusing opioids or not. In the face of addiction, if there are no opioids, withdrawal will occur and that is not an acceptable option for many opioid addicts.

Some of the most notable signs of opioid addiction include the following:

  • unexplained and serious financial troubles
  • sudden and frequent increase in legal troubles
  • significant decline in personal hygiene and cleanliness standards
  • severe disturbances in sleep cycles (i.e.sleeping during normal waking hours and vice versa)
  • frequent disappearances during extended social situations
  • appearance of track marks or abscesses on arms, legs, neck, in between toes, or top of hands
  • increased occurrences of emergency room or urgent care visits
  • belligerence or extreme agitation when asked or questioned about habits or opioid use
  • rapidly declining health
  • significantly increased isolation from friends and loved ones
  • seemingly frequent bouts with severe colds or the flu
  • severe mood swings

The major difference between opioid abuse and opioid addiction is that once addicted, an individual no longer has freedom of choice over opioid use. The very definition of addiction is the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma.4  While opioid withdrawals are not life-threatening, the discomfort and pain associated with them is among the most common cause of relapse among addicts, as many just simply cannot tolerate the symptoms of withdrawal.

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Opioid Withdrawal Symptoms

Many have referred to opioid withdrawal symptoms as among the most difficult to endure across the entire spectrum of addictive drugs. With symptoms ranging from moderate to severe, opioid withdrawal presents a host of physical and psychological symptoms which are tumultuous for any individual. Typically having an ominous beginning, the first signs of oncoming withdrawal are excessive yawning and a runny nose. From there, the symptoms worsen and become more extensive, including the following:

  • flu-like symptoms
  • fever
  • severe headache
  • muscle aches and spasms
  • nausea
  • vomiting
  • diarrhea
  • agitation
  • anxiety
  • insomnia
  • abdominal cramping and pains
  • high blood pressure
  • goosebumps
  • elevated heart rate
  • intense cravings
  • sweating
  • dilated pupils
  • watery eyes

Opioid withdrawal can begin within 6 hours of the last dose of opioids, but that time varies depending on individual tolerance and opioid use habits. It is because of these symptoms that most opioid addicts do everything within their power to avoid withdrawal, even if that means breaking the law or stealing from a loved one. This is also where many who started with abusing opioid prescriptions transition to heroin. Once in the throes of opioid addiction, and facing impending withdrawal symptoms, addicts will do anything to "get well". At this stage in opioid abuse and addiction, use of the drugs is no longer a recreational thing; it's more of a necessity because the brain has grown dependent upon opioids.  This does not mean that an addict is incapable of getting high, but it comes at a much higher cost because significantly stronger or quantitatively higher doses are needed to experience a euphoric high.

Despite the fact that there is no threat of death from opioid withdrawal, it is understandable why addicts who try to quit cold turkey and without a medical detox abandon the process for a speedy return to opioid use.

Opioid Detox

The process of opioid detox can vary depending on individual circumstances and preferences, but there are a few different options available. Considering the discomfort and pain of opioid withdrawal symptoms, the goal of any detox is to rid the body of opioids and their byproducts safely and as comfortably as possible. Although all symptoms cannot be avoided, many can be managed with medications carefully monitored by doctors.

Medical Opioid Detox

The most common form of opioid detox is a traditional medical detox. This form of detox takes place in a setting with some medical capabilities, but not specifically a hospital setting. Many addiction treatment facilities are able to provide a medical detox which is fully capable of any medical requirements which may arise during the process. While the length of time to complete detox depends on individual circumstances, the general time period is between 5 and 10 days. A completely normal feeling may not be fully restored, but the process of detox is usually complete by days 6 through 10.

The most notable benefits of medical opioid detox are:

  1. typically completed in less than 10 days
  2. medications are provided to manage symptoms like high blood pressure, anxiety, insomnia, and agitation
  3. the body is completely rid of opioids, allowing full focus on recovery thereafter
  4. available through virtually all drug treatment programs

Medical detox has long been considered effective in the process of addiction treatment. As the first essential step in the recovery process, opioid detox lays the groundwork for the success of the entire rehab process.

Opioid Detox for Medically Assisted Treatment (MAT)

Growing more popular with the extraordinary rates of opioid addiction, is medically assisted treatment which involves using medication to manage opioid addiction in recovery, rather than detoxing completely from the drugs. There are two medications used for this process; methadone and buprenorphine.

Methadone Treatment

Methadone, a synthetic full opioid agonist and long-acting drug has been used as an effective opioid addiction treatment medication for over 30 years. It is required to be used in conjunction with an opioid recovery program and works by binding to the opioid receptors, and maintaining its length of action for 24-36 hours.

Methadone is typically prescribed based on individual tolerance and begun around 24 hours into opioid withdrawal. Heavily regulated, methadone must be provided by an opioid treatment provider (OTP) certified by SAMHSA (Substance Abuse and Mental Health Services Administration). Although the minimum recommended time for methadone treatment is one year, it is not required for the duration of life and may be discontinued through a slow tapering process assisted by the prescribing physician. An appropriate time for discontinuation of methadone is determined by an assessment of the individual's assimilation to sober living and healthy habits.

