Opioids: Abuse & Addiction Treatment
What Drugs Are Opioids?
Opioids are a class of drugs that include both legal medications and illicit substances such as:1-4
- Heroin, an illegal and very addictive opioid derived from morphine.
- Fentanyl, an extremely potent synthetic opioid prescribed for severe pain (such as severe post-surgical pain) but also produced illegally and sold on the street or added to other illegal drugs.
- Prescription painkillers, such as oxycodone (OxyContin), hydrocodone (Norco), morphine, and codeine.
All opioids are controlled substances, as they have a high potential for abuse and dependence.
Opioid Abuse Statistics
The United States has been struggling with a decades-long epidemic of opioid misuse, addiction and overdose that continues to this day.5 According to findings from a 2019 national survey, it’s estimated that among Americans age 12 or over:6
- 1 million people used an opioid in the past year.
- 7 million people misused a painkiller in the past year.
- 745,000 people used heroin in the past year.
- 6 million people had an opioid use disorder in the past year 2019.
- 4 million people had an opioid use disorder relating to prescription pain medications in the past year in 2019.
- 438,000 people reported a heroin use disorder in the past year in 2019.
Opioid misuse can have tragic consequences. This is apparent in the number of fatal overdoses the U.S. has seen over the last two decades—between 1999 and 2019, almost 500,000 people died as a result of opioid overdose in the country.5
Unfortunately, the opioid overdose epidemic is not going away. In 2019 alone, more than 70% of the nearly 71,000 overdose deaths that year involved opioids.5
The rising numbers of overdose deaths are partly attributed to the increased presence of extremely potent opioids, such as fentanyl or carfentanil, in heroin, illicitly manufactured pills and other drugs of abuse.7 Between 2018 and 2019, overdose deaths involving synthetic opioids, such as fentanyl, rose by more than 15%.5
Effects of Opioids
Opioids work by binding to and activating opioid receptors in the brain and central nervous system to decrease a person’s perception of pain.8 They also slow breathing and relax the body and can produce pleasurable feelings such as relaxation and euphoria.9 When they bind to opioid receptors concentrated in the brain’s reward pathway, they also cause a surge of dopamine, a neurotransmitter associated with the repetition of pleasurable and important activities.8,10 The pleasurable effects of opioids and the surge of dopamine they cause promotes repeated drug-taking and contributes to the drug’s high abuse potential.3,10
People who abuse opioids tend to regularly increase the dose or use opioids in dangerous ways (such as by snorting or injecting them) to achieve more intense feeling of pleasure.9,11 However, as they do so, they increase the risk and severity of the negative side effects,3 which include:3,12,13
- Itchy skin.
- Facial flushing.
- Slowed breathing.
Opioid Overdose Dangers
Opioid overdose can occur when opioids are taken in high enough doses that the body experiences life-threatening symptoms.8
The 3 typical symptoms of identifying an opioid overdose are known as the “opioid overdose triad.” They are:14,15
- Extremely small (pinpoint) pupils.
- Significantly decreased level or loss of consciousness.
- Slowed, difficult, or no breathing.
Someone showing these signs needs help immediately. Other signs and symptoms of an opioid overdose include:16,17
- Choking or gurgling noises.
- Skin that appears pale or blue or feels cold.
- Limp body.
- Weak or absent pulse.
- Low blood pressure.
- Extreme drowsiness.
- Profound confusion (delirium).
The effect of opioids on a person’s breathing is what makes overdose on these drugs so dangerous. The lack of adequate respiration can lead to hypoxia, a condition where not enough oxygen gets to the brain. This can quickly lead to permanent brain damage, coma, or death.8
An opioid overdose may often be reversed if a person acts quickly by calling emergency services and administering naloxone, a drug that can reverse symptoms of an opioid overdose, if they have it on hand.15 Learn all about naloxone and how to find it in Orange County.
Opioid Overdose Risk Factors
The risk of overdose is increased in opioid users who:13, 15,18
- Continually increase their dose.
- Use painkillers without medical supervision.
- Inject opioids.
- Return to using opioids after having stopped for an extended time period.
- Combine opioids with alcohol or other drugs that slow breathing (e.g., benzodiazepines, barbiturates, or sleep aids such as Ambien).
- Have comorbid medical and/or psychological conditions.
- Have experienced a prior overdose.
While the above risk factors indicate who may be more vulnerable to overdose, anyone who uses opioids is at risk, and risk increases with misuse, especially with the increased presence of super-potent synthetic opioids such as fentanyl being added to counterfeit pills, heroin, and other illicit drugs.5,9
Opioid Dependence and Withdrawal
Over time, consistent use of opioids can lead to your body becoming dependent on them to feel well and avoid withdrawal symptoms. Dependence is a normal consequence of the body adapting to continued opioid use and can occur in the absence of an opioid use disorder, or addiction.3
Cutting back significantly or quitting opioids altogether results in physical and psychological withdrawal symptoms in those who have become opioid-dependent. How severe withdrawal will be can be influenced by several factors such as the specific opioid(s) used, how long and how often they were used, the individual’s general health, and other drugs or medications a person regularly uses.3
The symptoms of opioid withdrawal are often very unpleasant. They are rarely life-threatening, although dangerous complications, such as dehydration related to vomiting and diarrhea or exacerbation of pre-existing cardiac conditions, can arise. 19
Medical detoxification can take a lot of the pain and suffering out of the withdrawal process. Doctors can provide medications to relieve symptoms, decrease drug cravings, and monitor your condition to watch for any complications of withdrawal. Medical detox is available in both inpatient and outpatient settings. 19
For those who are not only dependent on but addicted to opioids, detox alone will likely not be sufficient; additional treatment is needed in order to maintain recovery.20
Treatment for Opioid Addiction
Addiction is a far-reaching disorder affecting the brain. Opioid addiction, which is diagnosed by doctors as opioid use disorder, is marked by the inability to control your use of opioids, even after they have caused significant harm in one or more areas of your life.8,21
Addiction is a disorder that, while not curable, can be effectively treated and managed.22 When you’re in the midst of an opioid addiction, it’s easy to feel that there is no hope or that you’ll be stuck in a cycle of compulsive use forever. This is not true. Treatment works, and there is hope for you. Even if you’ve tried rehab in the past and gone back to opioid use, you can still recover. Relapse is a common part of the recovery process, and it may take several attempts to achieve lasting recovery.22 If you’ve relapsed, you may need an adjustment in your treatment plan.23
The path to opioid addiction recovery is unique from person to person—and often from treatment attempt to treatment attempt—and may involve one or more levels of care. Treatment options include but are not limited to medical detox, inpatient rehab, outpatient therapy, sober living, and mutual support groups like Narcotics Anonymous (NA). 22,23
Many people utilize medications as part of their treatment in order to bolster their sobriety and help prevent relapse.23 Despite pervasive myths that maintenance medications like methadone or buprenorphine negate a person’s recovery, using these medications does not mean you’re not sober or that you’ve replaced one addiction for another. The combination of medication with behavioral therapy (often called medication-assisted treatment) has been proven clinically effective and has been shown to adequately address the needs of most patients.24