Opioids are among the most effective medicines we have for controlling pain. Unfortunately, they are also powerfully addictive because they act on the brain’s reward pathways. Opioid addiction is a serious problem which often requires medical help to overcome.

Anyone who uses opioid medications regularly for several weeks or longer, will eventually become physically dependent on them. This means that when they stop taking them suddenly, they will experience physical and psychological withdrawal symptoms.

Even someone who takes an opioid painkiller like hydrocodone exactly as prescribed can (and will) become physically dependent after a certain period of regular, daily use. Opioid dependence is the physical reliance upon the drug, but it is often accompanied by opioid addiction, which is a psychological reliance and relationship with the substance.

Opioids are a class of drugs which act on the brain’s opioid receptors to release the neurotransmitter dopamine (among other effects). They include drugs like morphine, codeine, oxycodone (OxyContin), heroin, and fentanyl. The primary effect of opioids is to reduce the perception of pain.

However, because they work in the brain’s reward pathways, opioids have other side effects. The sense of euphoria and well-being opioid users often feel contributes heavily to the addictive qualities these drugs have.

Opioids are mainly prescribed by doctors as painkillers for patients with severe or chronic pain who cannot get sufficient pain relief from non-narcotic or over-the-counter medications (e.g., NSAIDs, steroids etc.). In addition to dependence on legally prescribed opioids, addiction to illicit opioids, like illegally manufactured fentanyl has become an enormous problem in the U.S.

 

Opioid addiction has been a challenge for decades. But the OxyContin crisis which began in the U.S. in the late 1990s represented a tremendous paradigm shift. Manipulative marketing practices by Purdue Pharma and other pharmaceutical companies convinced many doctors to prescribe powerful opioids for even mild to moderate pain.

The result was a tragic increase of opioid overdose deaths which began in 1999 and has continued through 2024. As prescriptions to OxyContin and other opioids skyrocketed, so did opioid addiction and opioid overdose deaths. While the maker of OxyContin has since been brought to heel in court and forced to pay out millions of dollars to the governments in states ravaged by opioid addiction, the problem persists.

As access to prescription opioids began tighten up after 2010, many opioid addicted individuals turned to other sources rather than quitting. Turning to the street for illegal painkillers tablets, which are often counterfeit and even heroin when their drug of choice was unavailable.

In 2013 we began to see the beginning of a “third wave” of opioid overdose deaths. It is believed that illegally manufactured fentanyl and carfentanil is largely responsible for the third wave we now find ourselves in the middle of. Drug cartels and dealers found that fentanyl could be used to extend their heroin supply and increase profits. Before long, fentanyl was found in other drugs, including a large quantity of fake Percocet and other counterfeit painkiller tablets.

As of 2024, the fentanyl and carfentanil crisis shows no signs of abating unfortunately, but intervention and treatment efforts continue and help for opioid addiction is more available than ever before.

Drug overdose is a leading cause of death in the U.S. claiming more than 100,000 lives every year. The majority of these overdose deaths involve opioids. As fentanyl is increasingly found in heroin and the majority of fake pain pills sold on the street, the opioid deaths related to overdose have only continued to climb.

Prescription opioid addiction continues to be a problem. The most commonly prescribed opioid analgesics are oxycodone (such as Percocet), hydrocodone (such as Vicodin), and morphine sulfate (such as Kadian) are still popular in the U.S. and widely prescribed. Prescription monitoring programs in many states, such as The New Jersey Prescription Monitoring Program (NJPMP) and Florida’s E-FORCSE have helped save lives by making “doctor shopping” virtually impossible, but the danger is far from over.

There is good reason for hope where opioid addiction is concerned though. The tragic spike in opioid addiction and overdose deaths is a challenge that America’s addiction treatment providers are tackling head-on. The availability and effectiveness of treatment for opioid use disorders is higher than ever. We have learned a great deal about opioid dependence and how to help people addicted to opioids establish long-term recovery.

