There's no way to sugar coat it: abusing opioids — whether they are prescribed legally or not — is dangerous. It can have serious, long-term repercussions on your mind and your body. These dangerous and highly addictive drugs are at the center of one of the most significant problems facing our country today. In fact, every day, more than 115 people die from an opioid overdose. That's approximately 4.8 people every hour.
Even one person dying from this completely preventable problem would be too many, but almost five people every hour is horrific. If you or someone you love is addicted to opioids, then you are most likely living with the fear that you and your family may become tangled up in that statistic, too.
The term "opioid" is used to refer to a broad class of drugs comprised of both prescription painkillers and illegal substances, such as hydrocodone (Vicodin®), and oxycodone (OxyContin®), as well as heroin and fentanyl. Spotting someone who is using and abusing one of these substances can be a challenge, particularly if they have become addicted to a prescription medication that they initially obtained in a completely safe and legal manner. Statistics show that 21 to 29 percent of people who are prescribed an opioid painkiller end up misusing them, and somewhere between 8 and 12 percent develop an addiction — also known as an opioid use disorder.
Whether you began using an opioid in a legal manner or not, use of these dangerous and highly addictive substances can have severe consequences if you take them in large amounts. Drugs of any kind are chemicals — when ingested into your body in these amounts, they can cause serious, potentially life-threatening problems.
All opioids are derived from a chemical compound extracted from poppies. In various forms, they have long been known as a substance that can relieve pain and induce feelings of pleasure. The drugs within this family work because they mimic the function of the body's natural endorphins, which are chemicals the body releases that stimulate feelings of pleasure and well-being. They also reduce feelings of pain. The body naturally releases endorphins when a person exercises, which is why most people experience a pleasurable sensation after doing some kind of physical activity.
The problem with opioids is that they are not natural endorphins — they are a much stronger version of your body's natural chemicals, but when you take them, it is still introducing a foreign substance into your body. When a person takes opioids, these chemicals attach themselves to receptors in the brain the same way endorphins would, signaling the brain to produce the same feelings of pleasure and release from pain. However, opioids are much stronger than our body's natural endorphins, so the feelings and sensations they create are greatly magnified from what a person would experience from natural endorphins. This is what makes them such effective pain relievers.
No harm done, right? Wrong.
When a person uses opioids to initiate those feelings of well-being and release from pain, the brain and body get excited and want to feel that way again. So, the receptors in the brain ask for more endorphins — aka opioids — to recreate the same feeling. It also activates the neurotransmitter "dopamine," which is a "messenger" of sorts that can be created in different areas of the brain. Depending on which part of the brain produces the dopamine, the mind and body can respond in different ways.
When opioid use stimulates dopamine, it stimulates the chemical made in the part of the brain that regulates moods and recognizes feelings of pleasure and euphoria. When it registers these, it reinforces those positive feelings and makes the person want to have that feeling again and again — in a sense making the feelings a "reward" to be obtained again and again.
This is a natural process, but, similar to the endorphins we discussed earlier, using opioids stimulates a huge and unnatural elevation of these signals in the body. The "high" people get when opioid use elevates their dopamine levels is more significant than anything the body can produce naturally. So, not only do people tend to want to recreate it by taking opioids again, but their body eventually needs more and more of it to experience that same level of high.
We'll talk more about it later, but, for now, it's also important to know that part of the reason opioids are so addictive is because of the withdrawal that happens after an opioid leaves the body can be intense. Opioid withdrawal is harsh. So, even people who attempt to stop using opioids may find that their withdrawal symptoms are so extreme that they want to take more to end or avoid the way they feel without them.
That is exactly how an overdose can happen.
In general, there are three primary reasons why a drug overdose occurs:
This can stem from a variety of factors, but may often be found in someone who was buying a certain level of heroin off of the street, and they may have unknowingly purchased a product with a higher level of purity. When you take the same amount of a drug that is higher in purity, it puts more of that drug into your system than you have been used to in the past, and the body may not be able to handle the sudden increase.
An overdose can also happen when a person who has been "clean" relapses and decides to use again. Someone who has used drugs in the past may take the same amount they were taking before going into treatment for their addiction, not taking into account the fact that their body's tolerance is not as high because of the time they spent not doing drugs.
Prescription opioid overdose deaths happen when a person has combined prescription opioids with benzodiazepines, medications typically used for sedation, to induce sleep, prevent seizures or relieve anxiety. The combination of these two classes of drugs can have fatal repercussions.
While all drug overdoses are severe, opioid overdose is particularly so. Why? Because opioids bind to specific receptors on the brain that also control breathing. These receptors control how deeply a person breathes, as well as how often they take a breath. When a person ingests large amounts of opium, it will slow down their breathing. If they have ingested enough opium, they will stop breathing and, if they aren't treated quickly, they will die.
