Opioid Addiction: The Road to Recovery

We hear it on the news and read about it online, see it in social media and in tweets almost every day: there's an opioid crisis in the United States. People are becoming addicted to prescription painkillers, with many then transitioning to illegal substances like heroin and fentanyl.

Is the nation facing a true crisis of opioid addiction? Is there a way to counter it? Is recovery from opioid addiction possible?

Are We in Crisis?

What exactly is a ‘crisis'?

"a condition of instability or danger, as in social, economic, political, or international affairs, leading to a decisive change." – Dictionary.com

Based on this definition, do opioid abuses and overdose rates rise to the level of a national crisis? Does the number of addicted people in the U.S. present a "condition of instability or danger?" Let's remove the emotional component of addiction and look at the available data to answer that question.

What Do the Numbers Say?

Opioid overdoses claim the lives of 130 Americans every day.

One hundred thirty people.

Every day.

The National Institute on Drug Abuse describes this as a ‘crisis.' Not only does the misuse of and addiction to opioids present a serious threat to national public health, it impacts the nation's social and economic welfare.

According to the Department of Labor and Industry, opioid overdose was the cause in 42,249 deaths in the United States in 2016. That's a staggering statistic unto itself, but there are more which are equally as disturbing:

• On average, health care providers write 650,000 prescriptions for opioid medication on any given day in the U.S.
• 3,900 people use prescription opioid medication for non-medical reasons daily, on average, in the U.S.
• In 2015, the Council of Economic Advisors estimated the cost of the opioid crisis in the U.S. at $504 billion, or 2.8 percent of GDP for that year.
• The number of annual opioid-involved overdose deaths has risen from less than 10,000 in 1999 to over 70,200 in 2017.
• The majority of those suffering an opioid-involved death are between the ages of 25 and 55 years old.

These startling statistics are only the tip of the iceberg that is the opioid crisis in the U.S.There can be no doubt that it is, by definition, a crisis.

A National Emergency

A study in 2017 of claims made to Blue Cross Blue Shield found an increase of 493 percent in the claims filed bearing a diagnosis of "opioid use disorder" between 2010 to 2016. Data from 2012 to 2014 from the National Survey on Drug Use and Health found 4.31 percent of Americans aged 12 and older use prescription pain medications for non-medical purposes.

The link between prescription drug use and the use of illicit opioids is undeniable. Many who become addicted to heroin or synthetic opioids such as illegally manufactured fentanyl began by misusing prescription opioids.

In an effort to combat these alarming trends, President Trump declared the opioid crisis a national emergency in October 2017. This move opens hard-hit communities to more federal public health funding.

How bad is it? According to the Journal of American Nurses, dependence on and addiction to opioids explains why Americans consume 80 percent of the world's supply of opioid pain relief medication. In addition, Americans consume 99 percent of the worldwide production of Hydrocodone, a synthetic opioid pain killer.

Recognizing Addiction

People experience pain at times. Some suffer from it on a chronic level. To relieve pain, physicians legally prescribe analgesics (pain relievers) like hydrocodone and oxycodone. These are opioids – a broad group of pain-relieving medications derived from opium, a drug extracted from the juice of the opium poppy. The chemicals in opioids interact with the nervous system to diminish pain.

Pain relievers are a necessary treatment for those who are suffering a legitimate medical condition for which the medications are legally prescribed. When taken as directed and managed by a physician, these drugs can help chronic pain sufferers to maintain their quality of life.

Those who misuse these prescription drugs take the medication in a manner or dose other than prescribed. Under these conditions, addiction is likely.

Opioid abuse usually exhibits in three common categories:

• loss of control
• craving and preoccupation with using the drug
• continued use of the drug despite negative consequences

Some common behaviors and observations that indicate a person may have an opioid addiction include:

• They finish their prescription medication before they should and begin seeking more.
• They may call the pharmacy to request early refills, often providing elaborate explanations as to why they need to refill the prescription early.
• They make recurring requests to their doctor, or multiple doctors, for refills of opioid prescriptions.
• They may seek opioids from sources other than their doctor, including stealing the medication from family and friends.
• They're observed to sleep more than usual or experience unexpected periods of euphoria.
• Their need to take the drug interferes with or takes priority over normal daily activities, even interfering with their job.
• They exhibit a decrease in normal activity, a decline in the ability to function, and a deterioration of relationships with family and friends.
• They experience withdrawal symptoms when they don't have access to the drug.
• They may experience constipation.
• They may exhibit increased confusion and impaired coordination, including falling.

Opioid medications impact brain function. Mixing opioids with other drugs can enhance the effects, such as the following:

• Very slow breathing rate
• Decreased heart rate
• Very small pupils that don't react to shining a light in the eye
• Deep sleep from which others can't awaken you
• Loss of consciousness
• Lips or fingernails appearing blue or purple

Should you observe these symptoms in someone, call 911 or your local emergency number.

