Opioid Addiction & Treatment: An In-Depth Overview

Opioid Addiction

What are Opioids?

Opioids come in various forms, both prescription painkillers and synthetically produced illegal substances. Many addictions start because they were in pain from an injury or operation and their doctor prescribed a painkiller. It doesn’t take long for tolerance to develop, requiring a higher dose to achieve the same level of relief. However, doctors, now well aware of the risks of these highly addictive medications, will often not increase one’s dose and before you know it, these people are seeking the drugs on the street – the start of an opioid addiction. 

Even when these medications are used as prescribed, there is a high potential for addiction, overdose and death. The effects of the medication start to subside, leaving one with an overwhelming desire to take more – an indication that addiction is developing.

Types of Opioids

  • Opium, Heroin
  • Morphine, Codeine
  • Hydrocodone, Hydromorphone
  • Oxycodone, Oxymorphone
  • Methadone
  • Fentanyl (available by prescription and illegally)

Fentanyl is a potent synthetic opioid that is 50 to 100 times stronger than morphine. Fentanyl is responsible for more overdoses and drug related deaths than any other substance in the United States. Illegally manufactured fentanyl is made in labs and sold in various forms such as powder, pills, liquid and sprays.

Key Facts About Opioids

  • Opioids include the compounds that are extracted from the poppy seed as well as synthetically produced versions that work on opioid receptors in the brain in the same way
  • Half a million deaths worldwide are attributable to drug use with more than 70% of them being related to opioids
  • Opioids such as morphine, oxycodone and tramadol are commonly prescribed by doctors for pain
  • When prescribed dose is not adhered to, prolonged use and recreational use can lead to opioid addiction
  • Opioids can cause respiratory issues hence the large number of overdose deaths
  • Naloxone, if given quickly, can prevent opioid related deaths
  • There are a number of effective treatment interventions for opioid addiction but less than 10% of people in need actually receive the help

From 2019 to 2020:

  • Close to 600,000 people died from an opioid related overdose in the US (prescription & illegal)
  • Opioid related deaths rose by 38%
  • Prescription opioid related deaths rose by 17%
  • Heroin related deaths declined by 7%
  • Synthetic opioid related deaths rose by 56% (fentanyl)

The rise in opioid related overdose deaths took place in 3 waves:

  1. The first wave began in the 1990s with a huge increase in the prescribing of opioids.
  2. The second wave started in 2010 with a massive spike in overdose deaths related to heroin.
  3. The third wave began in 2013 with an increase in overdose deaths related to synthetic opioids, particularly fentanyl.

A large number of the opioid related deaths can be linked to polydrug use – using opioids in combination with another drug.

The Opioid Epidemic

The opioid crisis began in the 1990s with the introduction of new painkillers that pharmaceutical companies claimed were safe. Doctors started prescribing these new wonder drugs which were later discovered to be extremely addictive. Rates of abuse, addiction, overdose and death skyrocketed. It can be said that the negligent practices of the pharmaceutical companies and doctors are 100% responsible for the opioid epidemic which destroyed the lives of millions of people.

  • It is estimated that the opioid crisis costs up to $80 billion a year in healthcare costs, lost wages and strain on the justice system
  • Opioid use was once an issue in urban areas but in recent years use in rural areas has skyrocketed
  • People with co-occurring disorders or other SUDs face a higher rate of addiction

Opioid Overdose

Opioid use can lead to death due to the effects of opioids on the part of the brain which regulates breathing. An opioid overdose can be identified by a combination of three signs and symptoms:

  • pinpoint pupils
  • unconsciousness
  • trouble breathing

Worldwide, drugs are responsible for about half a million deaths with more than 70% of being related to opioids. Approximately 115,000 people died of opioid overdose in 2017 alone.

Opioid overdoses have increased throughout many countries, in part due to the increased use of opioids in the management of chronic pain and increasing use of highly potent opioids appearing on the illegal drug market. In the US, the number of opioid-related deaths increased by 120% from 2010 to 2018 with two-thirds of the  deaths in 2018 involving synthetic opioids, such as fentanyl.

There is evidence that fentanyl is being added to other drugs, such as heroin, to increase potency and fentanyl is being sold as counterfeit tablets that are made to look like prescription medications. Therefore, many users do not know they are taking fentanyl which has a huge impact on the risk of overdose and death.

