What is Opioid?  - 

Opioids are medicines that are prescribed to relieve pain. The pain is reduced by controlling the intensity of the pain signals that are sent to the brain. Some of the examples of Opioid includes Morphine (e.g., Kadian, Avinza), Hydrocodone (e.g., Vicodin), Oxycodone (e.g., OxyContin, Percocet), Codeine and other related drugs. Hydrocodone products are commonly prescribed for very painful conditions (dental and injury- related pain).

What is Opioid abuse?

When a person takes more than the prescribed dose or when the Opioid is taken without a prescription it is called Opioid abuse. Due to this the patterns in the brain may start to change. If the Opioid is taken with alcohol or dissolved into solutions and used via injection, it can lead to Opioid abuse. Snorting (crushing pills into powder and inhaling through the nose) is also another form of Opioid abuse. When Opioids are taken in higher dosage, the user may experience pleasurable side effects (euphoria, relaxation, less body pain). Acute Opioid Withdrawal Syndrome (body reacting poorly due to absence of Opioids) leads to escalating patterns of abuse. Some include increase in doses, rise in the frequency of usage and even changes in the method of ingestion. Development of addiction is due to both prescription Opioid dependence and Opioid abuse. Opioid dependence is the physiological state of the user where the drug is necessary to prevent withdrawal symptoms. Craving and compulsive use are psychological problems that need not necessarily be indicated to show addiction. Using of the drug for a long time can also result in Opioid abuse.

Signs and symptoms of an Opioid overdose

Some of the signs of Opioid overdose are slurred speech and even confusion while trying to communicate. Stumbling while walking or feeling dizzy after consumption of Opioid is also considered as a symptom. When the user is having trouble staying awake and even has difficulty in speaking after using the drug, or wakes up from sleep regularly is also a sign that the user is having an Opioid overdose. If the user is lacking stiffness or rigidity of body he might be suffering an overdose of Opioid. Other signs are slowing of heartbeat, shallow breathing. Some signs that can be easily noticed include blue lips or fingernails and pale skin.

Diagnosis of Opioid overdose

Pulse oximetry can measure Opioid overdose. The percentage of oxygen in blood can be measured using a pulse oximetry. This can be done by using a small instrument usually placed on your finger. An Arterial Blood Gas (ABG) test can be used to measure oxygen content of blood but in addition it also measures the Carbon-Dioxide content. The ABG test also measures the pH and the amount of bicarbonate of the blood sample. Levels of Opioids and other substances can be checked by blood and urine tests.

Who is at risk for Opioid addiction?

For the experience of psychoactive effects, people usually start prescription Opioids. Other begin with a medical need that evolves into addiction. In the development of this addiction risk plays a major role.  Whatever the reason maybe the result is dangerous.  Opioid abuse is spread across a wide and diverse demographic of individuals. This epidemic can be characterized by the user's age, gender, race, socioeconomic status, geographical area, and any medical or clinical history.

• AGE:  Youngsters of age 18 – 25 are said to be the most vulnerable to Opioid abuse but it is seen higher for people between 45 and 54 years of age. Middle- aged users are said to have to highest risk of Opioid abuse in the group of individuals. The younger group of people also are at risk. For the people above the age of 50 increase in use of Opioids have been seen at an increase of 60% between 2003 and 2010.
• GENDER: Abuse- prone medications are more often prescribed to women than to men, yet the use of Opioid medications non medically are at higher rate for men. Despite the above fact the rates of requirement of emergency for complications relating to many Opioid abuses are equal for both men and women. The rates for Opioid overdose is increasing in women rapidly from 1999 to 2013. A high 400% increase has been recorded for women undergoing Opioid overdose. We should understand the gender approach of Opioid addiction to help the assessment of treatment utilization and success.
• RACE: Opioid overdose problem have been found to be highest among white people. It is then followed by the other races like the black patients, Asians, Hispanic patients even if their social or economical status is not taken into consideration. Coming to a more detailed review, it is seen that American Indians/ Alaska Natives and non-Hispanic whites have three times higher rates of Opioid overdose. Blacks and Hispanic whites coming next in the line. White physicians prefer to prescribe the Opioid medications to patients of their race than other races. So we need to understand and educate the effect of race on prescribing practices.
• SOCIOECONOMIC STATUS: There are different types of people in the society. There are people who earn a lot and also earn very little. This income level is related to prescription Opioid problems. Low socioeconomic status neighborhood people who suffer pain are prescribed with less Opioid medication when compared with people in the high socioeconomic status neighborhoods. It is found that people with higher education have three times less chance of receiving an Opioid medication. The socioeconomic status can affect Opioid abuse in a number of ways. They can shape the habit of usage of drugs, availability of health resources can be influenced and also affect the adherence to medication.

Why Prescription Opioid abuse?

Some of the major reasons users abuse Opioid are Self-medication, Recreational Highs and Dependence or Addiction. In order to understand how to deal with this problem we need to view the drug in the social sphere, i.e., how this drug is viewed by the society.