You may be familiar with the overdose reversal drug called naloxone or Narcan. This is a medication that healthcare or emergency response teams can inject into an overdose victim to restart their breathing and reverse the effects of an opioid overdose. While this has been used effectively in many situations, it can provide a false sense of security for overdose victims and their loved ones.
There are three reasons for this.
The effectiveness of naloxone or Narcan does not last as long as the effects of the drug in a person's body. A person who has been treated with naloxone should be carefully monitored after it is administered to make sure they do not slip back into their overdose state after it wears off, which is possible.
Naloxone or Narcan only provide short-term treatment for an overdose. A person who has experienced an overdose needs to be evaluated by medical and mental health professionals to determine an appropriate long-term course of action that addresses the underlying cause of their overdose and possible dependence on opioids.
Recently, some drug dealers have been selling a drug labeled as the opiate fentanyl that is actually a version of fentanyl laced with a hazardous chemical. This synthetic version is very nearly Narcan-resistant, meaning a person who overdoses on it may not respond when the overdose reversal drug is administered.
Individuals who overdose on opioids are at a significantly higher risk of experiencing cardiac arrest than individuals who experience an overdose from non-opioid drugs. People who overdose specifically from the opioid heroin are at an even higher risk of sudden cardiac arrest. There are a variety of reasons why this may happen, but it is most likely either because they:
We have already talked about the fact that a person who has overdosed on opioids may develop slow and shallow breathing or stop breathing altogether. However, it is important to remember that it's possible for a person to stop breathing but still have a heartbeat. If you encounter a person who does not appear to be breathing normally, it is critical to first stop and check for a heartbeat and pulse to determine whether they may be in cardiac arrest. This determines the "next steps" that you will need to take and is critical information to share when you call for emergency medical help.
Cardiac arrest is the medical term for what happens when a person's heart stops beating. It indicates a failure in the heart's "electrical system" that can be fatal. When a person goes into sudden cardiac arrest, they require immediate CPR and/or AED treatment to restart their heart. Ideally, this would be administered by Emergency Medical Services when they arrive at the scene of a suspected overdose. However, if EMS does not arrive quickly enough, a bystander may need to perform CPR or, if properly trained, use an AED to attempt to restart that person's heart.
Please understand that when a person is in the midst of sudden cardiac arrest, they are considered clinically dead, as they are without a heartbeat. Now, this doesn't mean that quick and skilled medical attention cannot save them, because it most certainly can. If you discover someone who does not have a heartbeat, you should immediately call 9-1-1.
If you overdose on opioids, your risk of cardiac arrest goes up. Because people often hide their opioid use for different reasons, you may not be using somewhere you can be found quickly. Every extra second a person goes without breathing or in cardiac arrest can be the difference between life and death. This is why death by opioid overdose is such a big deal — there is not much time to save someone's life when they overdose on opioids.
Anytime you use and abuse a drug over time, it is going to have a severe impact on your body. Long-term use of opioids — prescription or not — is no different.
Remember the ways that opioids can alter your brain — by impersonating natural chemicals and signals? Over time, your brain adapts to the presence of opiates and functioning based on that. So, when it doesn't have those chemicals nearby, it makes the person who has been taking them very sick. They become so ill from these "withdrawal" symptoms that they will do anything they can to make them go away — including taking more opioids.
So, unlike other drugs that become addictive because of the effects they produce, opioids often become addictive because people want to avoid what happens when they STOP taking them. What are some of those symptoms? Within 24 hours of the last time a person takes an opioid, they may experience some combination of the following:
These are just some of the symptoms of opioid withdrawal. It is typically painful and intense, lasting anywhere from three days to a week before the symptoms begin to subside. Depending on the circumstances and severity of the addiction, it could be up to six months before these symptoms disappear completely.
Yes, opioid addiction and overdoses are serious. We would be doing you a disservice if we pretended otherwise. You need to know the facts to make wise, informed decisions for yourself or your loved one who is struggling.
However, please know this: There is hope, and there is help. It is possible to live a clean, healthy life after struggling with an opioid addiction — with the right tools and treatment.
At Diamond House Detox, our goal is to create an intimate, home-like environment for people suffering from opioid addiction. The withdrawal period associated with opioid dependence is often scary and overwhelming because of how physically ill people become during this time. By providing the comforts of home at our northern California-based facility, as well as a compassionate, caring, trained professional staff, we can help addicts through the initial phases of detox and encourage them to begin their journey to recovery. While the journey through addiction is one that will last a lifetime, we pride ourselves on providing our residents with the tools they need to begin taking care of themselves, both mentally and physically.
If you or a loved one are struggling with opioid addiction, don't wait to get help — every minute counts. Contact us today for free, confidential assistance and support.
Content medically reviewed by Vicky Magobet, PMHNP-BC, on August 15th, 2018.