What behaviors should I watch for that might suggest one of my loved ones is addicted to opioids?
What can I do to help prevent a family member, or myself, from becoming addicted to opioids?
How should I dispose of unused opioid prescriptions?
What is addiction?
How do opioids work?
How does opioid addiction affect a person’s brain?
How quickly can someone become addicted to opioids?
What is withdrawal from opioids?
If a pregnant woman uses opioids, can the baby be affected?
Are there effective treatments for opioid use disorder?
Q: What behaviors should I watch for that might suggest one of my loved ones is addicted to opioids?
A: Signs of addiction might include:
- Disinterest in normal activities.
- Lack of energy in completing routine tasks.
- Declining performance at school or work.
- Altered behavior.
- Drastic changes in relationships.
- Sudden financial management issues.
- Decreased appetite and weight loss.
- Bloodshot eyes and rundown appearance.
- Increased defensiveness.
- Unusual smells on breath or clothing.
Q: What can I do to help prevent a family member, or myself, from becoming addicted to opioids?
A: Addiction prevention begins on two fronts:
- Make it a priority to communicate well with your medical professionals, including your doctor or nurse and your pharmacist. Get clear information on why you’re being prescribed opioids instead of another treatment, what danger signs to heed, and how to correctly follow the prescribed dosage. Following those instructions is vital. Also get clear information on how to dispose of any leftover medication once it expires or is no longer needed for the prescribed purpose. Keeping unused or expired medications around the house is a risk, to you and others.
- Establish open communication with family members. If the prescription is yours, explain how you will be taking it; if it is a family member’s, talk to the relative about the dosage instructions. Help each other strictly follow the directions. Also: Don’t share any prescription medication; track usage of prescription pills to safeguard against pilfering; lock up addictive prescriptions when possible; and store them in a high location, out of the reach of children (to prevent accidental poisoning).
Q: How should I dispose of unused opioid prescriptions?
A: Disposing of unused medication at a drug drop-box location is the best method to keep opioids from building up in your home. Many medications cannot be safely thrown in the trash or flushed down a toilet. Another good option is to participate in a take-back day, such as those organized by the Ohio Attorney General’s Office or the Drug Enforcement Administration. On these days, law enforcement agencies host collection bins.
The medicine collected on take-back days usually goes to a specially approved location for two-stage incineration. In the first stage, temperatures range from 1,600 to 1,800 degrees; in the second, they reach 2,000 degrees or higher. The intense heat breaks the chemical bonds in the medications, turning them into harmless compounds with biproducts consisting mainly of carbon dioxide and water.
Q: What is addiction?
A: Addiction it is the most severe form of substance use disorder. In the case of drugs, substance use disorder generally involves a cycle of craving the drug; a euphoria when the drug is taken that creates positive reinforcement; and anxiety, stress and dysphoria when not high. The degree of those experiences can range from mild to severe — i.e., addiction.
Another way to think about it: Substance use disorder is compulsive behavior, or repetitive actions that are excessive and often done to relieve anxiety (think of cigarette smokers as an example).
The official word on what qualifies as substance use disorder comes from a manual used to diagnose mental disorders, the Diagnostic and Statistical Manual of Mental Disorders. To count as having a drug-based substance use disorder, a person must experience at least two of the following symptoms (with only two representing a mild case). Addiction would be diagnosed at six or more of these symptoms:
- Hazardous use: Taking the drug has resulted in risks to a person’s health, including blackouts or overdoses and driving under the influence.
- Social/interpersonal problems: Use of the drug has caused relationship issues or conflicts.
- Neglected major roles: The person has failed to meet work, school or home-based responsibilities, such as being a good parent.
- Withdrawal*: The person experiences negative effects when stopping use of the drug.
- Tolerance*: Over time, the person has to use more of the drug to achieve a high.
- Larger amounts of the drug used or longer period of drug use: The person has increased the amount of the drug used or the time spent using the drug.
- Repeated attempts to control use or quit: The person has been unsuccessful in decreasing use of or quitting the drug.
- Frequent use of the drug
- Physical or psychological problems related to use: The person has experienced health problems (such as collapsed veins and liver damage) or psychological problems (such as anxiety or depression)
- Activities given up to use: A person might avoid activities with family or friends or skip work or school.
- Cravings
* Exception: Withdrawal and tolerance alone do not qualify as substance use disorder. Another of the symptoms also must be present. That is because medications such as anti-hypertension agents and blood pressure drugs also could cause withdrawal and tolerance.
Q: How do opioids work?
A: When a person takes an opioid – such as oxycodone, morphine or heroin — it travels through the blood stream and attaches to receptors in the brain, spinal cord and other areas of the body.
When no drugs are involved, the receptors usually work with opiate-like substances that your body naturally produces, such as — when you exercise or ride roller coasters — endorphins. Endorphins regulate dopamine
Endorphins work by limiting an inhibitor (gaba) that itself would usually limit how much dopamine is downstream in the brain. Less inhibitor equals more dopamine., which acts as a signal in your brain to activate a natural reward system and then record that good feeling. That turns into positive reinforcement — basically, encouragement for you to repeat the dopamine-producing behavior.
