Folks, we have an epidemic…

Opioids activate special opioid receptors, one of which, the µ (pronounced mee-oo) subtype, is involved in addiction to many drugs, such as nicotine, ethanol , THC, ketamine, and amphetamine. But, as would follow, given that only opioids directly activate this receptor, they are all the more addictive

It’s common medical practice to prescribe opioids for physical pain. They are perhaps more useful in this respect than any other drug class. But the industry falsely states that people can’t become opioid addicts if their opioid medication is taken as prescribed. They also wrongly argue that opioid withdrawal lasts for a week. Both of these ideas are beliefs of highly-respected doctors.

Just about ten years ago, I was put on codeine for back pain. At most, it was used for six months at 60 mg per every four-six waking hours. Assuming I slept eight hours, that’s 240 mg per day. Assuming I slept 12 hours a night, that’s 120 mg per day. As a rough guess, lets average it. So, 180 mg per day for 180 days.

If run through the opioid conversion calculator, that’s just under 22 mg of oxycodone, taken orally, per day for about 150 days. This falls on the lesser side of typical opioid use, forget levels of abuse. Yet I experienced a horrible mental backlash. It took about that many days on the stuff, to decently recover from being taken off the stuff.

We have a large amount of war veterans who have to live with chronic pain for the rest of their lives. They’re given opioids for the physical pain. Oftentimes, though, the emotional pain of their experience is not dealt with. Whether its a question of “not being tough”, not believing in mental illness, or otherwise thinking that it’s their burden to deal with, many veterans have horrible cases of anxiety and depressive disorders.

These hidden illnesses, combined with lower physical mobility, have veterans turning to their opioids to give themselves temporary relief. Soon enough, another mental illness (addiction) develops. Such situations, combined with the shift in treatment of chronic pain towards opioids, the ever-increasing availability of heroin, and the fact that heroin is oftentimes cut with the super-potent opioid fentanyl, create travesties that were supposed to be evaded thousands of miles away. And so many do not make it so far as that

Let’s look at the numbers…

From 1991 to 2013, the amount of prescribed painkillers in the United States rose by a factor of 270%.

From 2007 to 2015, the number of people in the United States abusing heroin doubled, to about half of a million people. The greatest increase in use has come from those of 18-25 years old.

More on the turmoil of our veterans.

People addicted to opioids begin to experience symptoms of withdrawal after about six to twelve hours of last use. The good thing is that, unless there is another significant medical problem present, opioid withdrawal isn’t known for being fatal, counter to alcohol and benzodiazepines. Symptoms of opioid withdrawal include, but are not limited to…

  • Insomnia
  • Dysphoria (a depressed mood)
  • Extreme anxiety
  • Irritability
  • Tremor
  • Significant sweating
  • A rapid heartbeat
  • Confusion
  • Nausea (frequently to the point of vomiting)
  • Muscle aches
  • Diarrhea
  • Chronic yawning
  • Lack of appetite
  • Significantly large pupils
  • Chronically runny nose
  • Shaking

Most people whom have been addicted to opioids for several months or longer, will experience a post-acute withdrawal syndrome (PAWS). Here is general timeline of heroin withdrawal.

And one for opioids in general. It says “opiates” – natural psychoactive drugs that activate the opioid receptors. “Opioids” include both natural and synthetic agonists of the µ receptor subtype (the one that produces addiction).

Physical dependence does not mean addiction. Addiction is a state of continuing to abuse a substance at higher doses over time, to achieve the original effect of the first few times (which does not happen). When opioids are taken in greater doses, and/or for a longer period of time than prescribed, that is abuse. The latter (abuse), if done enough, leads to the former (addiction). Symptoms of abuse include, but are not limited to…

  • Pinpoint pupils
  • Obvious euphoria
  • Chronic itching
  • Very slow breathing
  • Significant sedation
  • Slurring speech
  • Lack of awareness
  • Constipation
  • Nausea, especially to the point of vomiting
  • Lack of any pain

There must be at least two of eleven aspects present within a 12-month period, for opioid use disorder to be diagnosed, which criteria (conditions that are satisfied) are essentially the same for all drug abuse disorders.

