The Real Truth about Opioids – Part 1

Dear World

We have all heard opioids are becoming more popular and how addictive these drugs are.

We seem to lack the awareness and education that is needed to understand what these Drugs do and how they work.

Simple Living Global continue with their Real Truth series…

On the topic of Opioids – here is Part 1

Opioids

Opioid is a substance used to treat moderate to severe pain 

Opioids are like opiates such as morphine and codeine but are not made from opium.

Opioids bind to opioid receptors in the central nervous system

Opioids used to be called narcotics (1)

Opium | Heroin | Methadone | Buprenorphine | Codeine

Opium

The latex of the opium poppy has been used as a painkiller for thousands of years
It contains the opiates codeine and morphine and from these we have also derived the synthetic opioids heroin, methadone and buprenorphine.

They target the endorphin receptors in the brain, creating a dreamy sense of well-being.

In medicine, they play an essential role in controlling physical pain and are given to people with traumatic injuries or after surgery and to enable peaceful deaths for people with terminal illness.

They also dull psychological pain and seem to be particularly attractive to people who have suffered psychological trauma such as child abuse or living through War.

Carrying out normal activities under the influence of opiates is pretty difficult and even mild opiates such as codeine are not recommended for people driving or operating heavy machinery.

Some are highly addictive and repeated use leads to physical dependence and powerful withdrawal symptoms. The main harms they do to the body are causing nausea, vomiting and chronic constipation and of course the risk of death from stopping breathing in overdose.
Professor David Nutt – 2012 (2)

Despite all our other staggering pharmaceutical progress, our reliance on the opium poppy plant has not changed much.

Poppies make two of the world’s most widely used painkillers – codeine and morphine and the cough suppressant noscapine. (3)

So the first thing we need to know is that painkillers have been used for thousands of years from the poppy plant.

This tells us we had pain and found a way to deal with it.
In other words, we wanted relief and we found a Solution.

Then we created synthetic versions and their job is to get to the part of the brain that is going to make us forget the pain and replace it with a “dreamy sense of well-being”.

What exactly is a “dreamy sense of well-being” and is it something we want more of?

Yes – we would all agree that painkillers are needed in medicine and are essential for pain control during surgery, traumatic injuries and end of life care where there is a terminal illness.

However how effective are they really when we use them to “dull psychological pain” as mentioned above?

Are we simply toning the pain down so it is not acute but nevertheless it is still there and not going to go away?

Are opioids the answer to our psychological pain or is there Another Way?

The fact that we cannot carry out normal activities, as it is difficult under the influence of opiates; even mild opiates affect our driving ability.
This in itself speaks volumes

Have we read this clearly – even a mild dose affects our brain chemistry

Add to this – one very important factor
These drugs are highly addictive, which means we get used to taking them and over time, we need more of it to keep the pain away because we are not at any point asking why we have the pain in the first place.

What we want is the pain to go away but it cannot simply disappear forever because we are not asking any Questions as to how we got the pain.

What we are asking for is a Solution to take away the pain so we can feel the relief of having no pain.

Is this making sense?

NEXT

How serious is this –

  • These drugs are highly addictive
  • Repeated use leads to physical dependence
  • There are powerful withdrawal symptoms

So are we being Fooled into thinking there are drugs we can take to make the pain go away but the truth is the pain is just buried inside us and never goes away?

Could it be possible that while we try to deal with the pain by killing it – hence the name pain-killers, we are not really killing it but just pushing it further and deeper into our bodies?

Could it be possible that we get hooked and become dependent on these painkillers as we need them to keep the pain away, as we simply do not want to deal with whatever is coming up for us?

Could it be possible that we want the ‘quick fix’ method and so painkillers seem to do the job and we forget the long-term consequences?

Could it be as simple as tracing our steps back to see how we are living and moving that may have got us to this pain?

NEXT

Why are we using a drug to suppress our cough?

Is the body communicating something to us with our cough?

Are we open to the possibility that the cough is needed to bring us back to balance as we had gone off track?

Are other illnesses and dis-ease in the body simply a correction – a healing to bring us back, as we deviated from our natural path?

Are these Questions too far-fetched, way off and out there, OR will the scholars of the future study this book and other writings from this website and know there were those who were presenting the Truth back in the early 21st century?

Endorphins: Natural Pain and Stress Fighters

Endorphins are among the brain chemicals known as neurotransmitters, which function to transmit electrical signals within the nervous system.

They are found in the pituitary gland, in other parts of the brain or distributed throughout the nervous system.

