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Prescription Painkillers (Opioids) < Back

By Lindita Djokovic

History

Prescription opioids such as morphine, hydrocodone (Vicodin), or oxycodone (OxyContin) are a class of drugs that are legally prescribed to relieve pain. According to historic documents, opioids were one of the first recorded therapeutic pain relievers used by humans. Opioids originally were extracted from the seed pods of the opium poppy. Many of the opioids used today are synthesized by chemists to mimic the properties of natural opioids.

How It’s Used

Individuals are typically prescribed these medications after undergoing surgeries ranging from dental procedures to cancer treatments. Prescription opioids are also known for their high abuse potential – according to the Substance Abuse and Mental Health Services Administration (SAMHSA), prescription drugs, including opioids, are more commonly abused than any other drug besides marijuana and

alcohol. For this reason, they are specifically prescribed in small dosages over short periods of time to avoid their misuse by individuals.

Despite these measures, the last decade has seen a dramatic rise in prescription opioid abuse in the United States that has reached epidemic proportions. The U.S. Department of Health & Human Services (HHS) reported that nearly 30,000 people died of a prescription drug overdose in 2015, and over three quarters of those deaths resulted from prescription opioids. Compounding the problem, as many as three million individuals in the United States have been diagnosed with an opioid-use disorder, many of whom began using the drug as prescribed for pain management. With the number of individuals using opioids on the rise, and with many of these individuals not receiving appropriate treatment for their addiction, the death rate from misuse of opioid pain relievers in 2015 was nearly 6 times higher than it was in 1999.

How It Works

Opioids act directly on specific opioid receptors located in the spinal cord, brain, and gastrointestinal tract, reducing the body’s perception of pain. Opioids also affect other brain areas which play a role in emotion and reward, which can lead to an emotional “high”, especially if taken in large doses. In many cases, this “high” encourages the misuse (and abuse) of the drug. Opioids can also have undesirable effects such as depression, constipation, drowsiness, and nausea. While prescription opioids are generally taken orally, they can be crushed and injected into the bloodstream or snorted for a faster and more powerful effect, which increases the intensity of the high, but also increases the chance of having other adverse, medical issues or overdose. Many individuals who misuse prescription opioids falsely believe that prescription drugs are safe compared to illegal drugs, however this is only true if the drug is used properly. Death as a result of improper use of prescription opioids far exceeds deaths from both heroin and cocaine overdose combined. Additionally, some people transition from abusing prescription opioids to using heroin, which is chemically similar to opioid painkillers but often easier or cheaper to acquire. This transition can expose users to other health risks, including contaminants and bloodborne pathogens.

Treatment

The opioid epidemic in the United States has spurred many pharmaceutical companies to create drugs that can reduce addictive cravings and dependence on opioid drugs. Some commonly prescribed medications are methadone and buprenorphine (brand name Subutex). Methadone is a long-lasting opioid which can be administered in a controlled setting to manage withdrawal and cravings. Buprenorphine is a weak opioid that activates the same receptors as other opioid drugs, reducing an addict’s drug cravings substantially while also countering typical withdrawal symptoms. In order to decrease the abuse potential of buprenorphine, it can be combined with the opioid blocker naloxone When this combination (called Suboxone) is taken properly, the naloxone is inactive and the buprenorphine has the desired effects of reducing craving and withdrawal symptoms. However, if crushed and injected into the bloodstream, the naloxone will trigger withdrawal symptoms and block the effect of the buprenorphine. The aim is to give patients the medication they need to manage withdrawal and cravings while preventing abuse.

For more successful treatment results, many treatment centers and individuals use medications and therapy simultaneously. Cognitive Behavioral Therapy (CBT) and contingency management can be highly effective. Contingency management is a reward-based system in which patients regularly earn money or points for negative drug tests, which can be exchanged for prizes that encourage a healthy lifestyle. CBT is a type of therapy that encourages an addict to identify and change their thought process, expectations, and behaviors related to drug addiction. CBT aims to equip the patient with skills to cope with daily challenges in a healthier manner — instead of relapsing back into drug-taking. Studies show that the most effective way to treat drug addiction is through a combination of medications and therapy.

References

Alderks, C.E. Trends in the use of methadone and buprenorphine at substance abuse treatment facilities: 2003 to 2011. The CBHSQ Report: April 23, 2013. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK384659/

Opioids: the prescription drug & heroin overdose epidemic. (2016, March 24). Retrieved from https://www.hhs.gov/opioids/

Prescription drug misuse and abuse. (2015, October 28). Retrieved from https://www.samhsa.gov/prescription-drug-misuse-abuse

SAMHSA. (2015, August 20). Prescription drug abuse webinar for corporate medical officers and medical review officers [Video File]. Retrieved from https://www.youtube.com/watch?v=8d0d_XiHImE&feature=youtu.be

Schuckit, M. A. (2016). Treatment of opioid-use disorders. The New England Journal of Medicine, 375 (16), 357-368. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMra1604339#t=article

The National Institute on Drug Abuse. (2014, November 13). Heroin. Retrieved from https://www.drugabuse.gov/publications/research-reports/heroin

The National Institute on Drug Abuse. (2017, May 14). Prescription pain medications (opioids). Retrieved from https://teens.drugabuse.gov/drug-facts/prescription-pain-medications-opioids

The National Institute on Drug Abuse. (2017, May 24). Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids      https://www.ncbi.nlm.nih.gov/books/NBK384659/