Opiate Dependency

Effects of Opiate and Other Drugs

Of all addictive substances, opiates can be considered the most serious type of drugs. This is because it is fatal and is even more dangerous when taken with other substances. Other substance types are stimulants, depressants, and hallucinogens. Stimulants, like cocaine and diet pills, can speed up the body systems. Depressants, like alcohol and benzodiazepines, slow down the body systems. Hallucinogens, like LSD and mushrooms, alter perceptual experiences where people have thoughts or have sensory experiences that are not real. The effects of opiate substances like heroin and opiate pills (Vicodin, Percocet, oxycodone, etc.) is euphoria or “high” feeling. Physicians may prescribe opiates in pill form to relieve pain, or people can illicitly buy and inject heroin from dealers on the streets. Like heroin, opiate pills can be snorted. Sometimes addictions of alcohol, benzodiazepines, or cocaine can lead to opiate dependency and cross addiction.

Pain Management Can Lead to Opiate Addiction

People can easily and unknowingly become dependent on opiate pain medication. Often people are prescribed opiate medications to reduce pain due to a medical problem or condition. There are many medical diseases and physical conditions that can cause pain. People who have been injured on the job, or due to participation in sports, or in car accidents are prescribed opiate pain medication. However, an opiate pain medication is supposed to be temporary. It is a stopgap until a wound heals or surgery can repair injury, physical therapy can restore functionality. Just because the pain is taken away, it does not mean that the medical problem is resolved. Without medical intervention, a physical problem or injury can get worse without knowledge because the pain is no longer felt. Pain has a purpose. It is our body's way of telling us that something is wrong and needs to taken care of. When taken as prescribed and under the supervision of a doctor, opiates are an appropriate and safe medication to relieve temporary pain.

How Opiate Addiction Develops

Problems of addiction occur after long term opiate use. This is due to tolerance. To get the same effect, people must use more of the substance in amount and frequency. Thus, no euphoria or relief of pain occurs without increasing its use. After extended opiate use, physical problems can accumulate. Then increased pain is felt when that use stops. This usually leads recovering addicts to think that their additional medical problems started upon abstinence. In reality, the physical problems started long before. The recovering addict had not felt the pain because they were illicitly using opiates. Opiates can be taken at dangerous levels causing other medical problems and symptoms leading to death. Before this point, physician will stop prescribing it. However, people want to continue using it for pain as their physical problems have not been fixed or they have become physically and/or emotionally dependent. With increased tolerance, people can become physically dependent and have very uncomfortable withdrawal symptoms when they stop their use. This includes muscle aches, cramping, tearing of eyes, runny nose, yawning, inability to sleep, agitation and anxiety. To stop the withdrawal, addicted individuals will often continue or go back to their drug use rather than seek medical treatment.

Physical and Emotional Dependency of Opiate Addiction

Along with physical dependence, emotional dependence develops as opiate addiction progresses. Opiate pills can ease both physical and emotional pain. It can decrease feelings of anxiety and depression and reduce mental health symptoms such as mania or psychosis. Unconsciously, people with addiction maladaptively learn to self-medicate to cope of stress and anxiety. Thus, they do not learn effective ways to deal with demands and problems of everyday life. In addition, stressors increase with continued use as they become preoccupied with their drug use. They cannot function mentally or physically at work. The resulting job loss creates financial problems and conflict among family members. Cognitive deficits of lack of concentration, memory loss and impaired thinking affect employment tasks and parenting responsibilities. Emotional symptoms of anxiety, anger, depression, isolation, and irritability hinder positive social interactions and cause marital conflict.

Symptoms of Opiate Overdose that Lead to Death

Usually people with drug dependency will not seek counseling until they have suffered physical, cognitive, emotional, social and/or economic consequences. Unfortunately, opiate addiction can become so chronic that an excessive number of opiates are used at one time. In some cases, this can result in overdose and/or death. Early symptoms of sedation may be limp body, pale face, clammy skin, blue lips and fingers, itchy skins, slurred speech, nodding, and vomiting. Fatal symptoms of overdose include pinpoint pupils, slowed or stopped breathing and unconsciousness. These symptoms lead to inadequate oxygenation, brain damage, stopped heart and death. It is essential for emergency medical services, such as 911, to intervene immediately when any symptoms of overdose are identified and the addicted individual be admitted to the hospital. A new medication of Narcan can be given, via nostrils to stop overdose and prevent death.

Opiate Addiction Intervention and Treatment Models

Often people will try to stop drug use on their own. However, they are unable to manage urges. They can't reduce and completely stop their use because of withdrawal symptoms. Although withdrawal symptoms will only occur for 2-3 days, symptoms can be uncomfortable and dangerous. When my opiate addicted clients decide that they cannot stop illicit drug use or remain abstinent on their own, they turn to medical or counseling professionals.There are two types of treatment models for opiate dependency. One treatment model is total abstinence in which patients are admitted to a medical detox and inpatient treatment. Patients immediately abstain from opiates. They are medicated while under 24-hour professional supervision. This alleviates the suffering from uncomfortable withdrawal symptoms. They continue total abstinence and receive psychoeducational addiction and relapse prevention during outpatient counseling.

The other type of treatment is Medication–Assisted Treatment (MAT). In this model addicted clients are given medication of methadone or suboxone. These medications reduce cravings and/or block the "high" if opiates are used illicitly. Clients of Methadone Maintenance Programs (MMP) dose daily at program facilities until they earn take home bottle privileges. When they do, they can take their doses in the comfort of their home. Gradually, they attend the Methadone program less and less until they only attend to dose once weekly. Clients prescribed suboxone by a physician can fill their prescription at a pharmacy like any other medication. They can take their medication at home. Suboxone contains buprenorphine and Naloxone. Buprenorphine eliminates physical cravings of illicit opiates. Naloxone blocks the effects or “high” from illicit opiates if a client uses. Subutex is buprenorphine or suboxone without the Naloxone. Regular outpatient substance abuse counseling is an integral part of both medication–assisted programs. Due to tolerance and to avoid overdose, both medications are initially given/prescribed in small amounts. Then the dosage is increased until the client no longer has withdrawal symptoms or craving to use illicit opiates. The type of MAT recommended upon evaluation is determined by the client’s history of drug use and treatment as well as their physical well-being assessed by a physical exam. Aftercare outpatient counseling and participation in a support group in the community, such as 12 step meetings are recommended for both total abstinence and medication-assisted opiate recovery programs.