Stress and pain are the two most common factors leading to the release of endorphins.

Endorphins interact with opiate receptors in the brain to reduce our perception of pain and act similarly to drugs such as morphine and codeine.

In contrast to the opiate drugs, activation of the opiate receptors by the body’s endorphins does not lead to addiction or dependence.

In addition to decreased feelings of pain, secretion of endorphins leads to feelings of euphoria, modulation of appetite, release of sex hormones and enhancement of the immune response.

With high endorphin levels, we feel less pain and fewer negative effects of stress. Endorphins have been suggested as modulators of the so-called “runner’s high” that athletes achieve with prolonged exercise.

While the role of endorphins and other compounds as potential triggers of this euphoric response has been debated extensively by doctors and scientists, it is at least known that the body does produce endorphins in response to prolonged, continuous exercise. (4)

Opioids bind to and activate opioid receptors on cells located in the brain, spinal cord and other organs in the body, especially those involved in feelings of pain and pleasure. (5)

Hello

Can we learn something here about these brain chemicals called Endorphins?

They are already naturally present inside us and they have a job when we get Stress or pain – they release and we feel better.

Note –

THE BODY’S ENDORPHINS DO NOT LEAD TO ADDICTION OR DEPENDENCE.

Hello and Hello

Do we get it?

When our body gives us the natural painkiller by releasing endorphins – it is responding to Stress or pain and we get to feel better.

As it is a natural response coming from our body, which always knows what is best for us, we do not get addicted or dependent on it.

However, if we are not dealing with our Stress then we are going to want the same drug or something similar to take that pain away.

Bingo – we have created opioids but we did not sign up for the side effects and the fact that it is addictive and many who take the drug become dependent.

When we over exercise – we feel less pain and fewer negative effects of stress but does the pain actually go away or is it suppressed?

Does this mean we need to achieve prolonged exercise to get the same buzz and is this what the so called “runner’s high” means?

Is this why so many get addicted to exercise because it releases these endorphins that give us the intense Happiness and excitement and keeps the pain away?

In other words, we have found a form of self-medication that works because we get a euphoric response.

But does it really work or are we just simply fooling ourselves?

Does it last or do we need more of the same to feel what we want?

Are we ever considering if our need to push our body through over exercise is because deep down we are not feeling great at all?

In other words, we have buried stuff that is causing us pain and misery and this fitness business gives us some natural medicine, where we get to feel an intense happy state.

Whilst we seek this pleasure we are willing to take any drug to give us the repeated experience we desire.

In other words, we want to feel certain feelings and we want other ugly feelings to just go away and we will do what it takes for that to happen.

Opiates or Opioids

Some people carefully distinguish between these two groups of narcotic drugs.
Others use the two terms interchangeably or prefer one over the other.

As our language is changing – many including journalists and politicians refer to all of these drugs as “opioids.”

Both opiates and opioids are used medically and are prescribed for –

  • Pain relief
  • Anaesthesia
  • Cough suppression
  • Diarrhea suppression
  • Treatment of opiate/opioid use disorder

Both opiates and opioids are used illicitly by those with a substance use disorder.

The main difference is in how opiates and opioids are made. (6)

This is serious stuff

We are using these drugs to relieve us from the pain we feel

We are also using them to knock us out by anaesthesia. That means artificially induce before surgery.

This confirms how potent and powerful these drugs are as they can totally take us out where we are not awake or coherent.

Next – they are used to suppress a cough or diarrhea

Again, we get assistance to stop something that disturbs our body and we leave it at that.

Do we ask how on earth did we get to the point where we have diarrhea?

Are we putting it down to a bad eating moment or is there something more that our body might be communicating?

Are we prepared to dig a bit deeper and ask some more Questions or is life just too overwhelming to get all forensic with the detail stuff?

Now the next is a real big HELLO

We use opiates and opioids as treatment of opiate or opioid use disorder

How can we use the same drugs to deal with the disorder that it created in the first place?

WHY IS THIS NOT MAKING ANY SENSE

Let us not forget there is a huge demand and so we have an illicit market supplying those who have a drug addiction, also called substance use disorder.

It is a disease that affects the brain and the behaviour leads to an inability to control the use of drugs or medication, be it legal or illegal.

Important NoteAlcohol, Marijuana and Nicotine are considered drugs

Simple Living Global has delivered the Real Truth about all the above drugs to bring more awareness by way of education and understanding.

Opiates

Opiates are chemical compounds that are extracted or refined from natural plant matter (poppy sap and fibers).

