Even when Prescribed, Opioids can Cause Addiction and Overdose
By Anne Watkins
According to new research conducted by the nonprofit organization Group Health Cooperative, it's not just illicit users who overdose on opioid painkillers.
The study looked at 10,000 people who had received opioid prescriptions over a 90-day period. Of that group, 51 experienced at least one overdose and six people died from an overdose.
That may not seem like a huge number, but when you account for the fact that several million Americas are prescribed opiate drugs each year, this adds up to hundreds of deaths annually. Of course, this figure doesn't take into account the many thousands of overdoses and deaths that occur because of illicit opioid use.
Because both illicit and prescription opioid use continue to grow each year, experts don't expect this problem to go away anytime soon. Because of that, it's important to spread knowledge about how dangerous opioids can be and ensure that doctors only prescribe these drugs when necessary.
Opioid Abuse a Growing Problem
Since the late 1990s, opioid use had grown markedly in the United States, largely as a result of increases in the rate of prescriptions for drugs such as Vicodin and OxyContin.
As heroin use remains at a relatively low level, these prescription medications have become the drug of choice for recreational opioid users. More than 5 million people in the United States obtain illicit painkillers each month, and 2.2 million use these drugs illicitly for the first time each year.
Recreational opioid users obtain the drugs in a number of ways:
- 55 percent get them for free from a family member or friend who has a legitimate prescription
- 14 percent buy it from a friend or acquaintance
- 19 percent obtain it from a single doctor
- 1.6 percent obtain it from multiple doctors
- 3.9 percent obtain the drug from dealers or strangers
These data suggest that, even with illicit opioid use, the drugs most often come from legitimate prescriptions rather than directly from the black market.
But even though illicit opioid use accounts for the bulk of opiate-related overdoses and deaths, the Group Health Cooperative study reminds us that legal, prescription use can be just as dangerous. Given the nature of how the drugs work, no one who takes opiates is completely safe. Tolerance increases rapidly, addiction is easy to develop and withdrawal symptoms can be extremely harsh.
How Opiate Addiction and Overdose Happen
Opiate addiction can develop in as little as one week of regular use. With repeated use, the drugs alter the behavior of areas of the brain known as opioid receptors.
Under normal circumstances, these receptors are what cause people to experience feelings of pleasure and reward, and they also facilitate the body's natural painkilling process. Using an opioid drug on a regular basis gradually desensitizes these receptors to the usual pleasure stimuli. In the process, it also rewires the brain so that users need the drug to feel any sort of pleasure or pain relief.
The more the brain grows accustomed to opioid stimulation, the more a user needs to take to achieve the same effect. For people who take a drug such as Vicodin and Oxycontin, the effects are strongest after the first few doses, and even prescription opioid users often end up taking more than the recommended dosage to feel relief.
In many cases, this is what leads to overdose. The user feels the need to take more and more of the drug while their tolerance gets higher and higher. Many of the most serious overdose cases occur when someone stops taking the drug for a few days and then goes back to it. It takes no more than a few days for the body to readjust its tolerance level, so that when a returning user takes an elevated dosage, the body might not be able to handle it and cause an overdose.
The writers of the Group Health Cooperative study noted that many of the people who overdose or become addicted to prescription drugs suffer from additional problems. For example, many have clinical depression or anxiety, and many have a history of drug or alcohol abuse. As a result, they're much more likely to use prescription drugs in ways that are reckless and self-destructive.
Safer Prescriptions
As the opioid drug industry has grown, there has been a simultaneous growth in public awareness of chronic pain and related issues, such as arthritis and fibromyalgia. The result is that more patients are requesting opioid medications, and the medical industry is giving them what they want.
Because of this, it's only natural that the raw numbers of people becoming addicted to and overdosing on opioid medications would rise. Most doctors are very responsible and careful about whom they prescribe these drugs to. Most of the problems occur due to lack of information about a patient's predispositions, patient dishonesty or simple carelessness.
Even so, these problems could largely be avoided if doctors do two things:
- Prescribe opioids only as a last resort and
- Allow patients to take opioids for no more than two weeks.
Ending Prescription Opioid Addiction
While it's relatively easy to prevent overdosing on prescription opioids, addiction often sneaks up on people. It can occur in just a week or two, and it can become powerful even before the patient is aware that it's there.
If you suspect that you're addicted to a prescription opioid painkiller, talk to your doctor about how to transition off of the drug. You may need to go through a detox process, which can take up to a week. If your addiction has been going on for a long time, your doctor may recommend methadone or suboxone replacement therapy to wean you off the drug.