What Are Prescription Opioids?
Opioids are drugs that act on the nervous system to relieve pain. They slow down the actions of the body, such as breathing and heartbeat, and affect the brain to increase pleasant feelings. The medication comes in a pill, a liquid, a wafer or in a patch worn on the skin. Continued use and abuse can lead to physical dependence and withdrawal symptoms. The abuse of opioids, which get their name from opium, a drug made from the poppy plant, is a serious and challenging public health problem. Deaths from drug overdose have risen steadily over the past two decades and have become the leading cause of injury death in the United States.
How Are Opioids Used?
Prescription opioids are available as immediate-release (IR) or extended release/long-acting (ER/LA) formulations. While the improper use of any opioid can result in serious side effects, including overdose and death, that risk significantly increases with ER/LA formulations. Prescription opioids taken in combination with other misused or abused prescription drugs such as benzodiazepines (e.g. sedatives like Xanax) and antidepressants are commonly linked to overdose deaths. Examples of prescribed opioid medications include:
- Codeine—an ingredient in some cough syrups and in one Tylenol® product
- Hydrocodone—Vicodin®, Lortab®, or Lorcet®
- Oxycodone—Percocet®, OxyContin®, or Percodan®
- Morphine—MSContin®, MSIR®, Avinza®, or Kadian® Propoxyphene—Darvocet® or Darvon®
Who is Abusing Opioids and How Do They Get Them? Opioid medications are sometimes misused to self-medicate or to get a good feeling, called a “rush” or “high.” People misuse medications by taking their own prescriptions improperly, stealing medications, going to multiple doctors to get larger quantities or buying them from drug dealers. Sometimes to get high, they drink a large amount of liquid medicine or crush the pills to ingest, snort or inject them. And some people seek a high from heroin, an illegal opioid that can be smoked, snorted or injected. Existing evidence shows that individuals at greatest risk for prescription opioid overdose include:
- Men (although overdose among women is on the rise);
- People living in rural areas (clusters in the Southeast—especially in the Appalachian region);
- Adults aged 45-54 years;
- People who obtain multiple controlled substance prescriptions (especially the combination of opioid analgesics and benzodiazepines) from multiple providers;
- People who take high daily dosages of opioid pain relievers.
Among persons aged 12 or older in 2012-2013 who used prescription pain relievers nonmedically in the past year, 53 percent received them from a friend or relative for free and approximately 15 percent bought or took them from a friend or relative. However, recent research indicates that the source for nonmedical users varies significantly depending on the frequency of nonmedical use. While those who use the drugs non-medically less than 30 days a year are most likely to obtain their drugs from a friend or relative for free, the highest-use, highest-risk nonmedical users who reported non-medical use 200 or more days a year were more likely to obtain their drugs directly from a doctor’s prescription. There is a clear correlation between opioid prescribing rates and overdose death rates in the United States. The total number of opioid pain relievers prescribed in the United States has skyrocketed in the past 25 years. The number of prescriptions for opioids, like hydrocodone and oxycodone products, have escalated from around 76 million in 1991 to nearly 207 million in 2013. The United States, their biggest consumer globally, accounts for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet).
Tolerance and Dependence
Prescription drugs, especially opioid analgesics—a class of prescription drugs such as hydrocodone, oxycodone, morphine and methadone used to treat both acute and chronic pain— have increasingly been implicated in drug overdose deaths over the last decade. From 1999 to 2013, the rate of drug poisoning deaths involving opioid analgesics nearly quadrupled. A person who takes opioids can become tolerant of them. This means that more of the drug is needed to obtain its effects. It is also possible to become dependent on opioids—to feel sick if there are no opioids in the body. This sickness is called withdrawal. Tolerance and dependence are common side effects of prescribed opioid medication. If tolerance is a problem, doctors may adjust the person’s dose or change the medication. People who have become dependent on opioid medication but are ready to stop taking it can taper off (take less and less) to avoid withdrawal. This should be done under a doctor’s care. Tolerance and dependence also occur in people who misuse medications or take heroin. Over time, such people often begin to feel uncomfortable without the opioid and need to take it just to feel normal. Those who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed. For example, OxyContin is an oral medication used to treat moderate to severe pain through a slow, steady release of the opioid. People who abuse OxyContin may snort or inject it, thereby increasing their risk for serious medical complications, including overdose.
What are the Effects of Opioid Abuse?
Taken as prescribed, opioids can be used to manage pain safely and effectively. However, when abused, even a single large dose can cause severe respiratory depression and death. Properly managed, short-term medical use of opioid analgesics rarely causes addiction. Regular (e.g., several times a day, for several weeks or more) or longer term use or abuse of opioids can lead to physical dependence and, in some cases, addiction. Physical dependence is a normal adaptation to chronic exposure to a drug and is not the same as addiction. In either case, withdrawal symptoms may occur if drug use is suddenly reduced or stopped. While the relationship between opioid overdose and depressed respiration (slowed breathing) has been confirmed, researchers are also studying the long-term effects on brain function. Depressed respiration can affect the amount of oxygen that reaches the brain, causing a condition called hypoxia. Hypoxia can have short- and long-term psychological and neurological effects, including coma and permanent brain damage. Only under a physician's supervision can opioids be used safely with other drugs. Typically, they should not be used with other substances that depress the central nervous system, such as alcohol, antihistamines, barbiturates, benzodiazepines or general anesthetics, because these combinations increase the risk of life-threatening respiratory depression. Continued use or abuse of opioids can result in physical dependence and addiction. The body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced or stopped. Tolerance can also occur, meaning that long-term users must increase their doses to achieve the same high.
Looking For a Clean and Sober Life?
Naloxone is an effective drug to reverse overdose from both prescription opioids and heroin. Naloxone binds to opioid receptors and can reverse the effects of other opioids. It can quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of heroin or prescription opioid overdose. As of July 1, 2015, 39 states have statutes that allow for “third-party” prescriptions of naloxone (i.e. the prescription can be written to friend, relative or person in a position to assist a person at risk of experiencing an opioid overdose). Medication-assisted treatment (MAT) is treatment for addiction that includes the use of medication along with counseling and other support. MAT is the use of medications (i.e. buprenorphine, methadone, extended-release injectable naltrexone), in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders, including opioid use disorders. MAT is a safe and effective strategy for decreasing the frequency and quantity of opioid use and reducing the risk of overdose and death. Opioid addiction is a chronic disease, like heart disease or diabetes. A chronic disease is a medical condition for life. It cannot be cured, but it can be managed. A person with an addiction can regain a healthy, productive life. Most people cannot just walk away from addiction. They need help to change addictive behavior into non-addictive, healthful patterns. They can get this help with treatment—with the care of doctors and substance abuse treatment providers.