Social Acceptability: Young abusers are more prone to start abusing the drug due to social acceptability. Since it is a prescription medicine, youngsters are constantly exposed to Opioid prescription users in their house taking the medication. This suggests some kind of social acceptability. Also social media gives scope for such youngsters to get more idea of Opioid abuse, and meet more like-minded people.

Availability

Opioid is a readily available drug. Sometimes Opioid abusers fake symptoms to get a prescription for abusing the drug. And some even go to multiple doctors at the same time to obtain more prescriptions. However, the most common way of obtaining the drug is through a friend or relative who is an Opioid prescription user. Sometimes the friend or relative offer it to them, or the abusers sometimes steal them.

Mental Health Correlation

Depression and Anxiety are two mental health issues that Opioid users have been associated with very often. It happens in two ways, either the underlying mental health problem causes the substance abuse problem or the prolonged abuse of the drug causes depression or anxiety. It is possible that when suffering from acute anxiety or depression, it may not be possible for drug abusers to understand the risk of prescription abuse. There are chances for the drugs to develop into a mental health issue. It is always better for the treating doctor to know about the patient's medical history for better prescription.

Effects of Opioid Abuse

Opioid abuse can cause severe respiratory problems and can even lead to death. When consumption is not properly managed it usually leads to addiction. Longer term use of many Opioids will lead to something called physical dependence. It is different from addiction. Physical dependence means that the Opioid is necessary for the body to adapt or function in a proper manner. Some symptoms like restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with raising of hairs on the body (goose bumps) and sometimes movement of legs without control can be experienced if the drug usage is stopped or reduced. Research has proven that Opioid drug abuse can have some serious side effects on the brain. It is found that the oxygen that reaches the brain can be affected due to depressed respiration, the condition being called hypoxia. This condition can have some effects including coma and permanent brain damage. Some say that the brain's white matter deteriorates with consumption of heroin.

Other substance use disorder

Many times the Opioid abuse is seen to increase with some consumption of some foreign matter like poly- substance. Generally rates are higher with alcohol abuse. One chemical which is highly dangerous is Benzodiazepines. The mix of this in Opioid abuse is seen to be the most, followed by alcohol and marijuana. Reports show that teenager's most popular addiction is alcohol and then usually marijuana.  Benzodiazepines and alcohol are depressant agents and have very bad harm on the user. It can slow the heart rate and also the breathing of the user. Education about this co-use is very important especially to the adolescent population.

Opioid Withdrawal Treatment

Self help for treatment of Opioid abuse can be hard and very dangerous. Treatment of Opioid abuse requires medicines, support and even counseling. Withdrawal treatment can occur at home using medicines and a very strong help in terms of support. This is a very difficult method and must be done slowly. A facility can also be used for detoxification. The user is not usually taken to a hospital unless the symptoms are severe. Some of the medicines include Methadone (used to relieve symptoms and also helps in detox), Buprenorphine ( Opiates withdrawal and also shortens the length of detox), Clonidine ( helps to reduce muscle aches, sweating, runny nose, cramping, agitation, anxiety). There are some other medicines that can treat vomiting, diarrhea and can also help with sleeping problems. Naltrexone is taken usually as a injection or even in pill form, and helps to prevent relapse. After detox most of the people require long term treatment.

Treatment for drug abuse happens in two ways: inpatient and outpatient treatment. Inpatient treatment requires the patient to stay at the rehab facility for the length of the treatment. This warrants intensive treatment for the problem. Outpatient treatment requires the patient to check in with the doctors every day of the week, except for weekends and holidays. In the inpatient treatment chances of relapsing are very low due to lack of access to drugs within the facility. Further the distractions of day-to-day life is lesser in the facility. 24/7 care is provided in the inpatient treatment, which could help long term users. Before choosing the kind of treatment, the history of the user needs to be taken into account. For a long term user who has suffered from multiple instances of relapses, it is best to choose the inpatient treatment. For a short term user less vulnerable to serious withdrawal symptoms can opt for the outpatient treatment.

Alternative pain management Approaches

Since managing pain is very much needed and Opioid medication comes with higher risks, people need alternate way to cope up painful conditions.

• ACUPUNCTURE: Acupuncture is the process of inserting thin needles into some points on the body to reduce pain. This has proved to have an effect on headaches and back pain.
• STRESS REDUCTION: Stress can be the result of some pain conditions. Some methods like yoga, meditation, music therapy, massage and biofeedback can help calm the mind and body to manage pain.
• EXERCISE THERAPY: Doing physical exercises or activities regularly helps people with pain issues.
• PSYCHOLOGICAL THERAPY: Most of the patients who undergo pain are in depression. Having a cognitive-behavioral therapy proves to help minimize pain by thoughts and emotions.
• HYPNOSIS: Hypnosis is a state of concentration. Focus is the key in hypnosis. They are said to help pain relating to cancer, headaches, arthritis, post- surgery.
• MEDICAL MARIJUANA: Marijuana has been found to help reduce pain for patients but it may have some side effects relating to health. So it is advisable to consult before using Marijuana as an alternate pain management option.

A combination of multiple approaches is the best way for a non- Opioid pain management. approach.