Buprenorphine Treatment

Buprenorphine is similar to methadone, but it is a partial opioid agonist, which means it does bind to opioid receptors, but not to the full extent of methadone. Additionally, buprenorphine has a ceiling effect, so it does produce opioid-like effects, but only to a certain point and no additional dosages or quantities will produce greater effects. Buprenorphine also contains naloxone, an opioid antagonist which remains completely inactive unless the drug is abused and attempted to be injected intravenously. Intravenous administration activates naloxone, which precipitates immediate opioid withdrawal.

With a long action of 36-72 hours, burprenorphine is used and regulated similarly to methadone. Also required to be provided through only SAMHSA certified opioid treatment providers, and in conjunction with a treatment recovery program, buprenorphine treatment can begin 24 hours into opioid detox. Buprenorphine, like methadone, fills the opioid receptors which prevents withdrawal symptoms and allows addicts to focus on their recovery plan until such time that they and their prescribing physician agree to discontinue the treatment.

The benefits of medically assisted treatment in opioid detox are as follows:

  1. opioid withdrawal symptoms are largely avoided with the administration of methadone or buprenorphine
  2. long-term treatment is provided with these medications, further encouraging recovery minded lifestyle choices and habits
  3. decisions regarding the length of treatment with methadone or buprenorphine can be made by the individual with professional medical consultation
  4. slow taper is available when the individual is stable enough in recovery to discontinue the treatment

Methadone and buprenorphine are similar, but tend to be prescribed differently depending on individual circumstances. Individuals who are accustomed to higher doses of opioids are more likely to do better with methadone, because there is no ceiling on its effects. However, those who have lower tolerances to opioids are more likely to benefit more from buprenorphine which has a much lower potential for abuse and overdose.

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Opioid Addiction Treatment and Recovery

Opioid addiction treatment is the best way for addicts to discover their own paths towards recovery from opioids. Addiction treatment today is designed with individuals in mind because there is no singular path to recovery for all addicts. In addiction treatment, opioid addicts are able to address more than just addiction. Effective opioid addiction treatment programs not only provide individualized attention to each person, but also helps to establish a unique recovery program which specifically fits the needs and preferences of each individual. With no foreseeable end to the opioid addiction crisis or the vast availability of opioids, it is increasingly important for recovery to be a meaningful and realistic individual journey. Some of the most important aspects of an effective opioid addiction treatment program include:

  • individual therapy
  • discovering underlying issues and trauma which may have contributed to opioid abuse
  • group counseling
  • addiction education
  • learning about the science of addiction
  • understanding of how addiction effects entire families
  • supplemental therapies like acupuncture, equine assisted therapy, yoga, music and art therapy, and experiential therapies
  • family counseling
  • lifestyle coaching
  • aftercare planning

Aftercare Planning

Aftercare planning, as the name implies, is making a plan for maintaining sobriety after treatment has been completed. Aftercare can consist of several different things and is intended to solidify the skills and education provided by the treatment program. Some of the most important aspects of aftercare include things like:

  • Sober living environments (SLE), where recovering addicts live in a group home with light structure. Recovering addicts generally maintain regular AA/NA meeting schedules and start the process of transitioning back to work, school, or other productive activities in life. Residents can leave in the morning, conduct their business, and return by a designated time for the rest of the evening. This allows people to get back to life outside the confines of the treatment facility, but still reside with a recovery-minded population and a strong support system for their own sobriety.
  • Life planning, which typically occurs before the treatment program is completed and may cover things like job training, resume building, meeting locations and schedules, and contact information of other individuals in recovery, sometimes including staff at the treatment program who may be helpful allies or potential sober coaches in the journey of recovery.
  • Outpatient treatment is often recommended for individuals who have completed drug treatment and is a less intensive level of care. Each individual is able to set days and times to attend based on their schedule. Outpatient treatment is a valuable tool which provides more skills and education for recovering addicts.

As opioid addiction continues to ravage individuals and families across the United States, the need for effective detox and treatment grows more imperative. Much like alcohol, opioids are a part of our society, so we must learn to abstain and live in recovery despite the presence and wide availability of these addictive drugs. Personalized and comprehensive treatment programs are the best opportunity for opioid addicts to reclaim their lives with new skills aimed at maintaining recovery. If you, or someone you know is struggling with opioid abuse or addiction, help must be sought immediately. Opioid addiction will not get better on its own and is guaranteed to escalate to more dangerous levels with each day it goes unaddressed. At Pax House Recovery, we understand the struggles of addiction and we know the importance of individualized and personal attention, and treatment with compassionate and comprehensive care. If you, or a loved one is ready to begin the journey to freedom from opioid addiction, please call us now and speak confidentially with one of our caring treatment consultants. We are here to listen and help you reclaim your life, on your terms.

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