Opioid addiction: What you need to know

The issue of opioid addiction in the United States has been brought front and center by various groups, including the White House and the Centers for Disease Control and Prevention, in an attempt to make strides in fighting this growing problem.

As part of national efforts in fighting this issue, Baylor College of Medicine is one of more than 60 medical schools across the country that committed to requiring students to take some form of prescriber education, in line with the newly-released CDC Guideline for Prescribing Opioids for Chronic Pain, in order to graduate.

Dr. Thomas Kosten, Jay H. Waggoner Endowed Chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor, helps address some common questions about opioids and addiction in the Q&A below.

Q: What are opioids?
A: Morphine, oxycodone, codeine, buprenorphine, fentanyl, methadone and a large number of other pain medicines that produce their effects by inhibiting various brain cells called neurons through binding to the mu opiate receptor. These addictive drugs produce dependence and a withdrawal syndrome if used daily for several months.

Q: What are opioids generally used for?
A: Pain relief.

Dr. Thomas Kosten, Jay H. Waggoner Endowed Chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine.

Dr. Thomas Kosten, Jay H. Waggoner Endowed Chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine.

Q: Why are they addictive?
A: They change the brain to make the person want and need more and more of the opiate to get the effects of pain relief and to avoid withdrawal symptoms, which can last from seven to 14 days and resemble a bad case of influenza. These symptoms are not life threatening, but are very uncomfortable.

Q: How big of a problem is opioid addiction in the United States and around the world?
A: In the United States, we estimate 4.5 million opiate addicts currently, and 19 million persons are prescribed opiates every year. Worldwide, the problem is at least 10 times larger and primarily involves morphine rather than the other synthetic opiates such as Vicodin that are abused extensively in the United States.

Q: What is being done to address this problem?
A: Many new treatments such as buprenorphine are being applied. Buprenorphine has lower abuse potential (due to fewer euphoric effects) and a favorable safety profile compared to other opioids. Naltrexone blocks opiates for long periods of up to a month with injections, but is much less used, and methadone maintenance has been available for more than 50 years. To address overdoses and deaths, naloxone is being used by not only medical personnel but also average citizens.

Q: What are other medication options that should be considered?
A: Many non-opiate and non-addictive medications are available for pain, including non-steroidal anti-inflammatories, tramadol, physical nerve blocks, local anesthesia and a wide range of non-medication interventions.

Q: What are some general signs of opioid addiction?
A:  Addiction can show no signs other than the acute effects of opiates in sedation, pain relief and overdose, which is associated with inability to breath. For withdrawal, all the signs of severe influenza can be experienced– nausea, vomiting, diarrhea, tremors, fever and chills, blood pressure and pulse rate increases and muscle aches.

Q: What should you do if you suspect someone you know is addicted to opioids?
A: Help them seek treatment with a qualified professional.

For more information on opioid addiction, visit the National Institute on Drug Abuse website.

-By Dipali Pathak

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