Examples of Opiates:

  • Opium
  • Morphine
  • Codeine
  • Heroin (6)

Heroin is one of the world’s most dangerous opioids (5)

People using heroin are at risk of contracting blood infections by sharing needles.
Injecting heroin can also damage the veins and arteries and may cause gangrene. (7)

Hello

For those who inject heroin – are they in a state to even consider the consequences of needle sharing or blood infections?

Do they need the pain to go away or are they going to think about the damage to arteries and veins and possibly getting gangrene?

Are our heroin users not interested in anything else, other than the next hit?

Opioids   

Opioids are chemical compounds that generally are not derived from natural plant matter.

Most opioids are “made in the lab” or “synthesized”

A few opioid molecules – hydrocodone, hydromorphone, oxycodone may be partially synthesized from chemical components of opium, other popularly-used opioid molecules are designed and manufactured in laboratories.

Note – nearly all opioids are synthesized

 500 different opioid molecules created by the pharmaceutical industry

Some are widely used medically and some are not.

Examples of well-known opioids used medically in the U.S.

  • Dextromethorphan
  • Dextropropoxyphene
  • Loperamide
  • Hydrocodone
  • Oxycodone
  • Oxymorphone
  • Meperidine
  • Methadone
  • Fentanyl/Fentanil
  • Carfentanyl/Carfentanil

Opiates and Opioids 

Both groups of drugs are narcotics

The word “narcotic” means sleep-inducing or numbness-inducing
From the Greek narkoun – “to be numb”

If a person is dependent on (addicted to) one particular opiate or opioid drug – whether it is medically prescribed or illicitly obtained, switching to a different opiate or opioid can maintain their dependency or addiction.

Substituting one opiate or opioid for another can prevent withdrawal symptoms

Many of us are aware of people with real, actual pain who became dependent on prescription pain-relieving narcotic drugs, then switched to illicit opioids or the opiate heroin when the medically-supplied narcotics run out. (6)

As with all Drugs we have opioids – made in the laboratories

Most of us have heard news stories with the rise in use of Fentanyl addiction

These groups of drugs are narcotics and does the origin of this word tell us something more…?

To be numb – numbness inducing

We all know we are human beings that feel and sense everything

If we want to ‘numb’ those feelings, we can with our drug of choice

But do we want to know WHY we want to be numb in the first place?

Is something bugging us, bothering us and we don’t deal with it?

Can this habit of not dealing with what we feel, lead to pain and misery?
Can that pain lead to even more pain just because we keep ignoring it?
Can that ignoring over time, bury the pain deeper inside our bodies?

Does this lead us to seek something to relieve us as the pain is too much?

Is this where we find the drug of choice and what we did not consider was all drugs have side-effects and all drugs alter our natural state?

Could it be possible that in this altered state of being, we make choices that are not going to support our body to deal with whatever pain we have coming up?

Could it be possible that in this altered state of being we feel our head being fed with what we need to do next and it is in total dis-regard for our precious body?

Could it be possible that in this altered state of being we are not taking responsibility for everyday life tasks as we are simply not aware?

In other words, we have switched off and made a choice to be “numb” as these drugs give us that.

Could it be possible that we have gone way too deep with the drug of choice and we want more drugs to keep that pain at bay as things are not working?

Dear World

How serious is it when so called sensible, normal people take prescription pain-relieving narcotic drugs and never thought they would end up getting supplies from the illicit market as they have become addicted and they cannot go down the medical supply route anymore?

Types of Opioids

Opioids also bind to the opioid receptors in the gastrointestinal tract.

There are illegal opioids like heroin as well as legal opioids that are prescribed for pain relief.

There is a dangerous trend where those who have become addicted to prescription opioids begin using heroin because it is cheaper.

3 Main Types of Opioids

Natural
Alkaloids, nitrogen-containing base chemical compounds that occur in plants like opium poppy.

Natural opioids include morphine, codeine and thebaine.

Semi-Synthetic
Created in labs from natural opiates, semi-synthetic opioids include:

Hydromorphone | hydrocodone | oxycodone
Heroin is also semi-synthetic and is made from morphine

Fully Synthetic Man Made
Completely man made including:

Fentanyl | pethidine | levorphanol | methadone | tramadol | dextropropoxyphene (8)

The Body’s ‘Natural Opioids’ Affect Brain Cells Much Differently than Morphine

Scientists shows that brain cells or neurons react differently to opioid substances created inside the body; the endorphins responsible for the “natural high” that can be produced by exercise, for example – compared to morphine or heroin or to purely synthetic opioid drugs, such as fentanyl.

