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Opioid addiction is a different beast compared with many other drugs.
First, when we talk about opioids, we’re talking about a wide range of drugs – from illegal street drugs such as heroin, to prescription painkillers such as oxycodone and morphine. Second, while there are similarities between the effects of opioid addiction and other drug addictions, there are some differences.
Opioids have become fairly ubiquitous drugs. Physicians prescribe them every day to help manage pain from surgeries, chronic conditions or cancer, among others. And the illegal variety is far more available today than it ever has been – with Chicago serving as a major hub along a common distribution route from South America and Mexico. Also, some legal prescription drugs, such as fentanyl, are now being illegally produced and sold on the streets, and many people may not even be aware of what they’re taking.
My patients in treatment for opioid addiction have different stories to tell about how they began using the drug, how long they’ve been using, how they get the drug into their system, how many times they’ve tried to quit, and on and on. How we treat each patient often depends on how long they’ve been using the drug, because the effects of opioids can escalate quickly.
While the potency of the drug and how quickly it’s felt can vary between the different types of opioids, the effects are similar. The first time you take opioids, or the first few times, you may experience:
What happens if you use opioids regularly – every day, multiple times a day, for months or years? Two things will happen fairly quickly in a short time – even within a few days or weeks:
Not everyone who uses opioids – even long-term – will develop an addiction. Almost everyone who uses opioids over a long period of time will develop a tolerance to them and experience withdrawal symptoms if they suddenly stop taking them. But, only a fraction of that group will develop a substance use disorder.
Addiction is distinguished by compulsive drug use despite sometimes devastating consequences such as health complications or a decline in quality of life. When this happens, we see a few things, including:
The good news is that while these changes can be long-lasting, they are reversible. After treatment and lifestyle changes, people no longer feel compelled to trade what they know is right for a high. And, in contrast to the changes in the brain that a drug such as methamphetamine causes, which people can’t always recover from, most brain alterations from opioids will return to normal after you stop using them.
The consequences of opioid addiction in many ways are the same as with other drugs, but there are some subtle differences.
For many people, addiction to opioids began with a prescription. As their addiction grows and they need more and more of the drug, some turn to heroin because it’s cheaper or, in some cases, more accessible. Heroin is more dangerous than prescription pills – you don’t know where it came from so you don’t know how strong it is or whether it’s laced with other potentially dangerous ingredients.
Opioids can be taken multiple ways: orally, smoking, snorting and injecting. Patients often tell us they progressed from method to method to increase how quickly the drug gets into their system. All of these methods are potentially dangerous, but injecting a drug comes with added risks. One of these is infection – viral or bacterial.
HIV and hepatitis C are the two main viruses we worry about when talking about injecting opioids – or any drug. This can occur when sharing injecting equipment such as needles and syringes with other people. Many patients with these viruses tell me they knew the risk, but they were so desperate to get the drug that in the heat of the moment, they used someone else’s equipment. Others simply were unaware of the danger of sharing these objects.
Bacterial infections can be contracted whether you share injecting equipment or not. They get into the bloodstream through the use of non-sterile equipment. This happens more when equipment is reused without properly cleaning it. People who inject drugs can lower this risk by using a full-strength bleach to clean their equipment, but many people just rinse it with water or don’t do anything at all. Some patients tell us they had access to new, clean equipment, but they didn’t want to take the time to get it. As the bacteria enters your bloodstream, it travels around the body and can lead to very harmful, sometimes fatal conditions.
I once had a patient who developed bacterial endocarditis and had to have her heart valve replaced. Soon after surgery, she relapsed and developed a new bacterial infection that went to her brain and caused a stroke. This young woman found herself paralyzed on one side because of a bacterial infection caused by dirty injecting equipment.
Many patients who struggle with addiction see their lives crumble around them. They may drop out of school, lose their jobs, or end up in the criminal justice system. They burn bridges by stealing from and lying to loved ones who tried to help them. This often leads to depression, which can hinder a patient’s drive to overcome their addiction. As a feeling of hopelessness sets in, they also may become careless, which puts them at increased risk for infection or overdose.
Of course, overdose is one of the most dangerous risks of addiction, and fatal opioid overdoses have skyrocketed. The rate of opioid deaths quadrupled between 1999 and 2014, with 28,000 deaths in 2014. The Centers for Disease Control and Prevention estimates that 78 Americans die every day from an opioid overdose.
Often, how we treat a patient with an opioid addiction depends on how long they have been using the drug and how severe the withdrawal symptoms are.
If someone recently started using, we first will try behavioral therapy, such as counseling, daily therapy groups or residential treatment. We also urge patients to join a support group such as Narcotics Anonymous or SMART Recovery.
Behavioral therapy doesn’t always work on its own. As mentioned earlier, withdrawal escalates quickly with opioid use. If withdrawal symptoms are severe, we’ll try to stabilize them with the help of medications such as buprenorphine. Medication-assisted treatment (MAT), which includes medications like buprenorphine, naltrexone and methadone, is an important therapy that may be used during withdrawal as well as for longer term treatment. When looking for a treatment center, ask if there are physicians available to prescribe these medications, because some facilities do not offer this.
Often, the biggest barrier in the journey to recovery is taking that first step. Surveys have shown that of the people who qualify for substance abuse treatment, only 10 to 15 percent even seek treatment. That’s a huge number of people who could benefit from treatment but don’t realize they need it, aren’t ready to take that step, or don’t want it. Also, as depression sets in, people’s motivation to start treatment or return to treatment can diminish.
Unfortunately, cost is often an issue. Even with good insurance, treatment programs are hardly ever 100 percent covered. And when you add everything up – therapy, lab work, medication – it can end up being quite expensive.
Numerous studies have shown that MAT is one of the most effective treatments for opioid addiction available, but there are barriers associated with it other than the cost. People have to stop taking an opioid for 12 to 24 hours or longer before starting buprenorphine, which can be difficult. Some of these drugs need to be taken daily at a clinic, so transportation comes into play. It also may mean taking time off work or away from family.
I often think of a patient who, after a long period of using opioids, stayed clean for several years. He had a stable job and was in a relationship. After being prescribed a painkiller for an injury, he relapsed and returned to heroin. I remind my patients that relapse is common – more than 50 percent of people will relapse within a year. So while we want to keep patients clean, we also want them to face reality and know that each time they come back to treatment, it increases the odds of them staying sober.
We provide education to our patients about staying safe if they do relapse. This can include the importance of not sharing needles and using clean needles to avoid infection. If someone has been in treatment for a while and relapses, their tolerance may not be as high as it once was, leading to a greater risk of overdose. For this reason, we talk about where to get naloxone – an antidote for opioid overdoses – and how to use it. Illinois residents will be able to buy naloxone without a prescription sometime in 2016.
Despite these barriers, there is hope. Treatment centers such as Linden Oaks have therapists who are highly trained in delivering the newest evidence-based therapies available and physicians who can prescribe buprenorphine and other medications onsite.
In addition to traditional treatment approaches, law enforcement and others have developed new ways to help people struggling with addiction. For instance, over the past 20 years, drug courts have proven to be a great asset in getting people the help they need. It’s like a souped-up contingency management program. The chance to have a felony conviction erased from their record provides a strong incentive to get treatment. If you or a loved one have drug-related criminal charges, consider a drug court program – it can help deal with the criminal punishment and treat the addiction at the same time.
You’re not alone! If you or a family member needs help to deal with addiction, fill out this assessment form online, and one of our team members will contact you. You can also call us at 630-305-5027.
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