This can be just a little confusing since many people use the terms “opiate” and “opioid” interchangeably. Opiates are a type of narcotic drug derived entirely from ingredients of the opium poppy plant. They include morphine, codeine, opium and heroin.

Opioids include any drug which acts directly on the brain’s opioid receptors and shares chemical similarities.

Opiates are naturally-sourced opioids. But there are also synthetic and semi-synthetic opioids which are not opiates.

Semi-synthetic opioids include the vast majority of prescription painkillers, i.e. Percocet (oxycodone), Vicodin (hydrocodone) and so on. Synthetic opioids are opioids which are made entirely in a laboratory and don’t contain any ingredients from the opium poppy. Examples of synthetic opioids include fentanyl, methadone and buprenorphine.

Opioids vs. Opiates:

• All opiates are opioids, but not all opioids are opiates.
• Naturally-sourced opioids like heroin and codeine are also called opiates.
• Semi-synthetic opioids like Percocet or Vicodin are simply called opioids.
• Fully-synthetic opioids like fentanyl or methadone are simply called opioids.
• Just use the term “opioid” unless there is a reason to specifically identify an opiate.

If someone is addicted to opioids, they may start displaying a number of different symptoms that can be difficult for friends or family members to spot on their own. One or two of these symptoms in isolation may not indicate a problem, but if you see three or more, it could be cause for concern. It’s better to be wrong and risk a little awkwardness or embarrassment than it is to remain in denial or accept excuses. Opioid addiction is serious and sometimes deadly. Don’t take any chances, if you think your loved one is addicted to opioids, give us a call to talk about how you can help them.

Some of the signs and symptoms of opioid use include:

• Dilated pupils
• Sleepiness or “nodding”
• Sleeping excessively all the time
• Relaxed, nasal-sounding tone of voice, vocal fry
• Neglecting personal appearance or hygiene
• Itchy skin and absent-minded scratching of arms, next, face etc.
• Withdrawal from physical contact or other previously enjoyed activities
• Obsessive focus on getting more drugs, often calling doctors’ offices to ask for prescriptions
• Being secretive with money or suddenly having a lot of it without a reasonable explanation
• Tolerance to the drug, needing higher doses over time just to feel high
• Constantly chewing gum or cigarettes instead of smoking them
• Severe constipation that requires enemas or suppositories
• Nausea or vomiting without another explanation
• Flu-like symptoms, body cramps and diarrhea (in withdrawal)

If you’re concerned that a loved one may be using opioids or developing an addiction, there are steps you can take to help.

First and foremost, talk with your loved one in private about your concerns; don’t confront them in front of other people who might react negatively or say something hurtful that would make the situation worse.

Explain how their behavior has been worrying you and ask them whether they’ve been taking any drugs – including prescription opioids – without getting medical advice first.

Remember to speak from love. Shame, blame or anger has NO place in this conversation. Not if you want to keep the lines of communication and to get the person to ultimately accept help. Anger, shaming or guilt-tripping won’t work. In fact, these behaviors will probably have the opposite effect you want them to.

Remember, first and foremost: You want your loved one to feel comfortable with telling you the truth about what’s happening. That is the only way you’re going to be able to help them. Tell them they are loved. Keep the lines of communication OPEN.

Opioid addiction does not discriminate. It does not care whether someone was taking a medication as prescribed or if they are abusing substances they bought off of the street. Anyone who uses opioids regularly for long enough will become physically dependent upon them.

There are many treatment methods for opioid abuse including therapy and rehabilitation in a treatment center that provides counseling, education on opioid misuse/abuse, group discussions with fellow patients, social support from other people in similar circumstances, and drug-free lifestyle strategies to help them avoid relapse after leaving the facility.

It’s important that once rehab has been completed there is still follow-up care available like psychotherapy or motivational interviewing so they can maintain their sobriety while feeling supported throughout their journey of recovery.

The key to successful recovery is to remember that recovery is a practice and a lifestyle. You do not “recover” at rehab and then simply go home and resume life as usual. Recovery is a state of being which requires a certain amount of vigilance to maintain.