Opioids and their subset of opiates are some of the most historically abused group of drugs. As a drug that produces euphoric effects, an altered state of consciousness, pain relief, or other mind-body effects—with religious experiences. Indeed, the precursors of opiate addiction probably trace back to early civilizations, long before anyone wondered whether opioids are addictive.
Dealing with substance and opioid addiction in today’s society, however, is complex: It’s fraught with a great many unknowns as to which method, medication, or treatment is best to overcome it, ongoing research into vaccines to prevent it in the first place, decoding the brain to pinpoint the origin of the disease, and so much more. Opioid addiction is front and center in this ongoing quest to understand how to heal brains that have been hijacked by drugs.
What is an Addiction to Opioids?
How does taking an opiate substance like heroin become a full-blown opioid addiction? What is the mechanism of action by which this process happens?
Mechanism of Action
When someone takes an opiate, prescription drug or heroin, the drug produces feelings of euphoria and pleasure, which in turn positively reinforce the brain’s reward pathway. Whether injected, smoked, or snorted, the drug makes its way to the brain, and there, enzymes convert heroin to morphine. Then, morphine binds to opioid receptors in certain brain parts (nucleus accumbens, thalamus, cerebral cortex, brain stem, ventral tegmental area, and spinal cord), associated with the reward and pain pathways. Binding to the pain pathway produces a numbing of pain, or analgesia.
In the nucleus accumbens, there are three neuron types involved in the action of the morphine, releasing dopamine in one, a neurotransmitter called gamma-aminobutyric acid (GABA), and a third that is the site of dopamine receptors. To feel the euphoria, the heroin user uses the drug again, essentially teaching the brain through reinforcement that heroin use produces the high.
Over time, and with repeated use of the drug, the effects of the drug diminish. It doesn’t produce the same high it initially did. This is tolerance, which occurs at the level of cellular targets. To overcome tolerance, the person takes more of the drug, more often.
Continuing use of the drug results in dependence, which is when the neurons, having adapted to the morphine, only function in a normal manner when the drug is present. When heroin is discontinued, withdrawal sets in, involving physiological reactions. Some of these are mild, while others may be life-threatening. To avoid these unpleasant withdrawal symptoms, the user again takes the drug.
The transition from dependence to addiction can be swift. It occurs when users continue drug use despite negative consequences and regardless of physical and/or psychological problems likely worsened by drug use. They have frequent, intense cravings and spend inordinate amounts of time thinking about, searching for, and obtaining the drug, taking it, and recovering from the effects. By the time addiction sets in, professional drug addiction treatment is necessary to overcome substance addiction.
When Does Use Become Addiction?
Perhaps the easiest way for opiate use to become an addiction is through overuse, abuse, and long-term use of prescription opioid medications, such as those prescribed for pain management, including fentanyl, oxycodone, hydrocodone, and extended-release morphine. According to the Centers for Disease Control and Prevention (CDC), fentanyl is a man-made synthetic opiate that is 50 times stronger than heroin, an illegal drug of abuse, and 100 times more potent than morphine. Carfentanil, which is a structural analog of fentanyl, is reported to be about 10,000 times more potent than morphine.
When access to a prescription drug is cut off, many people who’ve become dependent on the drug or are engaging in drug abuse turn to heroin and other street opiates. Snorting, crushing, smoking, and injecting heroin is an almost-certain path to addiction.
When the effects of drug use wear off, intense drug cravings and compulsive urges to use begin, leading to a frantic search for the drug with the intent to use again. This repetitive cycle is characteristic of the disease of addiction, comprised of psychological and physical dependence, increasing physical and psychological effects, and many negative consequences as a result of the addiction.
Can you become addicted to opioids? Here is the sober truth: For some individuals, opioid use quickly morphs into opiate abuse and then into opioid addiction. In some cases, and depending on the substance and amount used, addiction may occur after one-time use.
Tolerance occurs when the body becomes used to a substance or medication and the effectiveness of the drug diminishes. The result of substance tolerance, especially to highly addictive opioid drugs, is a risk for addiction, dependence, and overdose. Another risk with substance tolerance is developing a cross-tolerance, which is becoming tolerant of other drugs in the same class.
