What are opioids and why is there a crisis?
By Dr. Dwight Tyndall
So what are opioids and why is there a crisis? Technically, an opioid belongs to the class of drugs that binds to opioid receptors in the brain and the body. When activated these receptors are excellent for controlling pain and this was the first medical use of opioids.
However, besides binding to opioid pain receptors, opioids also produce other effects in the body since these same receptors can trigger different effects. These effects can range from anxiety, depression, euphoria and respiratory depression.
Common medical opioids are morphine, fentanyl, dilaudid, codeine. These are used primarily to control pain whether due to surgery, an injury or for patients with chronic pain such as patients with end-stage cancer.
The most widely known non-medical opioid is heroin. Heroin is chemically derived from morphine but has significantly quicker onset and has a more pronounced euphoric effect. It is this euphoric effect that is believed to be the cause of its high abuse potential. Interestingly, heroin was initially marketed by the Bayer pharmaceutical company in 1895 was a non-addictive over-the-counter cough suppressant.
Although opioids, except for heroin, have true medical uses, it is the euphoric side effect that is the source of the potential abuse and the current opioid crisis. As someone becomes addicted to the euphoria, or the high, that an opioid produces, it usually takes more and more of the drug to produces the early highs.
This often leads to the addicted person consuming more and more of the drug to produce the desired high. Since opioids also cause respiratory suppression, the increased amount of the drug will eventually lead to a severe drop in breathing (an overdose) to the point where the addicted person stops breathing, leading to death.
This is the crux of the current opioid crisis: As more and more people abuse the drugs, there are more and more people overdosing and dying from the severe respiratory suppression and/or suffocation. Narcan or naloxone, an opioid antagonist, is used to treat an opioid overdose. Narcan works by binding to the opioid receptors and blocking the effects of the opioid including the euphoria and its respiratory suppression.
Another source of overdoses is that a relapsing addict will resume taking an opioid at their most recent dose level, which will be toxic since their bodies are no longer accommodated to such a high dose.
Treatment of opioid addiction is usually behavior modification with psychotherapy. For some addicts with chronic opioid use, methadone can be used to manage the withdrawal symptoms while not providing the euphoric effect. Unfortunately, methadone, since it is also an opioid, also has addictive potential.
Opioid withdrawal, although unpleasant, is not life-threatening and can start within hours of the last drug administration. Symptoms can include depression, anxiety, muscle cramping, agitation, nausea, vomiting, diarrhea and opioid craving.
Cold turkey or sudden cessation of opioid use is not recommended. Rather, cessation should be done by slowly decreasing the amount of drug used, combining with behavior therapy and medications to control the symptoms associated with withdrawal.
The current opioid overuse is a crisis for many reasons. Firstly, the multiple overdoses and deaths place significant demand stress on the first responder system as well as on surviving family members. There is also an increase in crimes as some addicted persons who are unable to obtain gainful employment turn to petty crimes to support their habits.
The solution to the opioid crisis is complex and will depend on education to prevent initial opioid abuse, limiting the access of both prescription and illegal opioids, as well as readily available rehabilitation programs to aid those who have become dependent.