Opioids are powerful painkillers that are available with a prescription. They work to change the way the brain perceives pain as well as its emotional response to it.
While opioids offer several therapeutic benefits in pain management, they also pose many serious risks. Many people abuse opioid medications for the euphoric feeling they produce. This abuse can lead to subsequent addiction, overdose and even death.
Due to their potentially deadly risks, opioid medications are considered controlled substances and classified as Schedule II drugs. This classification means that opioids have a high potential of abuse and can potentially lead to severe psychological and physical dependence. They are also considered to be dangerous.
Opioids have a high likelihood for abuse. According to the American Academy of Neurology (AAN), nearly half of all people who take opioid medications for at least three months are still using opioids five years later.
And the Centers for Disease Control and Prevention estimates that more than 115 people die every day in the United States from overdose by prescription painkillers.
The Cause of the Epidemic
Opioids have been around for many years. Morphine and codeine, for example, date back to the 1800s.
More recently, healthcare providers became lax about prescribing the powerful pain medications based on assurances by the pharmaceutical companies that the drugs were not addictive. An uptick in prescriptions led to widespread misuse. By the time it became clear that the medications were highly addictive, it had become a public health crisis.
In 2015, more than 33,000 Americans died from opioid overdoses, including prescription opioids, heroin and illegally manufactured fentanyl. Another 2 million Americans suffered from substance use disorders related to prescription opioids. The National Institute of Health (NIH) reported that opioid overdoses increased by 30 percent from July 2016 to September 2017 in 52 areas throughout 45 states.
Opioids, Opiates and Narcotics: What’s the Difference?
The terms opioids, opiates and narcotics are often used interchangeably which can make learning about them confusing.
Narcotics include opioids and sometimes other controlled drugs.
An opiate is a natural alkaloid or organic compound derived directly from the resin of the opium poppy. Morphine is an example of an opiate. All opiates are opioids.
Opioids include natural opiates and synthetic opioids like fentanyl and heroin. As mentioned, the terms are often used interchangeably, but it’s important to remember that all opiates are opioids, but not all opioids are opiates. If it’s synthetic in any way, it’s not an opiate.
Morphine is one of the most well-known opiates because it is a highly potent pain reliever.
The opiate is generally used for severe pain management, but it is also used illicitly or recreationally. Improper use of morphine can lead to physical dependence and addiction.
Brand names of morphine include:
- Arymo ER
- MS Contin
Morphine Uses and How it Works
Morphine is used to treat moderate to severe pain.
It comes as a liquid or in extended-release tablets or capsules intended to relieve chronic severe pain that cannot be controlled by other, less powerful pain medications.
Morphine works by changing the way the body perceives pain. It bonds to certain opioid receptors in the brain and spinal cord preventing them from receiving pain signals. These receptors reside on the surfaces of nerve cells.
The chemical bond formed between the receptors and morphine also activates the receptors which results in various side effects – some of which can be dangerous.
According to the World Health Organization, the naturally occurring opiate codeine is the most commonly used opioid in the world.
While codeine is generally safe when taken properly, misuse can lead to physical and mental dependence that can progress to addiction.
Brand names of codeine and combination medications that include codeine:
- Tuzistra X
- Maxiphen CD
- Antituss AC
- Pentazine VC
- Robitussin AC
Codeine Uses & How It Works
Codeine is used to treat mild to moderate pain and is used in combination with other medicines to reduce coughing and diarrhea. It is available in combination with acetaminophens such as in Tylenol, aspirin, carisoprodol and promethazine.
Codeine targets specific areas of the brain depending on what it is used for. It can change the way the brain and nervous system respond to pain or it can decrease activity in the part of the brain that causes coughing. It begins working after being broken down by the liver into morphine.
It is intended to relieve symptoms, but it is not used to treat the cause of the symptoms or to speed up recovery from any illness.
Codeine can be taken by mouth in tablet, capsule or liquid form. It is not recommended for use in children under 12 years of age.
The way codeine works — and the possible side effects of the drug — may vary when it is combined with other substances.
Hydrocodone is a semisynthetic opioid and derivative of codeine. It is also known as a narcotic.
The drug is primarily prescribed and distributed in the United States. The International Narcotics Control Board previously reported that 99 percent of worldwide consumption of hydrocodone occurred in the United States.
