Opioid tolerance, dependence, and addiction all arise due to changes in the brain that occur from chronic opioid abuse.
According to a report published in Addiction Science & Clinical Practice, there are a number of factors, both environmental and individual, that influence whether someone experimenting with opiates will continue taking them. Those who do continue taking them likely do so because of the feelings of immense pleasure that opiates deliver when they stimulate the production of specific chemicals in the brain. Individuals who keep taking opioids will build up a tolerance for them, then potentially a dependence on them, and finally, a full-fledged addiction.
There are a number of drugs that fall under the opioid category, including oxycodone, hydrocodone, codeine, morphine, fentanyl, and heroin, and they are all incredibly addictive. According to the American Society of Addiction Medicine (ASAM), 23 percent of people who try heroin develop an opioid addiction. Of course, there are many others who develop a dependence with even the best of intentions. For example, many opioids are perfectly legal, and doctors often prescribe them to treat severe pain following surgery or an injury. Unfortunately, even under a doctor’s careful watch, individuals can still become dependent on opioids. According to a survey administered in 2012 by the National Institute on Drug Abuse (NIDA), 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers.
When individuals become dependent on opioids, they cannot simply stop taking them without running the risk of serious complications. Opioids affect chemical balances in the brain, and the central nervous system does not know how to respond if someone suddenly stops taking them. For that reason, many recovery programs use opioid replacement therapy to help individuals convert an addiction to a mere dependence.
Understanding Opioid Replacement Therapy
Suboxone is a prescription medication that contains buprenorphine and naloxone, and it is one of the medications that doctors may prescribe someone who is trying to recover from an opioid addiction. According to NIDA, buprenorphine is a partial opioid that can reduce cravings and minimize withdrawal symptoms of certain opioids. Naloxone, which is similar to morphine, is a synthetic drug that works by blocking opiate receptors in the central nervous system.
In opiate replacement therapy, which should only ever occur under a doctor’s supervision, individuals replace the opioid they are addicted to, whether it’s legal or not, with a longer acting, less euphoric opioid like Suboxone. The main goal of opiate replacement therapy is to facilitate some kind of stability in an individual’s life. Switching from a powerful opioid to Suboxone can help minimize and even eliminate the withdrawal symptoms that would have otherwise occurred. It can also help control cravings. Unlike more powerful opioids, Suboxone does not produce a strong euphoric effect; however, it is still possible to develop a dependence and even an addiction to it at some point. According to the National Alliance of Advocates for Buprenorphine Treatment, that is why some people are skeptical of opioid replacement therapy and argue it is simply replacing one addiction with another.
In order to understand how Suboxone can help someone struggling with an addiction to opioids, it is critical to understand the differences between tolerance, dependence, and addiction. According to ASAM, the three can be defined as follows:
- Tolerance: a state of adaptation in which enough exposure to a specific drug induces changes in bodily chemistry that result in diminishing one or more of the drug’s effects over a period of time
- Physical dependence: a state of adaptation that is classified by specific withdrawal symptoms produced by the abrupt cessation of a drug or rapid reduction of its dose
- Psychological dependence: a form of dependence that involves emotional and motivational withdrawal symptoms like anxiety, irritability, or dissatisfaction
- Addiction: a chronic neurobiological disease caused by environmental, psychosocial, and genetic factors that is characterized by impaired control over using drugs, compulsive actions in finding the next dose, intense cravings, and continued use of the drug despite the harm that it may cause
Proponents of opioid replacement therapy argue that though Suboxone might maintain some of an individual’s pre-existing dependence, it can eliminate cravings and compulsions for opioids while minimizing withdrawal symptoms. Opioid replacement therapy does not merely replace one addiction with another, but rather, it helps clients shift from addiction to dependence. And when clients are ready, they can taper off their Suboxone dose with the help of a doctor so all they are left with is simply a tolerance to opioids. According to a study funded by the Cochrane Collaboration, opioid replacement therapy is statistically significantly more effective than non-pharmaceutical approaches to treatment and recovery.
Avoiding Withdrawal Symptoms
Many recovery centers encourage clients to take their treatment one day at a time. That means individuals who are fighting addiction focus on the immediate future, which often includes withdrawal symptoms. Opioid withdrawal can be especially challenging if an individual tries to get through it alone, and life-threatening complications could arise. If a loved one is showing signs of an opiate addiction, undergoing medical detox should be the first step.
In a medical detox program, individuals experiencing withdrawal symptoms will have access to qualified healthcare providers 24/7 who know what to do if complications occur.
Part of the reason many doctors prescribe opioid replacement therapy is because drugs like Suboxone can help reduce and even eliminate the symptoms of withdrawal.
The intensity and duration of symptoms will vary among individuals, as will the overall timeline, but there are some general trends that withdrawal generally follows. Symptoms typically arise within the first 24 hours of the last dose. Common early symptoms of opioid withdrawal include:
- Muscle aches
- Excessive sweating
After the first 24 hours, additional symptoms often arise. These include:
- Abdominal cramping
- Nausea and vomiting
- Dilated pupils and blurry vision
- High blood pressure
- Rapid heart beat
Within 72 hours, symptoms of opioid withdrawal start to recede, and within one week, most people’s health has stabilized. Of course, clients taking Suboxone may not even experience any of the symptoms listed above.
Suboxone is not for everyone, but a doctor who specializes in substance abuse and recovery can determine if a loved one could benefit from taking it. Suboxone is entirely safe when taken as directed under the appropriate conditions; however, because it is a partial opioid, it is still addictive, and it’s possible to develop a dependence on it.
In an ideal scenario, an individual who wants to kick an opioid addiction would replace the opiate with Suboxone to minimize withdrawal symptoms and enter a medical detox program. After undergoing medical detox, the individual would enter an inpatient rehabilitation to participate in various types of therapy in order to understand how the addiction occurred in the first place. After completing inpatient therapy, many clients opt for outpatient therapy, so they can gain the tools needed to stay sober in a supportive environment before attempting to stay sober outside of treatment. Once the individual has reached a stable point, the doctor overseeing recovery may then start tapering the Suboxone until it is no longer needed at all.
If a loved one has developed an addiction to opioids, it’s never too late to seek help, and thanks to advancements in medicine, there are ways to get and stay sober without having to undergo a painful withdrawal period. Suboxone can make withdrawal symptoms entirely manageable, but it’s ultimately the support of family and friends, and the work done in comprehensive therapy, that will keep loved ones on the road to recovery.