Physical Effects of Opioid Addiction

The immediate effect of opioid ingestion is a feeling of euphoria, a temporary reduction in pain and anxiety, and possibly drowsiness. These effects are short-lived, often leading users to crave the feelings, and thus the medication that provides them.

Abuse and addiction can have negative physical effects on the abuser:

• nausea
• vomiting
• a weakened immune system
• slowed breathing rate
• increased risk of infectious disease, including HIV, from intravenous use
• increased risk for hepatitis from intravenous use
• collapsed veins and/or clogged blood vessels
• risk of choking
• coma
• death

The more someone abuses opioids, the more they develop a tolerance for the medication. This means they have increasing difficulty achieving the satisfactory high they crave. In turn, this leads to using more opioids, which only compounds the negative effects.

Withdrawal Symptoms

When an opioid addict stops using the drugs, withdrawal symptoms will set in. These physical manifestations can vary, but may include the following:

• anxiety
• insomnia
• agitation
• sweating
• muscle aches
• tremors
• nausea
• vomiting
• diarrhea
• extreme mental and physical discomfort

Even those with a mild dependence on prescription opioids may experience withdrawal symptoms. The intensity of the withdrawal and the length of time it takes depends on different conditions:

• the length of the addiction
• the type of opioid the addicted person used
• the size of the doses he or she took, as well as the frequency of dosing

Anyone who is experiencing withdrawal symptoms should consult a physician. Those whose addiction is long-standing should seek medical advice before quitting.

Mental and Emotional Effects of Opioid Addiction

Addiction to opioids is a disease of the brain. Dependence and long-term use of an opioid can result in long-term structural changes to the architecture of the brain. It also alters the biochemistry of the brain, changing the way the brain functions.

The wiring in our brains ensures we repeat activities necessary for us to live, such as eating and drinking water. Opioids trigger this center in our brain, fooling us into thinking that the opioid is something we must have in order to survive. This tricks the person into repeating the behavior over and over, even when it is detrimental to a person's health.

As the disease progresses, the addict may experience emotional and mental irregularities:

• hallucinations
• anxiety
• depression
• may feel lifeless
• inability to enjoy activities that used to bring pleasure

Repeated use of opioids can lead to impairment in the intellectual portion of the human brain, especially the center for judgment and decision-making. This is particularly dangerous for teens because this part of the brain is still developing in adolescence. Dependence on opioids during the teen years may prove more severe and more resistant to treatment.

Because of the impairment in thinking common in adolescent opioid addicts, the teen may flatly deny having a drug problem. They will go to great lengths to justify their opioid use to family and friends and offer elaborate excuses to minimize the consequences of their poor behavior choices.

An opioid addict will often say and do things that they would never have believed themselves capable of doing before their addiction. Addicts may find themselves lying to friends and family, or stealing from those they love. They may even commit criminal acts to obtain the drug their brains have convinced them they must have to survive.

The cravings of addiction are perhaps the worse manifestation of the changes in the structure and function of the brain. Opioids bring on powerful and long-lasting cravings. These can linger for months and even years after the addict quits. The cravings explain why there is such a high rate of relapse.

Impact of Opioid Addiction on Family and Friends

Opioid misuse and addiction can impact the user but can also harm those around them. For example, pregnant women who continue to misuse opioid drugs during pregnancy place the health of their baby at grave risk.

From 2000 to 2009, the use of narcotic pain medication by pregnant women increased five-fold, and it continues to rise. This results in the birth of infants suffering Neonatal Abstinence Syndrome (NAS.) This condition is not only linked to birth defects, it also forces the newborn to suffer severe withdrawal symptoms.

The number of American infants born addicted to opioids is increasing, with estimates at 6 out of every 1,000 births linked to NAS. Children born with NAS account for an 8 percent rise in the number of children of opioid-addicted parents entering foster care from 2012 to 2015.

The changes in behavior associated with opioid addiction can have a devastating effect on families and friends. Some typical behaviors that drive wedges into families and between friends may include:

• increased irritability or aggression
• changes in attitude and/or personality
• lack of energy and enthusiasm
• appearance of or worsening of depression
• a sudden change in social network and support as friendships become strained and break down
• dramatic changes in habits and priorities
• financial problems, including job loss, repossession of belongings and home foreclosures
• involvement in criminal activity

Older children of opioid-addicted parent(s) too often suffer neglect or child abuse. The home environment in these families is generally unstable, exposing children to experiences involving secrecy, loss, conflict, violence, and fear. The home environment may be chaotic.

Children living with a caregiver who has altered moods and/or is unstable are much more vulnerable to stress and trauma. They may develop problems with depression, anxiety, or other mental health disorders.

Children of parents who die from overdose suffer tremendous impact. It begins a cycle in which these children mature into adults who are themselves at risk of addiction, overdose and death.

