Who Is Most At Risk For Opioid Abuse?
The 5 populations most at risk for use, overuse and opioid abuse are:
• “Weekend warriors”
Opioid prescriptions for teens doubled in the period from 1994 to 2017. Teens use them for recreation as well as pain relief. They share medicines with adult and each other. They also abuse cough and cold remedies.
Women tend to suffer more health conditions that lead to chronic pain, such as arthritis (especially rheumatoid arthritis) and fibromyalgia. They are often prescribed higher doses, for longer periods of time which can lead to opioid abuse. Women might also be chemically more susceptible to dependence and addiction compared with men.
Seniors also suffer from pain-producing health conditions, such as arthritis, osteoporosis, and the general aches and pains of aging. Chronic pain ups the risk. Polypharmacy also increases their risk of addiction.
Those who get injured, or injured often in high-impact sports will often be prescribed opioids. Those will chronic pain will be most at risk of opioid abuse and addiction.
“Weekend warriors” sit most of the week, then try to cram all their physical activity and athletics into one day or weekend. This will often result in injury and acute pain. Regular workouts and good warmups and cooldowns can help avoid injuries.
Being proactive about medicines
Patients should not mindlessly take medicines. They should always ask why the doctor is prescribing a medicine, how long they need to take it, and if there are any safer alternatives, such as if they are worried about highly addictive opioids.
Look up side effects, both in the handouts you get about the medicine, and online. Check with a drug database such as drugs.com.
Check drug interactions at https://www.webmd.com/interaction-checker/default.htm
And check vitamins, supplements and so on at https://www.webmd.com/vitamins-supplements/ to see what various remedies are used for, and any potential risks and interactions.
Taking a drug holiday
Another option is to try a “drug holiday,” in which a person stops taking some or all their drugs to see how they feel without them. https://www.prevention.com/health/drug-holiday-facts
This is a good way to deal with polypharmacy and potential overprescribing.
As a result of the opioid abuse crisis, there is a trend amongst doctors of “de-prescribing.” Which medications are most prone to be addictive? Let’s look at a few of them next.
Opioid Medications That Are Highly Addictive
Opioids offer fast and inexpensive pain relief from moderate to severe pain which is either sudden (acute) or long-term (chronic). Around 80% of people will experience back pain in their lives, for example, and seek help from their doctor.
Other common reasons for pain relief include migraines, arthritis and injury, and pre- and post-surgery pain.
There are a number of different drugs that can ease pain. Opioids, also known as narcotic pain relievers, include morphine and codeine as well as synthetic versions of these drugs. All opioids carry a high risk of addiction unless they are taken as prescribed. Even they, they can be chemically addictive, and mentally addictive because they produce a “high” that is very enjoyable.
Most addictive painkillers
The most addictive painkillers, in alphabetical order, include:
Codeine is used for pain relief and cough suppression. Because it is considered to be a “mild” opioid, it is more readily available than other forms, but therefore more open to abuse and eventual addiction. Resistance to the drug builds up, leading to higher and higher doses.
Demerol is used to treat moderate to severe pain. Its active ingredient meperidine acts on certain centers in the brain to offer pain relief similar to that of morphine. It is often used to help put people to sleep before surgery and after childbirth. It is available as an oral solution, injectable solution, and tablets.
The active ingredient in Dilaudid hydromorphone, a strong opioid pain reliever used for severe pain. On a ladder of pain relief, with aspirin and Tylenol being the first options, Dilaudid is close to the top of the ladder, along with Demerol. It is most often used in a hospital setting but can be prescribed for severely ill people being cared for at home.
Fentanyl is actually more potent than morphine, the pain reliever derived from the opium poppy, and the source of heroin as well.
Fentanyl is used to treat patients with severe acute or chronic pain, or post-surgical pain. It is also used amongst patients who have become physically tolerant of other opioids and no longer feel their benefits. It can be used as pills, patches or an injection. It is highly addictive and experiencing an uptick in abuse due to its potent effects.
It is on the middle to upper portions of the pain relief ladder.
Hydrocodone is used to treat moderate-to-severe pain resulting from a chronic condition, injury, or surgical procedure. It is available as an oral syrup and oral tablet. It is at the upper end of the pain relief ladder.
It works by altering the brain’s perception of pain. In cough medicines, it decreases activity in the part of the brain that triggers coughing.
Lorcet is a combination of hydrocodone and acetaminophen, so it is stronger than Percocet and Percodan and used to treat moderate to severe pain. It is in the middle to upper range of the pain relief ladder. A similar drug would be Zydone.
OxyContin is used as a standard treatment for those with chronic pain. It is taken in pill form and is highly addictive due to its active ingredient oxycodone. Oxycontin is a time-released pill designed to last 12 hours. However, this can lead to physical and mental dependence due to a person feeling they need it in order to avoid pain, and therefore gradually becoming addicted to it. It is in the middle to upper range of the pain relief ladder.
Percocet and Percodan
These are similar to oxycontin in that their main ingredient is oxycodone, but in these drugs, the oxycodone is combined with acetaminophen (Tylenol). These are in the middle of the pain relief ladder, with the 2 active ingredients helping relieve not just pain but inflammation and swelling. It is in the middle to upper range of the pain relief ladder.
This drug is the same formulation as Lorcet. When combined with ibuprofen, it is known as Vicoprofen. It helps relieve pain and inflammation.
The effects of opioid abuse
The effect varies in different people, and in relation to the amount and length of time the opioids are taken.
The beneficial short-term effects of opioids include:
• Pain relief
• A feeling of euphoria (happiness, well-being)
• Sedation, such as before or during surgery
The effects can last for 4 to 6 hours, and longer if the medicine given is a time-release formulation.
Opioids cause the brain to release dopamine, which creates a pleasurable effect and starts to cause them to seek the “reward” of taking the drug again, which can lead to further opioid abuse and addiction.
Opioids alter the synapses of the brain, that is, the part of the nerve cells in the brain that send signals from one cell to the next. In some people, this “re-wiring” of the brain can happen in as little as 3 days, and lead to addiction.
The synaptic effects will result in a number of symptoms, including:
• Chronic sleepiness
• Trouble breathing
• Stomach ache
• An altered perception of reality, such as paranoia
• Redness in the face
One obvious sign of opioid abuse is narrowed pupils, due to the irises in the eyes relaxing.
Over time, symptoms will become more severe. Long-term effects include:
• Nausea and vomiting
• Abdominal bloating
• Mood changes
• Mental confusion
• Dizziness or faintness
• Difficulty urinating
• Dry mouth and throat
• Liver damage, especially if the drug being used is one that combines the opioid with acetaminophen
• Brain damage due to a lack of oxygen, due to the fact that breathing is slowed by this class of drugs
In cases of overdose, death can occur through the person ceasing to breathe, or their airway being blocked by vomit or another obstruction.
Drug dependence versus addiction
It is important to be clear about the difference between drug dependence and drug addiction. In the case of chronic pain, for example, the body will develop physical dependence on the drug, that is, the body will become accustomed to the medication and need it to function. It might develop a tolerance to the medication and need more and more.
The term addiction is used when the medication appears to be interfering with the individual’s life in some way. Their use of the drug is compulsive and out of control, with it being used regardless of any potential harm.
How do you know you are addicted? Let’s look next at some of the most common signs and symptoms.