A Practical Guide to Opioid Addiction and Opioid Detox

The opioid crisis is certainly a top of mind topic and in the news a lot these days with the latest facts and figures. The government is struggling with how to respond. In the meantime, you or someone you love may be battling this very addiction and need help right now. The consequences of waiting can be deadly.

If you’re taking prescription drugs or heroin, this practical guide provides an overview of opioids, self assessment, how use can turn into addiction, what treatment options are most effective for opioid addiction and overdose, plus a summary of Non 12 Step and 12 Step programs.

What are opioids or opiates?

Definition: Opiates or opioids are drugs, also referred to as narcotics that bind to specific receptors in the brain, spinal cord and gastrointestinal tract to minimize the perception of pain. Prescription opioids such as well-known OxyContin^® and Vicodin^® may be used to treat moderate to severe pain if over the counter options do not help a patient. Heroin is an illegal opioid made from morphine. Heroin can be injected, sniffed, snorted, smoked or mixed with crack cocaine. It’s also referred to as big H, horse, hell dust and smack.

Some common prescription opioids include:

• codeine, fentanyl (Actiq^®, Duragesic^®, Fentora^®)
• hydrocodone (Hyseingla ER^®, Zohydro ER^®)
• hydrocodone/acetaminophen (Lorcet^®, Lortab^®, Norco^®, Vicodin^®)
• hydromorphone (Dilaudid^®, Exalgo^®)
• meperidine (Demerol^®)
• methadone (Dolophine^®, Methadose^®)
• morphine (Astramorph^®, Avinza^®, Kadian^®, MS Contin^®, OraMorph SR^®)
• oxycodone (OxyContin^®, Oxecta^®, Roxicodone^®)
• oxycodone/acetaminophen (Percocet^®, Endocet^®, Roxicet^®)
• oxycodone/naloxone (Targiniq ER^®)[1]

Plus:

• amphetamine/dextroamphetamine (Adderall^®)
• benzodiazepine (Ambien^®, Ativan^®, Klonopin^®, Lorazepam^®, Valium^®, Xanax^®)
• nonbenzodiazepine (Lunesta^®)
• buprenorphine/naloxone (Suboxone^®)

If you or someone you know is taking any of the above substances including heroin, you can become addicted. If you do become addicted, it can be tough to stop taking the drugs on your own.

How do you know if you are addicted to opioids?

Shift in opioids taken

Of people entering treatment for heroin addiction who began abusing opioids in the 1960’s, more than 80% started with heroin. Of those who began abusing opioids in the 2000s, 75% reported that their first opioid was a prescription drug.[2]

It’s a fast growing problem

While prescriptions for opioids have reportedly decreased 41% since the peak of opioid prescriptions in 2010, the addiction problem is still on the rise. Unfortunately stricter prescription rules have not helped slow usage or fatal overdose. According to the acting director for the Center for Disease Control and Prevention (CDC), Dr. Anne Shuchat, “We still have too many people getting medicine at too high a level and for too long.” She went on to say, “If you are on opioids longer than three months, your risk of being addicted increases by 15-fold.”[3]

You are not alone. The problem is widespread and has now become one of our country’s biggest crises. According to the National Institute on Drug Abuse, an estimated 2 million Americans or more suffer from an addiction to prescription opiates, and nearly 500,000 are addicted to heroin.

From medical use to abuse

Many people who take prescribed painkillers for legitimate medical reasons end up using opiates recreationally because of the euphoric effects they get. Others increase doses to cope with pain once their bodies have built a tolerance. Sadly, opioid abuse has become quite common and those at risk are not just trying to get more drugs from various doctors but people like you and me that may be taking prescription pain medications for relief, even at low doses.

According to the National Institute on Drug Abuse (NIDA) people get opioids from three main sources: personal prescriptions, family and friends.

Self-assessment

If you or a family member or friend fall into one of the following categories or suspect addiction, it’s time to take a hard look at opioid usage. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), those at risk for opioid overdose includes a large potential population of opioid users that[4]:

• Deliberately misuse a prescription opioid or illicit drug such as heroin
• Take an opioid as directed, but the prescriber miscalculated the opioid dose or the dispensing pharmacist made an error, or they misunderstood the directions for use
• Misuse opioids and combine them with sedative hypnotic agents resulting in sedation and respiratory depression
• Use opioids for long-term management of chronic pain (whether related to cancer or not)
• Are heroin users
• Receive rotating opioid medication regimens (and thus are at risk for incomplete cross-tolerance)
• Are discharged from emergency medical care following opioid intoxication or poisoning
• Have a legitimate medical need for analgesia, coupled with a suspected or confirmed substance use disorder, or non-medical use of prescription or illicit opioids
• Have completed mandatory opioid detoxification or have been abstinent for a period of time (and presumably with reduced opioid tolerance and high risk of relapse to opioid use)
• Were recently released from incarceration and who have a history of opioid use disorder (and presumably have reduced opioid tolerance and high risk of relapse to opioid use)

If you’re taking prescription opioids, be sure to tell your doctor about any other medications you’re taking, all of them including antidepressants, antihistamines, sleeping pills, over-the-counter medications, herbal supplements and of course, other prescription drugs. Drinking alcohol while taking prescription drugs can be a dangerous combination.

If and when you recognize that you or a loved one is addicted, seek treatment right away to help avoid an overdose. Here’s what happens at a high-level:

Tolerance

Simply put, if you’re taking opioids, tolerance happens over time when the dose you need to get relief or to get a high, increases as your body gets used to the drugs.