Opioid Treatment

It is never recommended to detox on your own. Because the withdrawal symptoms are so uncomfortable, most people relapse. This is even more dangerous because when you stop using for a period of time, tolerance decreases and when you relapse and use the same dose as previously taken, it is often too much and leads to overdose and death.

Withdrawal symptoms are very unpleasant for people detoxing from opioids and can last anywhere from a few days to several weeks. The length of time for detox is based on the individual needs of each person including what opioid was used, duration of use and any medical or mental health issues.

Medically Supervised Detox

Detox offers support throughout the detox stage by a team of medical professionals in a safe environment away from triggers where withdrawal symptoms can be managed. It is at this stage that medication-assisted treatment (MAT) is used to reduce or eliminate withdrawal symptoms allowing people to focus on treatment and the recovery journey ahead.

Medication-Assisted Treatment (MAT)

MAT works from a whole-patient approach and works well to reduce the rate of relapse, overdose and death. It should always be used in combination with therapy (counselling and groups) at an inpatient treatment centre. Residential treatment is always the best choice but when not possible outpatient treatment is recommended.

What medications are used?

Methadone was developed in 1947 and started to be used to treat OUD in 1972. It is extremely effective in reducing cravings and withdrawal symptoms and also pain. The downside is that methadone has higher potential for abuse but even when this happens, the effects on one’s life is still better than when they were using opioids.

Buprenorphine (Suboxone, Subutex) works well to reduce cravings, pain and withdrawal symptoms. These medications produce feelings of pleasure and also have a risk of abuse. Buprenorphine has been the preferred MAT since its introduction in 2002.

Naltrexone blocks the effects of opioids and eliminates withdrawal symptoms. It does not work on the pleasure centres of the brain like the other two medications, reducing the risk of abuse.

These medications block the effects of opioids and reduce or eliminate the withdrawal symptoms and urges to use. MAT helps people achieve and maintain abstinence and reduces the number of overdoses and deaths.

Other medications may be used to address specific needs as determined by the doctor. Examples are Ativan for anxiety or Loperamide for diarrhea.

Inpatient Treatment

Inpatient programs provide treatment by a team of experienced addiction professionals where you are removed from your everyday routine and environment, reducing the risk of leaving treatment to use. Inpatient treatment provides the detox and emotional support you need to achieve recovery and has higher success rates than other methods.

It is always recommended that you commit to a minimum of 28 days but programs can last up to 90 days and beyond if required. Factors influencing your length of stay include:

  • What drug you were using, how much and for how long
  • Do you need detox
  • Any co-occurring disorders, other SUDs or medical issues
  • How long can you be away from home, work
  • Cost

Outpatient Treatment

Outpatient programs offer support through counselling and group sessions and are always recommended for aftercare when you leave inpatient. Programs vary in what is offered, types of therapy, hours per week and duration.

Therapy

Cognitive behavioural therapy (CBT) helps people change their current thought patterns and behaviours around substance use and identifies any co-occurring issues that may have been a contributing factor

Dialectical behaviour therapy (DBT) teaches skills that are effective in helping people to stop using, including distress tolerance, emotional regulation, interpersonal effectiveness and mindfulness.

Group therapy provides a sense of community and belonging which is essential in recovery. Peer support is very helpful in that it holds you accountable.

Family therapy helps to strengthen relationships by offering support for conflict and issues that resulted from the addiction.

12-Step groups like AA and NA provide members with a strong community of peers that helps in maintaining long-term recovery.

Holistic therapies are an important part of effective addiction treatment. These includes:

  • mindfulness / meditation
  • exercise / fitness
  • massage
  • yoga / pilates
  • acupuncture
  • music / art
  • nutrition / dietary

Aftercare & Relapse Prevention

When discharging from inpatient treatment, it is crucial to have an aftercare plan in place to provide support for your return home. People who don’t participate in aftercare have very high rates of relapse. To succeed in recovery you need to make therapy, groups, exercise and other forms of support a part of your life.

Aftercare plans are essential because they:

  • continue teaching the skills and tools from inpatient treatment
  • offer a sense of belonging and connection
  • increase your chance of success in recovery

If you’re struggling with opioid addiction, The Hills in Chiang Mai Thailand is here to help. The team will help address your issues and provide you with the tools and skills you need to live a life of sobriety. To learn more about The Hills as well as the benefits of going to Thailand for treatment, give them a call today.

Dr. Sutthipan Takkapaijit

Dr. Sutthipan Takkapaijit

Clinical Psychiatrist

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