Opioids
opioids
Opioids are a category of drugs that include heroin, morphine, methadone, codeine and fentanyl. Opioids decrease pain. The human body naturally makes small quantities of opioid compounds that bind to opioid receptors reducing pain and producing euphoria. Thus, opioid drugs, which mimic this internal painkilling mechanism, have an extremely high potential for abuse. Natural opioids, called opiates, are derivatives of opium, which is a naturally occurring compound found in the poppy plant.
Aside from their utility as analgesic drugs, opioid-like compounds are often found in cough suppressants, anti-nausea, and anti-diarrhea medications.
Opioid Abuse
There are now several synthetic versions of opiate drugs (called opioids) that have very potent painkilling effects, and they are often abused. These include prescription painkillers hydrocodone, oxycodone, and fentanyl.
Codeine is an opioid with relatively low potency. It is often prescribed for minor pain, and it is available over-the-counter in some countries. Like all opioids, codeine does have abuse potential. In fact, abuse of prescription opioid medications is becoming a major concern worldwide (Aquina, Marques-Baptista, Bridgeman, & Merlin, 2009; Casati, Sedefov, & Pfeiffer-Gerschel, 2012).
The Opioid Epidemic
The opioid epidemic, or the opioid crisis, refers to the extensive overuse of opioid drugs, both from medical prescriptions and from illegal sources. The epidemic began in the United States, starting slowly in the late 1990s but eventually leading led to a massive increase in opioid use in recent years, contributing to over 70,000 drug overdose deaths in the U.S. in 2018 and over 80,000 deaths in 2021. Fentanyl alone, being 50 times stronger than heroin and 100 times stronger than morphine, was causing about 200 overdose deaths per day in 2017.[1]
Opioids are a diverse class of moderately strong, addictive, inexpensive painkillers prescribed by doctors. Initially, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers, leading to widespread prescriptions. However, they turned out to be highly addictive.
Over time, people have shifted from prescription opioids to illegal ones like heroin and fentanyl, especially as prescriptions became harder to get. Studies show that most opioid abusers started with a legal prescription but later turned to illegal sources.[2]
Those addicted to opioids, both legal and illegal, are increasingly young, White, and female, with 1.2 million women addicted compared to 0.9 million men in 2015. The populations of rural areas of the country have been the hardest hit. Teen abuse of opioids has been noticeably increasing since 2006, with prescription drugs being used more than any illicit drug except marijuana; more than cocaine, heroin, and methamphetamine combined. The crisis has also changed many people’s moral, social, and cultural resistance to street drug alternatives such as heroin, with individuals often turning to street drugs once they are no longer able to secure a prescription opioid source.
Fentanyl, due to extreme potency and widespread misuse, is particularly problematic. It is often mixed, cut, or ingested alongside other drugs, including cocaine and heroin. Mixing with other drugs or disguising as a pharmaceutical makes it difficult to determine the correct treatment in the case of an overdose, resulting in even more deaths.
Heroin Abuse
Historically, heroin has been a major opioid drug of abuse. Heroin can be snorted, smoked, or injected intravenously. Heroin produces intense feelings of euphoria and pleasure, which are amplified when the heroin is injected intravenously. Following the initial “rush,” users experience 4–6 hours of “going on the nod,” alternating between conscious and semi-conscious states. Some people who have injected many times into their arms will show “track marks,” while other users will inject into areas between their fingers or between their toes, so as not to show obvious track marks. Like all abusers of intravenous drugs, heroin users have an increased risk of contracting both tuberculosis and HIV.
Opioid Withdrawal
Given that withdrawal from a drug often involves an experience opposite to the effect of the drug, it should be no surprise that opioid withdrawal resembles a severe case of the flu. While opioid withdrawal can be extremely unpleasant, it is not life-threatening (Julien, 2005). Still, people experiencing opioid withdrawal may be given methadone to make withdrawal from the drug less difficult. Methadone is a synthetic opioid that is less euphorigenic than heroin and similar drugs. Methadone clinics help people who previously struggled with opioid addiction manage withdrawal symptoms through the use of methadone. Other drugs, including the opioid buprenorphine, have also been used to alleviate symptoms of opiate withdrawal.