Dependence

If you’ve been taking opioids for a long period of time, your body gets used to the drug, and needs it to feel normal. If you suddenly stop taking opioids, you may experience withdrawal symptoms.

Addiction

Long-term opioid use causes changes in the brain. Once addicted, you may compulsively try to get more drugs despite the negative consequences or your desire to stop. You cannot deal with this alone, talk to an addiction treatment provider today.

Relapse

If you’ve successfully stopped taking opioids for a period of time, and then resume using the prescription drugs or heroin, you may have developed an addiction or dependence to the drugs.

Opioid overdose

Many people overdose on opioids. To determine if you or someone you know has overdosed, keep in mind the following symptoms in order of severity:

• Shrinking pupils
• Slurred speech
• Sweating
• Vomiting
• Slow or erratic breathing
• Slow or erratic heartbeat
• Unresponsive to outside stimulus
• Loss of consciousness

Respiratory depression is when the lungs aren’t ventilating carbon dioxide fast enough, resulting in higher levels in the blood. In turn, this can cause convulsions, unconsciousness, and death. If opioids are taken together with prescription antidepressants and/or alcohol, the risk of respiratory depression rises. When addicts relapse after rehab and go back to their old dosage, it can also cause an overdose since they no longer have the same level of tolerance.

Preventing Overdose

The CDC reported that over 16,000 Americans died of an overdose related to opioid painkillers in 2013 alone, that’s over 40 people everyday.[5] Fast-forward 3 years later, and that figure has more than doubled. The CDC continues to gather data on opioid-related deaths for 2016, however analysts at The New York Times went through public health records state-by-state and predict the death toll from opioids, including prescription painkillers and heroin, will land between 59,000 to 65,000, possibly more Americans than died in the Vietnam and Iraq war combined.[6]

This does not need to be you, or your loved one. Get help.

What are the best treatment options for opioid addiction or overdose?

The first step is opiate detox, which is much safer and easier with professional help. Medication-assisted detox in a supervised setting is the best possible plan for anyone undergoing opiate detox. Suboxone and Methadone have both shown success rates for people struggling with opioid addiction and withdrawal. Individualized treatment based on your addiction and circumstances is ideal to determine the addiction treatment that’s right for you.

Suboxone: Buprenorphine is the main ingredient in Suboxone, it binds to the same receptors in the brain as an opioid does to prevent the “high.” It is a partial opioid agonist that activates certain receptors in the brain, with limits to its effectiveness even in high doses.  Suboxone is less addictive, and in some cases can be prescribed for use at home. Suboxone has been shown to be a safer alternative than methadone to wean people off opioids.

Methadone: Methadone is a full agonist, which activates opioid receptors in the brain to a greater extent than Suboxone. The problem is that Methadone can easily be abused. When beginning treatment, the drug cannot be used unmonitored. Methadone sometimes provides better relief from opiate withdrawal than Suboxone especially for people with stronger addictions to opioids. While Methadone is still widely used in treatment, thousands of people die from Methadone overdoses every year.

It’s important to find a program with reputable doctors and high treatment success rates to determine what’s best for you.

Naloxone: Naloxone is used in treatment for opioid overdose to block the receptors and in turn the “high.” It is FDA approved and must be administered by a doctor. Some people do get an allergic reaction to Naloxone the presents like hives, swelling in the face, lips or throat. Again, being under the care of a reputable licensed doctor and treatment program is critical given this treatment can also cause symptoms of opioid withdrawal.

Probuphine Implants: A Buprenorphine and Naloxone mixture in the form of an implant placed in the upper arm, release buprenorphine to counteract opioid withdrawals and cravings. While Probuphine is still going through clinical trials and the FDA approval process, results to date have proven that it’s effective in treating addiction to heroin and prescription painkillers.

Managing withdrawal symptoms: One of the biggest concerns people have with quitting is withdrawal. When you decrease or stop taking opioids after heavy use, you will likely experience withdrawal. Potential withdrawal symptoms may be more intense with longer opioid use and stronger doses. Withdrawal is best managed under the care of a treatment facility to help you or your loved one through the more difficult symptoms, which include:

• Fatigue
• Depression
• Paranoia
• Insomnia
• Cramping
• Vomiting
• Diarrhea
• Fever
• Chills
• Elevated blood pressure
• Sudden mood swings

What is the difference between Non-12 Step and 12 Step approaches?

Two very different philosophies and approaches, it is not comparing apples to apples. While Non-12 Step focuses on a highly individualized, holistic approach to detox, treatment, counseling, and aftercare, largely popularized 12-Step programs can be a great form of aftercare following detox but as a means of ending opioid abuse, it does have shortcomings.

Here’s a snapshot of Non-12 Step vs. 12 Step programs:

Risk of relapse: Relapse is when you’ve had a period of sobriety, and then resume taking opioids. Opioids are highly addictive and many factors can contribute to the high rate of relapse. Completing a detox program, and residential inpatient rehab, putting an aftercare plan in motion and having a truly supportive social network can help you avoid relapse.

Relapse does not equal failure. If you do relapse, it’s important to get back on the path to recovery quickly.

At Malibu Rehab Center, we take a Non-12 Step approach with our Opiate Detox Program and Prescription Drug Abuse Program. Our goal is to make opiate and opioid detox as safe and comfortable as possible with state of the art treatment, facilities, and our high staff to client ratio and trained doctors provide the best care possible.

Please contact us if you’d like to learn more.

[1] WebMD

[2] National Institute on Drug Abuse

[3] New York Times, 7/6/17

[4] SAMHSA Opioid Overdose Toolkit

[5] Center for Disease Control and Prevention

[6] New York Times, 6/5/17

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