Brand names of hydrocodone and combination medications that include hydrocodone include:
- Zohydro ER
Hydrocodone is used to treat severe pain. It is intended for patients who need 24-hour pain relief that cannot be treated with other medications or procedures.
It is also taken in liquid form as an antitussive or cough suppressant.
According to the U.S. Drug Enforcement Administration (DEA), hydrocodone is equally as effective or more effective, depending on the patient, than codeine for cough suppression and nearly as effective as morphine for pain relief.
Once taken, hydrocodone is converted into metabolites in the liver. These metabolites are then used by the body to interfere with pain signals received by the brain.
Like all opioids, hydrocodone can be habit-forming. Its rate of abuse and risk for physical and psychological dependence is similar to morphine but less than oxycodone.
Oxycodone is a powerful opioid. Research shows that it is approximately 1.5 times more powerful than hydrocodone.
Due to its high level of potency, it is also available in combination with other drugs, such as naloxone, to help deter abuse.
Brand names of drugs containing oxycodone include:
Oxycodone is used to treat moderate to severe pain. It is only available to be taken orally as a tablet, capsule or solution (liquid) in the United States. Other countries, such as the United Kingdom, have approved oxycodone to be used intravenously.
Oxycodone comes in immediate- and extended-release tablets and capsules. Extended-release versions are used for continuous pain relief.
Oxycodone use can be short-term or long-term. It may be used to improve a patient’s quality of life when taken long-term. In a scientific review, controlled-release oxycodone was found to provide comparable pain relief for cancer pain to instant-release morphine, and with fewer side effects.
Similar to morphine, codeine and hydrocodone, oxycodone works by stimulating opioid receptors in the brain. This stimulation serves to increase a person’s pain tolerance rather than eliminate the actual pain.
Fentanyl is a powerful synthetic opioid and anesthetic. According to the Centers for Disease Control and Prevention, fentanyl is 50 to 100 times more potent than morphine. The CDC confirmed that fentanyl is more powerful than heroin and affects the body much quicker than heroin as well.
Brand names of fentanyl include:
Fentanyl is used to treat sudden severe pain primarily in cancer patients who are already taking and can tolerate narcotic pain medications or opiates. It can also be used to manage pain after surgery.
The opioid medication is given by injection, a patch on the skin, a nasal spray or by mouth.
Fentanyl is also commonly misused. Heroin and fentanyl look identical, which makes it easy to confuse the two. Law enforcement warns that dealers use this to their advantage by including fentanyl to heroin products to increase its potency. Unfortunately, this can be a deadly combination.
In fact, in 2017, the sharpest increase in overdose deaths according to the National Institute on Drug Abuse (NIDA), was related to fentanyl. Fentanyl products accounted for nearly 30,000 overdose deaths out of more than 72,000 drug overdose deaths overall.
Opioid medications contain a warning that the drugs may be habit-forming.
Taking more of the drug than what is prescribed, taking it more often than recommended or taking it in other unintended ways can increase a person’s risk of dependency, addiction or overdose and death.
Common side effects of opioid medications include headache, stomach pain and difficulty urinating. Side effects that may be a sign of serious or life-threatening reactions include:
- Fast heartbeat
- Shivering or tremors
- Severe muscle stiffness or twitching
- Irregular menstruation
- Decreased sexual desire or inability to achieve an erection in men
- Loss of coordination
- Nausea or vomiting
- Difficulty breathing or swallowing
- Rash, itching or hives
- Changes in vision
It is possible to overdose on opioid medications. An opioid overdose is a medical emergency.
A rescue medication called naloxone may be used to reverse the life-threatening effects of an opioid overdose.
Symptoms of an overdose might include trouble breathing, excessive drowsiness, fainting, dizziness, slow heartbeat, clammy skin, loss of muscle tone or loss of consciousness.
Suddenly stopping the use of opioid medications can result in withdrawal symptoms. Individuals should consult with their doctor about gradually decreasing their dose rather than suddenly stopping the drug.
Opioid withdrawal symptoms might include:
- Trouble sleeping
- Back, muscle and joint pain
- Nausea and vomiting
- Loss of appetite
- Diarrhea and/or stomach cramps
- Fast heartbeat
- Increased breathing rate
Opioid addiction affects people throughout the United States every day. If you or a loved one live with an opioid addiction, contact The Recovery Village to talk to a representative about treatment and detox programs. Through treatment and recovery, people living with addiction can obtain the healthy future they deserve.