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 opioids will continue taking them.
Those who do continue taking them likely do so because of the feelings of immense pleasure that opioids 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 prescription and illicit drugs that fall under the opioid category, including oxycodone, hydrocodone, codeine, morphine, fentanyl, and heroin, and they’re all incredibly addictive. According to the American Society of Addiction Medicine (ASAM), 23% 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 when prescribed by a doctor to treat severe pain following surgery or an injury.
Unfortunately, even under a doctor’s careful watch, individuals can still become dependent on opioids. The National Institute of Drug Abuse estimates that roughly 21% to 29% of patients prescribed opioids for chronic pain misuse them. According to the 2018 National Survey on Drug Use and Health, an estimated 9.9 million people aged 12 or older misused prescription opioids in the past year.
When individuals become dependent on opioids, they will experience mild to severe physical withdrawal symptoms if they simply stop taking them, such as agitation, anxiety, tremors, muscle aches, and more. For that reason, many recovery programs use medication-assisted treatment to help reduce cravings and withdrawal symptoms.
Understanding Medication-Assisted Treatment
In medication-assisted treatment for opioid use disorder, which should only ever occur under a doctor’s supervision, individuals replace the opioid they’re addicted to with a longer-acting opioid like buprenorphine or methadone that doesn’t produce the same euphoria produced by the abused drug.
The main goal of medication-assisted treatment is to facilitate some kind of stability in an individual’s life by minimizing and even eliminating the withdrawal symptoms that would have otherwise occurred should the individual simply quit taking the drug.
Suboxone is a prescription medication that contains buprenorphine and naloxone, and it’s one of the medications that doctors may prescribe someone who’s trying to recover from an opioid addiction. Buprenorphine is a partial opioid agonist that binds with the body’s opioid receptor but only partially activates it. Naloxone is a synthetic drug designed to rapidly reverse opioid overdose. It’s an opioid antagonist, which means it works by blocking the body’s opioid receptors.
Unlike more powerful opioids, Suboxone doesn’t produce a strong euphoric effect; however, it’s still possible to develop a dependence and even an addiction to it. That’s why some people are skeptical of medication-assisted treatment and argue it’s simply replacing one addiction with another.
In order to understand how Suboxone can help someone struggling with an addiction to opioids, it’s 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’s 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’s 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 medication-assisted treatment for opioid use disorder argue that although Suboxone might maintain some of an individual’s pre-existing dependence, it can eliminate cravings and compulsions for opioids while preventing or reducing withdrawal symptoms.
Indeed, it doesn’t “replace one addiction with another,” but rather, it shifts someone from addiction to dependence, helping to prevent relapse to the use of addictive opioids. And when people are ready, doctors can assist them with tapering off Suboxone, putting them on a path toward physiologic normalcy disrupted by chronic opioid use.
According to a study funded by the Cochrane Collaboration, medication-assisted treatment of opioid use disorder 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 opioid 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.
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 and bone pain.
- 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 heartbeat.
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 isn’t 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’s a partial opioid agonist, it’s 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 opioid with Suboxone to minimize withdrawal symptoms and enter a medical detox program. After undergoing medical detox, the individual would enter an inpatient rehabilitation program 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.