Researchers’ findings may help to explain why the use of synthetic opioids can lead to addiction.

Since both synthetic opioids and the natural “endogenous” opioids produced by the brain, bind to and activate opiate receptors on the surface of nerve cells, scientists have long assumed that both types of molecules target the same cellular systems.

However, new research reveals that these molecules also activate opioid receptors inside cells and that the locations of these activated intracellular receptors differ between natural and synthetic opioids.

‘There has been no evidence so far that opioid drugs do anything other than what natural opioids do, so it has been hard to reconcile the experiences that drug users describe – that opioid drugs are more intensely pleasurable than any naturally rewarding experience that they have ever had.
The possibility that these opioid drugs cause effects that natural opioids cannot is very intriguing because it seems to parallel this extremely rewarding effect that users describe.”
Mark von Zastrow – MD, PhD | Professor of Psychiatry | UCSF (9)

“Drugs, which we generally thought of as mimics of endogenous opioids, actually produce different effects by activating receptors in a place that natural molecules cannot access.”
Miriam Stoeber PhD (9)   

Morphine and synthetic opioids crossed cell membranes without binding receptors or entering endosomes. They travelled directly to the Golgi apparatus, reaching their target much more quickly than endogenous opioids got into endosomes, taking only 20 seconds compared to over a minute. This time difference could be important in the development of addiction, the researchers said, because typically the faster a drug takes effect, the higher its addictive potential.

New Study led by UC San Francisco

Do we always want the fast road to get away from pain, even if the faster drug has a higher addictive potential?

Are our lifestyle choices generally about getting things faster and faster and not giving any time or space for any real change?

Prescription Opioids

Pain relievers with an origin similar to that of Heroin

Opioids can cause euphoria and are sometimes used non-medically, leading to overdose deaths.

Common Commercial Names

Codeine
various brand names

Street Names

Captain Cody | Cody | Lean | Schoolboy | Sizzurp | Pancakes and Syrup | Loads
Purple Drank with glutethimide: Doors & Fours

Common Forms

Tablet
Capsule
Liquid

Common Ways Taken

Injected
Ingested (often mixed with soda and flavourings)

Fentanyl

Street Names

Apache | China Girl | China White | Dance Fever | Friend | Goodfella | Jackpot | Murder 8 | Tango and Cash | TNT (10) | Great Bear | He-Man | Poison (11)

Common Forms

Lozenge
Sublingual Tablet
Film
Buccal Tablet (10)

Sublingual and Buccal Medication Administration

Definition
Sublingual and buccal medication administration are two different ways of giving medication by mouth.

Sublingual administration involves placing a drug under our tongue to dissolve and absorb into our blood through the tissue there. Buccal administration involves placing a drug between our gums and cheek, where it also dissolves and is absorbed into our blood.

When Sublingual and Buccal Drugs are Given

 Doctors may prescribe sublingual or buccal drugs under any of the following circumstances:

  • the drug needs to get into our system quickly
  • patient has trouble swallowing medication
  • the medication does not absorb very well in the stomach
  • the effects of the drug would be decreased by digestion

The cheek and area under the tongue have many capillaries or tiny blood vessels. There drugs can be absorbed directly into the bloodstream without going through our digestive system. (12)

Common Ways Taken

Injected
Smoked
Snorted

Hydrocodone or Dihydrocodeinone

Street Names

Vike | Watson-387

Common Forms

Capsule
Liquid
Tablet

Common Ways Taken

Ingested
Snorted
Injected

Hydromorphone

Street Names

D | Dillies | Footballs | Juice | Smack

Common Forms

Liquid
Suppository

Common Ways Taken

Injected
Rectally inserted

Meperidine

Street Names

Demmies | Pain Killer

Common Forms

Tablet
Liquid

Common Ways Taken

Ingested
Snorted
Injected

Methadone

Street Names

Amidone
Fizzies with MDMA: Chocolate Chip Cookies

Common Forms

Tablet

Common Ways Taken

Ingested
Injected (10)

Methadone also comes in the form of a dispersible tablet (tablet that can be dissolved in liquid), concentrate solution and solution. These forms can be taken by mouth.