When an opioid connects with the brain receptor, it triggers the release of dopamine, the good feeling and the recording of it. When a person is in pain, taking an opioid dampens the ability to feel the pain. But when there is no pain involved, opioids simply stimulate euphoria and build cravings — repetitive drug-seeking behavior.
Q: How does opioid addiction affect a person’s brain?
A: Chronic use of opioids alters how the reward system in a person’s brain functions: The shape of the dopamine reward pathway changes. The receptor that opioids and endorphins attach to changes. Enzymes that regulate dopamine change. As a result of these changes and others, more and more of the drug must be taken to achieve a pleasurable effect.
Chronic opioid use also causes enzymes and receptors that regulate the brain’s memory pathways to change, which is why people who have stopped taking drugs can so easily relapse. Seeing an object, or a person, they associate with drug use can stimulate those pathways and trigger a relapse. (Thus, staying drug-free takes a lot of work and support from family and friends.)
These brain changes are part of why substance use disorder is classified as a disease; it’s actually somewhat similar to how changes in the body caused by a bad diet and lack of exercise can result in diabetes. However, there is hope. Recent studies have demonstrated that after a person stops taking a drug, at least some of the affected parts of the brain slowly begin to return to a more balanced state.
Q: How quickly can someone become addicted to opioids?
A: Patients taking opioids for pain may not even realize that they’ve slipped past the line between controlled use and substance use disorder. And the duration of opioid use isn’t necessarily the most important factor in determining whether patients cross the line.
Studies have suggested that age, socioeconomic factors and genetics all contribute to a person’s potential for developing addiction. For example, some people naturally lack a brain enzyme that breaks down dopamine, meaning that they naturally have higher levels. Their body responds by learning to downplay dopamine. Such a person would need a higher opioid dosage to combat pain, putting him or her at higher risk for addiction.
Why does one person end up addicted to opioids while another person has no trouble taking them — and stopping their use? Doctors and scientists don’t know all of the answers yet, and that’s part of why SCOPE and the Ohio Attorney General’s Office are embarking on a genetic study.
Q: What is withdrawal from opioids?
A: When a person is taking an opioid, the drug induces a suppression of the body’s “fight or flight” system. The person becomes tired and calm, blood pressure and body temperature drop, their pupils become tiny, and muscles relax. However, when the drug is abruptly stopped, the “fight or flight” system reactivates. Body temperature and blood pressure increase. Muscles twitch, and the person can become irritable and anxious.
Q: If a pregnant woman uses opioids, can the baby be affected?
A: The baby can, indeed, be born with a dependence to opioids. Unfortunately, after birth, the baby can go into acute withdrawal, a condition known as neonatal abstinence syndrome (NAS). For more information on how drug use during pregnancy can affect babies, see this explanation from the National Institute of on Drug Abuse.
Q: Are there effective treatments for opioid use disorder?
A: There are effective treatment measures to counter the effects of chronic drug use. Treatment is individualized; ideally, it combines behavioral therapy and Medication Assisted Treatment (MAT). Medications can be used to help with detoxification and to decrease cravings and the symptoms of withdrawal (which can include muscle aches, restlessness and anxiety). Behavioral therapy can help change the brain memory pathways that reinforce the addiction. It can also provide motivation to stay clean or stay in treatment, and help alleviate stress or social issues that often drive people back to opioids.
In devising recommendations for how Ohio can prevent more people from falling victim to opioid use disorder, SCOPE extensively reviewed a host of scientific findings. The committee came up with a three-pronged plan of attack after evaluating studies that examined risk factors associated with opioid addiction and reasons why people abstain.
Here is the full report.
The following list highlights just some of the recommendations:
Target Area No. 1: Professional Education
Goal: Increase awareness of opioid use disorder issues among professionals in Ohio – especially doctors, nurses, pharmacists and other medical professionals – via medical school and continuing education
Recommendations include:
- Survey the academic medical programs across the state to find out what they teach about substance use disorder, pain management and treatment options. Use the results to establish core competencies powered by the latest national standards and scientific advances.
- Establish continuing education requirements to keep those in all state-regulated licensure programs up-to-date on substance use disorder.
- Create a human resources pilot program to share strategies for recognizing opioid use disorder.
Target Area No. 2: Opioid Storage and Disposal
Goal: Decrease the number of opioids available for potential abuse by better targeting who gets opioids, the quantity given in prescriptions and safe disposal practices
Recommendations include:
- Support research that helps determine the typical need for opioids after surgery and specific injuries.
- Promote safe storage and disposal of opioids to the public, medical professionals and care organizations, while pushing for additional safe disposal options.
Target Area No. 3: Behavioral Economic Approach
Goal: Create behavior-intervention programs for teens and children that go beyond what classic programs such as DARE do to discourage and prevent opioid abuse
Recommendations include:
- Develop a knowledge-based intervention program that includes behavioral “nudges” employing social norms, loss aversion and hyperbolic discounting (ideas explained in the report).
- Develop a cognitive-behavioral training program that teaches kids to identify their personality type and associated coping strategies, the short- and long-term effects of those strategies, and how to challenge personality-specific cognitive distortions in real life.
Read the full report for further details.