Opioids have long been used to treat acute pain or cancer-related pain, and occasionally opioids are prescribed for certain chronic, non-cancer pain as well. They can also be highly addictive substances, and the threat of abuse can become a real concern for patients who need these drugs to manage pain.
Below, Dr. John Franklin, Director of the Addiction Psychiatry Division at Northwestern Memorial Hospital, discusses the benefits and dangers of prescription opioids.
What are some of the most common opioids?
JOHN FRANKLIN, MD: They fall into two major categories. There are opioid drugs that are derived from naturally occurring substances, drugs like morphine and codeine, and then there are synthetic types of opioid medications, like Oxycontin, Vicodin, and Norco.
How do these medications work? What effect do they have on the body?
We have naturally occurring pleasure centers in the brain that contain what we call "opioid receptors." Receptors are like catcher mitts that receive the chemicals and turn on the pleasure system. That's why these drugs have such a powerful effect. The pleasure of the medication depends on what kind of medicine it is, how it's administered, and how it's used. Medicines that get to the brain quicker, that have a steeper rise in the blood level, are more pleasurable or euphorigenic. So if the drug is given thorough the vein (IV), you actually get a more powerful high than if you take it by mouth, because it gets to the brain quicker.
What are some of the other effects that opioids have on the body?
The pleasurable, dreamy, oceanic feeling is the rush that addicts are seeking. When people are first are exposed to opioids, they actually may find it unpleasurable. They may be nauseous, and may vomit. For some people it takes a while to build up tolerance. You can tell, sometimes, by just looking at somebody if they're using opioids. They may have small pupils, their breathing may be decreased. They'll complain of constipation. These are all effects that opioids have on the body.
Those are the immediate effects. What are some of the long-term effects of opioids?
Well, a primary long-term effect is addiction. Addiction could be defined as a form of loss of control of the use. The primary feature is an obsession with the use of a drug and a craving to continually use it.
So for those people who take prescription opioids to manage pain, and then become addicted to the drugs, how do they acquire them?
You can actually get almost anything on the street, both nonprescription and prescription drugs. The abuse of medicines like Vicodin and Oxycontin are actually epidemics right now, and these are manufactured drugs by drug companies. They may be prescribed legitimately for people who have pain conditions, but people divert them to recreational or street use. People can be getting them from their doctors. They may be having several doctors prescribing the same medication, or they buy it off the street. It's very expensive, but it's possible.
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If you think someone you know has an opioid dependence, what can you do for that person?
I think you shouldn't take it on yourself to try to cure a family member. It's important to recognize the problem, and not "enable" the person, or provide them with the means to continue their addiction. I think it's important to tell them how much the addiction is affecting you personally. Sometimes they will be more affected by how the addiction is hurting you, and less affected by hearing anything about themselves. And then I think it's essential to get the person the right professional treatment.
And what is that? A support group? A doctor?
It depends on what kind of opioid addiction it is. Some addictions can be handled pretty easily with detoxification, support and education. Some treatments require long, residential programs. It depends.
How can people in pain, who take prescribed opioids, avoid addiction?
I don't want to scare people. There are millions of people who take prescribed pain medicines for various reasons, and most people don't become addicted. When you're in acute pain, and you don't have a history of addiction to other substances, it is unlikely that you become addicted to drugs used for your treatment. If you know that you have had addiction to other substances, you need to tell your physician, and you need to stop using the medicine as soon as the pain is gone.
Anyone who is on one of these narcotics for three or four weeks will become dependent. They may not show the psychological manifestations of addiction, but they will be physiologically dependent. So the message is, if you need the pain medicine, take it, but stop taking it when you're no longer feeling pain.
