In our last piece, Signs of Opiate Addiction, we briefly discussed the terms opioids and opiates. Both are powerful drugs that are very effective for the relief of pain. And, as all too many of us have learned, they describe categories of dangerously addictive drugs. While the two terms are often used interchangeably, they differ. All opiates are opioids, but not all opioids are opiates. Confused? One way to understand the difference is to look at their origin.
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Generally speaking, opiates are derived from natural sources, principally the opium poppy. Morphine, administered by healthcare professionals as a pain reliever and anesthetic, is such a drug. So is heroin, which is illicitly manufactured as a “street” drug from naturally occurring derivatives of the opium poppy.
In modern usage, all opiates are now grouped under the larger category of opioids, which are substances which act on the body’s opioid receptors in the way naturally occurring opiates do. What’s this mean? The scientific explanation has to do with bio-chemical reactions at the cellular level of the central nervous system and the production of dopamine in the brain. The short answer is relief from pain and a feeling of euphoria.
In addition to naturally occurring and synthetic opioids, there are also semi-synthetic opioids, which are manufactured hybrids of naturally occurring opiates and synthetic opioids. A prime example of the last two decades is Oxycontin, the pharmaceutical brand name for a particular type of oxycodone. Methadone is also a synthetic opioid, often used to treat opioid dependence because it relieves withdrawal symptoms with fewer narcotic effects than other opioids. Fentanyl is also synthetic opioid, as is Percocet.
No matter their origin, all opioids are highly dangerous and highly addictive. Addictions manifest in severe physical withdrawals, debilitating psychological dependence, and self-destructive behavior. As we say, once an addict, always an addict. We also say: there is a solution. Recovery is possible from active addiction, one day at a time. Discovery professionals can help.
Opioids are highly addictive. Whether an individual’s gateway is from professionally prescribed pain meds, recreational use, or chronic abuse, the nature of addiction is the same. Some addicts come to their state “legitimately,” which is to say, administered by healthcare professionals.
Opioids such as morphine are used following surgeries. Those such as oxycodone, hydrocodone, and codeine are prescribed for short periods following medical procedures, and sometimes for cases of chronic pain. However, it doesn’t take long for patients to take a pathway leading through the stages of tolerance, dependence, and full-blown addiction.
Others begin their addictions with recreational use/abuse—it can be argued that any use of opioids to simply get high is abuse—and discover the allure of opioids’ powerful state of euphoria. Some persons are more predisposed than others to “go down the rabbit hole” and become regular, then chronic abusers.
No matter how one arrives at the state of addiction, it is almost impossible to stop. Studies have indicated there are some may be more likely to become addicted than others. Those who regularly smoke, drink alcohol, and smoke marijuana are more likely to become addicts, as well as those with families which have a history of addiction.
It’s important to note that anyone who uses opioids more than once without medical supervision and accountability is living at risk.
Several factors come into play, but recent studies show the dangers are real and, for some, almost immediate. According to a Center for Disease Control study, six percent of patients prescribed a single day’s supply of a narcotic painkiller may be still be opioid users a year later. This percentage doubles in just eight days of prescribed use.
These percentages may sound low, and many addicts may be quick to count themselves among those who can stop. But dependence is a real danger, and without help, can progress to tolerance, dependence, and addiction. Those with a prior history of drug abuse, and current or former smokers, have been shown to be more likely to be opioid users one year later. Mental health issues, such as anxiety and depression, can increase the odds of opioid addiction as well.
These numbers and studies may be a tip of the iceberg, since many opioid addicts begin their “careers” with recreational use born of curiosity. It may have begun in high school, as simple experimentation including alcohol or other drugs, or as a result of peer pressure. Many an addict tells of his first time becoming high as relief from anxiety or social discomfort, or as a life-changing, euphoric experience that he “cannot wait to feel again.”