  1. Taking them in greater doses, and/or for a longer period of time, than was originally planned
  2. An inability to decrease use
  3. Spending significant amounts of time procuring (getting), becoming high from, and/or recovering from, opioid intoxication
  4. Cravings
  5. A significant decrease in quality of employment, schoolwork, and/or maintaining one’s home, as a result of opioid abuse
  6. Opioid abuse causing problems with, or making much worse, social relations
  7. Giving up, or significantly spending less time engaging in, healthy recreational activities, socializing, and/or occupational (relating to work or position) activities
  8. Abuse of opioids continues in situations that would make use physically dangerous (such as driving a car)
  9. Abusing opioids, depsite knowing that the abuse has created, or is making worse, mental and/or physical health problems
  10. Tolerance
    1. Needing significantly increasing amounts of opioids to feel satisfied
    2. Taking the same dose of opioids, but experiencing significantly less euphoria when taking them
  11. Withdrawal (if opioids are taken according to medical guidance, this criteria is void)
    1. See the opioid withdrawal symptoms
    2. Opioids are abused to stave off withdrawal symptoms

Severity is either…

Mild: two to three criteria met

Moderate: four to five criteria met

Severe: six or more criteria met

Treatment for opioid abuse must include vocational training, psychological counseling, other medical services, and random urine tests

Medications are oftentimes used to help opioid addicts stay clean. These medications may be given…

  • Catapres (clonidine) reduces excitement by stopping the release of stimulating chemicals
    • It’s an adrenergic autoreceptor agonist
    • Basically, opioids reduce excitement in the brain, hence they’re depressants. When taken off of them, the brain becomes over-excited, to the point of extreme discomfort. This medication stops some of that excitement.
  • Evzio (naloxone) works opposite to how opioids work, and saves lives if given in response to an opioid overdose
    • It’s a μ opioid antagonist
    • People go from overdosed, on the way to death, to experiencing withdrawal, but alive
  • Vivitrol (naltrexone) works similarly to naloxone
    • It’s a monthly injection that stops all opioid-induced euphoria
    • The decision to not use need only be made every 30 days
  • Opioid Replacment Therapy (ORT)
    • Methadose (methadone)
      • It’s a μ agonist
      • Also, methadone is an NMDA antagonist
      • Methadone also antagonizes a nicotinic receptor, so may help in quitting tobacco
      • It produces effects slowly, which makes it less addictive
      • It leaves the body slowly (24-48 hours after one dose, half of it has been broken down)
      • It may cause heart problems, so supervision is needed
    • Buprenex (buprenorphine)
      • It’s a partial agonist at the μ opioid receptor
      • It tends to have a lower mortality rate than those prescribed methadone
      • It has a few active metabolites
    • Zubsolv/Bunavail/Suboxone is combination of buprenorphine and naloxone
      • This combination theoretically disables abuse
    • Probuphine is buprenorphine, with a twist
      • One has a tiny matchstick-like device placed under the skin
      • For six months, the user is given steady doses of buprenorphine this way
      • Blood levels are just about entirely constant
    • And in the near future, there will likely be a once-per-month, and once-per-week, shot of buprenorphine

Some people do not take officially indicated drugs for opioid addiction. This of course presents a variety of problems.

  • Kratom
  • Imodium (loperamide)
    • Used to deal with diarrhea
    • Safe when…
      • Used within the daily limit of 8 mg to 16 mg
      • Used for only two days at a time
    • Very dangerous when used at higher doses
  • Ibogaine
    • Taken from the root of the African iboga plant
    • Has a reputation for decreasing addiction to various drugs
    • A trip lasting well over 24 hours
    • A powerful hallucinogen
    • Schedule I controlled substance in the United States (completely and entirely illegal for any purpose)
    • Can be very dangerous, especially if one has pre-existing health problems
    • Al Jazeera, somewhat recently, ran an article on ibogaine
    • The Multidisciplinary Association for Psychedelic Research has information on ibogaine 
    • Various clinics across the world, such as this one in Spain, offer it for opioid addiction

And finally, opioid replacement therapies (opioid agonists) that aren’t offered in the United States…

  • These treatments are not effective without doctor oversight
  • They should only be used if nothing else works
    • Maintenance on sustained-release, oral morphine 
    • Maintenance on prescription heroin by intravenous injection
    • Maintenance on prescription Dilaudid (hydromorphone) by intravenous injection
    • Associated with almost entirely positive results
    • Used successfully, compared to methadone, in a number countries
      • Belgium
      • Iceland
      • Malta
      • Switzerland
      • England
      • Spain
      • The Netherlands
      • Germany
      • Canada

Surces: Abnormal Psychology: An Integrative Approach, Ben Komor, Stahl’s Essential Psychopharmacology, Dr. Michael Kuhar, Opioid Dependence Treatment: Options In Pharmacotherapy, http://www.webmd.com, http://americanaddictioncenters.org/,