Due to dramatically reduced tolerance, an overdose is a major danger of relapse to opiates after substance addiction treatment. The newly clean individual cannot return to taking the same dosage, amount, or frequency as before, may miss-gauge what is tolerable, and suffer an overdose. In fact, death may occur without emergency medical intervention.
What are Substance Addicts Chasing?
After a person develops substance addiction to opiates, the urge to experience the euphoria of first-time use once again is almost overwhelming. Smoking heroin or other opiates and inhaling the fumes, a process called “chasing the dragon,” results in a closed-circle behavior of drug-taking, drug searching, coming down, desperately pursuing the drug, and taking it again. The chase is also futile, with increasingly less likelihood of producing the desired high despite massive drug intake, yet requiring a continuing and escalating drug supply to stave off withdrawal symptoms.
As for what else substance addicts chase, regardless of how long they’ve been addicted, it may be a combination of a complete release, relief from pain, numbness, the abdication of responsibility, and escape from the stresses of life, ravages of mental illness, loss of a loved one, trauma, guilt, shame, or other powerful emotions.
Long-term Health Effects of Substance Addiction
Taking opioids over a long period of time has lasting negative health effects. Repeated opiate use decreases endorphin production and leads to lasting brain changes. In addition, substance addiction can result in:
- Increased pain sensitivity
- Weakened immune system
- Increased cardiovascular risk (heart attack, atrial fibrillation, heart infection)
- Decreased libido
- Dysfunction of the hormonal system
- Decreased testosterone
- Increased risk of overdose
What Happens When It’s Stopped Cold Turkey?
The human body reacts badly and immediately to stopping opiates suddenly, a process known as going “cold turkey.” The withdrawal symptoms, which range from mild to severe, even life-threatening, are not easy to go through and should never be attempted alone.
Furthermore, opiate withdrawal is more difficult and severe for most people than withdrawal from any other substances. The process of withdrawal from opioid addiction and the many opiates available today, given how many opioids are addictive, is best accomplished through professional drug addiction rehab. Medically monitored detoxification (detox) is the only safe way to effectively manage the withdrawal process from opioids.
Even for those who’ve gone through detox before and think they can handle stopping cold turkey solo, it’s a dangerous and unnecessary risk to take. Substance tolerance can make judging reactions unpredictable, potentially leading to a complete inability to make appropriate decisions. Rather than being able to ride out the withdrawal symptoms that arise during opiate withdrawal, returning to using may seem like the only way to go. That defeats the purpose of stopping the addictive opioids in the first place. Not only that, but the sense of failure and loss of confidence that this failed detox prompts may delay any further desire to overcome substance addiction.
Specific symptoms that can occur when someone stops opioids cold turkey include:
- Profuse sweating
- Muscle aches
Potentially life-threatening reactions during opiate withdrawal include:
- Brain dysfunction
- Cardiac arrest
- Opiate overdose
Why Substance Addiction Needs Treatment
Opiate addiction goes beyond being physically dependent on an opioid substance. Although going through detox is the first medical requirement to overcome substance addiction, including opioid addiction, detox alone will not eliminate the risk of relapse. In fact, without further treatment, substance addiction will again take over, leaving the now-clean individual highly prone to powerful triggers. These include psychological and social factors such as:
- Encountering environmental cues, such as the familiar sights and sounds of particular neighborhoods
- Participation in social networks where friends and members who are substance users post and encourage opiate use
- Hanging out with those who are current users of opioids
- Experiencing stress, particularly life stress that suddenly occurs
Dealing with cravings and overwhelming urges to use requires counseling, behavioral therapies, and perhaps medication-assisted treatment (MAT). It’s not enough to simply remove the substance that caused opioid abuse. That’s like putting a band-aid on a cut artery, which is both ineffective and bound to fail. Consistency, having a prepared relapse plan that consists of effective coping strategies, developing and maintaining a strong support network, and practicing healthier lifestyle behaviors are all integral to overcoming substance addiction. Indeed, they are at the core of treatment and central to why substance addiction needs treatment.