This leads to regular use, where negative consequences began to happen: hangovers, missed responsibilities, regular illness, cravings. It’s a short journey to dependence from this stage, which may manifest in psychological and physical symptoms. To stopping using became mentally anguishing. Physical withdrawal symptoms that look and feel like other illnesses began.
Professionally speaking, there are differences between tolerance, dependence, and addiction. It’s good to understand them—and better to understand that those who need recovery often seek false hope by taking refuge in classifying themselves by the two “less-serious” sounding terms, tolerance and dependence.
As a general rule, no untreated addict will want to admit he is one. Tolerance and dependence sound so much more manageable. The problem is that, addiction, in the words of the book Alcoholics Anonymous, is cunning, baffling and powerful.
Many come to their state what they feel are legitimate avenues, and therefore cannot or will not believe they are addicts. For instance, a diagnosis of chronic pain from injury or disease has led to a prescription of a synthetic opioid, such as Oxycontin.
Physicians are highly aware of the addictive nature of the medication, and strict laws on the prescription and dispensation are contained in the Controlled Substances Act. They are required to limit prescriptions and how often they are refilled. (For more information on the various types of drugs and the categories, or schedules, they fall under, read this Wikipedia article.
Oxycontin, the brand name for one type of oxycodone, is a Schedule II controlled substance which may be administered only via prescription.) Nonetheless, a tolerance to the medication often begins. It is only human nature to want pain to stop; when medications start to work for shorter period of time or with less effectiveness, it is only too easy to begin to take more than prescribed or self-administer in shorter timeframes.
Over time—and sometimes quickly, depending on the patient—a tolerance to a drug is acquired. More of the drug is required to achieve the same result. There are three types of tolerance: acute tolerance, chronic tolerance, and learned tolerance.
Acute tolerance refers to the reduced affect of a drug within a relative short time frame: for instance, a dose taken a few hours after an initial dose does not provide as strong an effect. Learned tolerance refers to a person’s ability to perform certain tasks while under the influence, usually acquired over a period of repetition.
Think of the man who learns to perform his job under the influence, the myth of the“functional addict.” (Performance in learned tolerance cases usually suffers when job requirements change from routine, or quick reaction time and “thinking on one’s feet” is required).
Chronic tolerance is acquired over of a period of time with repeated exposure to a drug, leading users take more to achieve the effect, in progressively shorter intervals. This is particularly dangerous, for obvious reasons, and often leads to full-blown addiction.
Tolerance to an opioid often leads to the spiral of dependence and addiction. Dependence and addiction are often used interchangeably, and some say it’s a distinction without a difference. They cannot stop, even though their lives have gotten out of control.
Strictly speaking, this is not true; dependence can be treated medically. It is possible for a opioid dependent person to be medically treated by detox procedures and a tapering off of less dangerous meds. Methadone treatment for heroin addicts is one.
However, many find themselves relapsing back into chronic use, with accumulating negative consequences. They simply cannot stop. It is no longer a question of willpower, or any type of choice. A person who relapses repeatedly after detox, or who cannot stop, is probably an addict.
Addiction adds psychological and spiritual components to chronic abuse. For instance, there are addictions which do not produce physical withdrawal symptoms which some find just as difficult to stop, even though they may not produce physical withdrawal. Cocaine and process addictions come to mind.
Unfortunately, with opioids, dependence on the drug, particularly for the euphoria it brings, often leads to addiction in a relatively short period of time. This is outwardly marked by debilitating withdrawal symptoms such as nausea, shaking, and sometimes life-threatening physical reactions, and—even after detox—a return to abuse.
An addict cannot stop. It is important to realize that persons who have reached this stage are not morally inferior or weak; they have a disease which requires solutions that include help in physical, psychological, and spiritual aspects of their lives to “get clean” and live whole.
Discovery Place is an affordable recovery center dedicated to helping men find personal recovery from alcohol and drug addiction. We offer the highest level of care for the most affordable cost. Period.
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