Opioid Addiction

Over the past 20 years, millions of people have struggled with addiction to opioids. This is one of the biggest health crises in the United States.

Fortunately, there are well-understood treatment options, including Medication-Assisted Treatment (MAT) with buprenorphine, naltrexone, or methadone, behavioral therapy, and aftercare programs.

What Is Opioid Addiction?

Opioid addiction is one of the leading causes of death and physical harm in the United States. More than 2 million Americans struggle with addiction to heroin and prescription narcotics.

The current epidemic of opioid abuse and overdose began in 1999, and since then, the issue has quadrupled. More than 70 percent of 70,630 drug-related deaths in 2019, 20 years after the beginning of the current epidemic, involved an opioid substance.

Between 2018 and 2019, according to data from the Centers for Disease Control and Prevention (CDC), about 130 people died every day because of an opioid overdose. Deaths involving opioids increased 6 percent; deaths involving a prescription opioid increased 7 percent; and deaths involving synthetic opioids, including methadone, increased 15 percent. One point of good news was that heroin-related deaths decreased by 6 percent.

Although these statistics are troubling, there are many evidence-based options for opioid addiction treatment. Medical science has studied the neurochemistry, behaviors, and mental health issues associated with opioid abuse, addiction, and overdose. Now, there is an understood path to overcoming this issue.

A standard program includes a combination of Medication-Assisted Treatment (MAT) and therapy — often Dialectical Behavior Therapy (DBT) or Cognitive Behavioral Therapy (CBT). Finding the right opioid treatment and recovery program near you can help you overcome this condition.

What Are the Causes of Opioid Addiction?

The CDC reports three waves of problem substances in the modern opioid abuse epidemic. In the 1990s, relaxing rules around prescription opiates led to a surge in overdose deaths due to painkiller addiction. In 2010, a resurgence in heroin abuse and overdose led to more deaths. Most recently, in 2013, cheap and illegally made fentanyl flooded the market, leading to a significant increase in overdose deaths.

The latest surge is one of the most intense. The chemical formula for fentanyl was designed to be one of the strongest prescription narcotics available, often used in end-of-life care, but fentanyl manufactured in illicit labs overseas is now sold as heroin or counterfeit prescription opiates like oxycodone or hydrocodone. Since fentanyl is so potent, it can cause overdose very quickly, even in people who have an opioid tolerance.

Addiction to opioid drugs is characterized by a powerful compulsion to take these substances, regardless of whether there is a source of physical pain. As the drug wears out of the body, it can lead to a sense of anxiety or panic in some people, which triggers this compulsion to take more.

The brain can quickly become used to the presence of narcotics, so the starting dose will soon no longer be effective. For people who received prescription painkillers, this may feel like the doctor-prescribed dosage no longer works and the pain becomes more intense. For people who abuse substances like heroin recreationally, this leads to a rapid escalation in the amount consumed.

As the body becomes more tolerant to the opioid’s presence, the brain develops a chemical dependency on the presence of this molecule. This means that a person struggling with addiction not only feels a compulsion to take more of the drug to feel good, but also feels like the drug is necessary for them to feel normal. When the person begins to take larger and larger doses of an opiate, this increases the risk of overdose and death.

The causes associated with substance abuse are complex, but medical researchers believe that a combination of factors can increase the risk of drug addiction, including these:

• Genetics
• Family history
• Mental health
• Environmental triggers
• Lifestyle factors

Most Abused Opioids

There are two basic categories of opioid drugs that someone may struggle with.

Prescription painkillers

According to the CDC, 38 people in the United States die every day due to drug overdoses involving prescription opioids despite attempts to change prescribing practices without causing harm. In the late 1990s, pharmaceutical companies developed new forms of prescription narcotics, including drugs based on either oxycodone or hydrocodone. They began to market these to the medical community with reassurances that the substances would not lead to addiction. Arguing that patients with chronic pain; severe injuries to the back, neck, or joints; or cancer should not suffer without treatment, doctors began to prescribe more of these substances to treat a wider range of conditions.

“38 people in the United States die every day due to drug overdoses involving prescription opioids…”

The CDC

Between 1999 and 2011, consumption of hydrocodone more than doubled. Consumption of oxycodone increased by 500 percent. Prescription painkillers are still the leading cause of opioid addiction in the US. Although prescribing practices have changed to include better oversight, lower doses, and even avoidance of these drugs for some types of pain, too many people receive prescriptions for these drugs and do not receive the supervision to taper off taking them. When they develop too high a tolerance or can no longer get a prescription, many people turn to illicit opioids, including heroin. In 2019 alone, more than 191 million opioid prescriptions were dispensed to Americans.

Illicit opioids

Heroin is the most famous illicit opioid drug, but others include counterfeit prescription narcotics, fentanyl, and several new synthetics. The original opioid drug, opium, comes from the opium poppy. It has been used by humans for both medicine and recreation for thousands of years. Fast-forward to the 19^th century and morphine is the first synthetic opioid drug to come from opium. Doctors believed morphine would be a great pain treatment, but it was found to be highly addictive. In response, heroin was developed, but this was found to be even more addictive than morphine.