Hope Springs Eternal

Addiction is a treatable disorder. Treatment methods based on the science of addiction can help people break their addiction to opioid substances and resume productive, fulfilling lives.

Those who break their cycle of addiction are on the road to their recovery. As is the reality of other chronic diseases such as asthma and heart disease, treatment for opioid addiction isn't a cure. Rather, it is a way of life that successfully manages the disease.

With treatment, people can counteract the destructive effects opioid addiction has on their brain and behavior.

They can regain control over their lives.

Treatment for Opioid Addiction

Opioid addiction is a treatable chronic disease that isn't curable but can be successfully treated and managed. It is possible for those suffering with this addiction to achieve recovery and lead productive, fulfilling lives.

Addiction to opioids is a chronic disease that impacts multiple aspects of a person's life, and the lives of those around them. Areas where opioid addiction affects a user's life include:

• his/her physical well-being
• the mental health of the addict and those around him/her
• social relationships of the addicts and his/her family and friends

For a treatment plan to be successful, it needs to address these components.

Opioid abuse and addiction is treatable in several ways:

• medications
• counseling in conjunction with behavioral therapies
• medication-assisted therapy (MAT). This includes medicines, counseling, and behavioral therapies. This provides an approach to treatment that considers the "whole patient," which improves chances of a successful recovery.
• hospital-based treatment and residential treatment

Often times, a combination of these treatment methods offer the best chance for recovery.

Detoxification

One of the first steps in any treatment regimen usually includes a supervised withdrawal from the opioid. This most often happens with support and medication to assist with symptoms of withdrawal.

Detoxification is not considered a treatment unto itself. Detoxification alone is not sufficient assistance for a person to recover from addiction. In cases where detoxification alone is not followed with subsequent treatments, the resumption of drug use is a very real possibility.

There are a select number of medications that can reduce the severity of withdrawal symptoms. These can make it easier to stop using the drug. This step in recovery is best carried out under the supervision of a physician.

Medication-assisted Treatment (MAT)

This type of treatment is exactly what it sounds like: treatment that uses medications, in combination with counseling and behavioral therapies, to treat opioid addiction. There are medications that can help reduce the cravings and the euphoria associated with opioid abuse. Risk of subsequent overdose may diminish with MAT.

The three drugs most commonly used in MAT are:

• Methadone. This drug is a full opioid agonist, meaning it works similarly to other opioids such as heroin, morphine or fentanyl. It acts more slowly, helping to reduce the euphoric highs while diminishing withdrawal symptoms.
• Buprenorphine. Known as a partial opioid agonist, this drug doesn't have the full effect of other drugs in the same class of semi-synthetic opioids, such as oxycodone or heroin.
• Naltrexone. This opioid antagonist blocks the sedative and euphoric effects, and reduces the cravings for opioids.

The length of treatment when using any of these three MAT drugs may span from months to years. In order to prevent relapses, long-term treatment is frequently recommended.

Behavioral Therapies

Studies show that treatments with medications and mobile applications can gradually help the brain adjust to not using the opioid. These help mitigate the severity of the cravings.

Preventing a resumption of drug use requires an on-going treatment process that includes behavioral therapies. The addicted person must learn to modify their attitudes and behaviors related to their drug use.

Types of behavioral therapies that can help the treatment process continue to the point of recovery include:

• Contingency management. This method uses positive reinforcement for compliance with treatment plans and desired behaviors. Measures include providing rewards or privileges for continuing abstinence, for continuing counseling sessions and participating, or taking medications as prescribed.
• Cognitive-behavioral therapy. This type of counseling attempts to help recovering addicts recognize, avoid, and cope with situations that are triggers for their drug use.
• Motivational enhancement therapy. With this therapy approach, the goal of strategies is to capitalize on the addict's readiness to change attitudes and behavior by entering treatment.
• Family therapy. This form is especially effective with young people. Family therapy helps people with drug problems and their families. It helps to address the influences on the addict that perpetuate the drug use patterns while improving overall family functioning.
• Twelve-step facilitation (TSF). This individual-based therapy usually follows a 12 week schedule of weekly sessions. Patients prepare to engage in a 12-step program of mutual support, along the model of Alcoholics Anonymous. These programs aren't medical treatments but offer social and complementary support to other treatment forms.

Outpatient and Aftercare Services

Most behavioral therapy methods and some medication schedules are available on an outpatient basis.

There are also residential programs where recovering addicts can obtain housing while participating in treatment services. These types of facilities are often known as "half-way houses." It provides a place for recovering addicts to live among their peers where they can give and get the support they need to continue recovery.

The Road to Recovery

Recovery begins with understanding that your addiction is a disease that responds to treatment. It isn't curable but it is manageable, and you can recover. You can get your life under control.

The first step is finding the help you need. Your road to recovery begins with Addiction Helpline America. Finding the rehab facility, and the help you're looking for, is a simple click away.

Take that first step to get on your own road to recovery.