The Harrison Narcotics Act, passed in 1908, was one of the first pieces of legislation to make some narcotics illegal. Since the development of morphine, doctors have struggled to find the right balance of painkiller treatment without triggering opioid addiction. In the 21^st century, new synthetic opioids are developed from chemical formulas stolen from research laboratories or patents, leading to inexpensive, highly addictive, and very deadly versions of prescription drugs — particularly fentanyl. These drugs are often 50 to 100 times more powerful than morphine, the first synthetic opioid, making them much deadlier. Although fentanyl is not strictly illegal — it is a Schedule II substance, requiring prescription oversight — heroin is a Schedule I substance according to the Drug Enforcement Administration (DEA), meaning it has no medical use. Counterfeit pills sold illegally may have prescription drug names on them like OxyContin or Vicodin, but they may instead contain heroin, fentanyl, or non-opioid drugs like methamphetamines.

Someone who begins abusing prescription painkillers may turn to illicit narcotics when they are no longer able to obtain the prescription substance. Or, someone may be introduced to illicit narcotics in a social setting, like a party. Frequently taking these drugs increases the chance of becoming addicted, especially if taken without a doctor’s supervision and prescription monitoring.

Common Signs of Opioid Addiction

If you take an opioid substance regularly and wonder if you struggle with addiction, consider these questions:

• Do you often think about the drug?
• Have you tried to stop taking the opioid before and could not?
• Have you taken the narcotic just to feel normal?
• Do you take the opioid drug because you worry about fitting in or feeling awkward or uncomfortable?
• Have you taken the drug, or taken more than a prescribed dose of the drug, to relax, especially after becoming stressed or upset?
• Do you worry about running out of the drug?
• Have you stolen prescription opioids or money for opioids?
• Have you ever experienced an opioid overdose?
• Have you ever lied to friends or family about how much of the substance you take?
• Have you found that you increased how much you took to achieve the original euphoric effects?
• Have your relationships, education, and/or professional life suffered because you took opioids?
• Have you ever been arrested or worried about being arrested because of substance abuse?
• Have you ever done something dangerous like driving while intoxicated?
• Do you experience withdrawal symptoms, like anxiety, muscle pain, exhaustion, and intense cravings, when you try to quit?

Perhaps you recognize some of these problems in a loved one and worry about how to address this issue with them. Supporting someone in overcoming an addiction can be one of the first ways they get the help they need.

Confronting someone struggling with substance abuse in an aggressive way, or attempting to guilt-trip them, might make them reject the idea and could trigger stress that makes them abuse the drug more. Talking to a loved one in a compassionate way, and reminding them that evidence-based treatment is available, can help them take the first steps toward recovery.

Opioid Addiction Treatment Methods

There are three main phases to the addiction recovery process.

Detox

This is the process of ending the body’s tolerance to and dependence on intoxicating substances. For opioid detox, Medication-Assisted Treatment (MAT) with one of two substances is common.

• Buprenorphine: This partial opioid agonist has revolutionized outpatient treatment for opioid addiction. This means that it can produce pain relief and mild intoxication, but these effects are less intense than with full opioid agonists, like heroin. For people who are physically dependent on opioids, taking a partial opioid agonist can suppress cravings without causing euphoria. More doctors can prescribe buprenorphine for outpatient use, without as much oversight as other types of MAT. The doctor will still oversee how much buprenorphine the individual takes and help them taper the dose down until their body no longer relies on opioids to feel normal.
• Methadone: One of the first medications offered as MAT for opioid addiction, methadone is a full opioid agonist, but it remains in the body for hours longer than other substances like heroin or oxycodone. This means that it offers relief from cravings, allowing the individual to focus on therapy and other forms of rehabilitation treatment. Since methadone can be addictive, it is administered at dedicated clinics with staff oversight. Doses will be slowly tapered over weeks or months until the person no longer struggles with intense drug cravings.

Sometimes, naltrexone is also used as part of MAT. After someone has gone through detox, if they relapse while they take naltrexone, they will not experience the same effects from opioids. This can help them stop seeking the positive effects of opioids.

Rehabilitation

Behavioral health treatment is the next step in opioid treatment. In some cases, the person may detox and then enter rehabilitation treatment. In other cases, slow detox with MAT and rehabilitation therapy will overlap. The focus of rehabilitation is behavioral therapy, based on talk therapy. This can be a support group, individual therapy, or both. These therapies help the individual understand potential causes of their addiction, the signs associated with addiction and withdrawal, and how to manage cravings or stress that might lead to a relapse.

Aftercare

It is increasingly common for people who leave a rehabilitation program to maintain some level of connection to the recovery community as a form of aftercare. This includes going to support groups, attending individual therapy, pursuing complementary treatments like yoga or art therapy, and other steps. Developing an aftercare plan might be one of the final steps in a rehabilitation program. This might include making a list of loved ones to contact in the event of a relapse, a daily schedule to remain focused on long-term health goals, and a list of important appointments like job interviews or doctors’ visits.

Opioid Addiction & Dependence Resources

The Substance Abuse and Mental Health Service Administration (SAMHSA) is a federal program that provides several resources to support those who seek opioid addiction treatment, mental and behavioral healthcare, or support for their loved ones.

Here are some of the resources offered by this agency:

• The Behavioral Health Treatment Services Locator
• The Opioid Treatment Program Directory
• The National Substance Abuse Helpline
• Screening, Brief Intervention, and Referral to Treatment (SBIRT)
• Information about recovering from substance abuse

You may be concerned about yourself or a loved one who struggles with opioid addiction, but know that there are many resources to help. Medical science offers a clear path to recovery, and many treatment programs offer unique services alongside detox and therapy, which can support your needs.