It also comes as an injection that is only given by a doctor

Methadone oral tablet is used to treat pain

It is also used for detoxification or maintenance treatment of an opioid drug addiction. (13)

Morphine
Various brand names

Street Names

M | Miss Emma | Monkey | White Stuff

Common Forms

Tablet
Liquid
Capsule
Suppository

Common Ways Taken

Ingested
Injected
Smoked

Oxycodone 

Street Names

O.C. | Oxycet | Oxycotton | Oxy | Hillbilly Heroin | Percs

Common Forms

Capsule
Liquid
Tablet

Common Ways Taken 

Ingested
Snorted
Injected

Oxymorphone

Street Names

Biscuits | Blue Heaven | Blues | Mrs O | O Bomb | Octagons | Stop Signs

Common Forms

Tablet

Common Ways Taken

Ingested
Snorted
Injected

Facing Addiction in America
Surgeon General Report on Alcohol, Drugs and Health | 2016

Prescription Opioids
Uses & Possible Health Effects

Short-Term Symptoms of Use

Pain relief | drowsiness | nausea | constipation | altered judgment and decision making | sedation | euphoria | confusion | clammy skin | muscle weakness | slowed breathing | lowered heart and blood pressure | coma | heart failure | death

For oxycodone specially:
Pain relief | sedation | respiratory depression | constipation | papillary constriction | cough suppression

For fentanyl specifically:
Fentanyl is about 100 times more potent than morphine as an analgesic and results in frequent overdoses (10)

Did we know prescription opioids are used as a short term high?

Are we aware those feelings of euphoria are temporary?

Who on earth comes us with these names on the street?

Are Pancakes and Syrup giving us that euphoric feeling and can we get the same buzz when we ingest or inject Codeine?

Is Fentanyl like winning the Jackpot for us as it gives us the intense excitement?

Why is Fentanyl called Murder 8 – is it trying to kill the soul of the human being?

Is Fentanyl associated with TNT as you can get an express delivery service?

Did we know that Fentanyl is 100 times stronger than morphine?

The fact that Fentanyl drug is so powerful – is this where the names Great Bear and He-Man come from?

Are we aware it is pure poison for our body hence the street name Poison?

Is there a link with the story of the film Goodfella and this potent drug?

What part of Methadone becomes Chocolate Chip Cookies to the user?

What is the feeling that we relate to with these cookies and the methadone ecstasy (MDMA) combo?

What are Analgesics

Analgesics are medicines that are used to relieve pain

They are also known as painkillers or pain relievers. Technically, the term analgesic refers to a medication that provides relief from pain without putting you to sleep or making you lose consciousness.

Many different types of medicines have pain-relieving properties and experts tend to group together those medicines that work in a similar way. Two of the most common groups of pain killers are non-steroidal anti-inflammatory drugs (NSAIDs) and Opioids (narcotics) and there are many more.

Sometimes experts will group analgesics together based on their potency or how strong they are.

World Health Organization Analgesic Ladder – step wise approach to pain relief recommends non-opioid analgesics such as acetaminophen and NSAIDs for mild-to-moderate pain; weak opioids such as codeine, dihydrocodeine or tramadol, for moderate-to-severe pain; and stronger opioids such as oxycodone and morphine for severe pain. (14)

So let us look at this section on Analgesics and keep it simple

Technically this word is telling us these are a group of medicines that relieve our pain – kill it but we will not lose consciousness or fall asleep.

Note the key word here is technically

If we use the word Reality and read this whole tablet of Truth being presented – what can we learn?

Who are the experts grouping medicines together that work?

Can we get their support to unite and work together to find out WHY anyone has pain in the first place, instead of seeking more ways to keep the pain away?

What we do know is that our world now has an Opioid crisis and that means SOMETHING IS NOT RIGHT.

The World Health Organization has this ladder – a scale

Question – is it a ‘wise approach’ if we have a world where many are addicted to strong opioids like morphine for severe pain?

Would a truly wise approach be putting all our experts, researchers and scientists on the job to find out WHY we get pain?

In other words, what is the root cause – where did it start?

Would it be a wise movement if we made sure ALL research and funding was independent and that means for the people as it is about the people?

Long-Term Consequences of Use and Health Effects

Heart or respiratory problems

Abuse of opioid medications can lead to psychological dependence

Extended or chronic use of oxycodone containing acetaminophen (non-opioid analgesic) may cause severe liver damage.

Other Health-Related Issues

Pregnancy-related:
Miscarriage | low birth weight | neonatal abstinence syndrome 

Older adults:
Higher risk of accidental misuse or abuse because many older adults have multiple prescriptions, increasing the risk of drug-drug interactions and breakdown of drugs slows with age. Also, many older adults are treated with prescription medications for pain.

Risk of HIV | Hepatitis | Other infectious diseases from shared needles

In Combination with Alcohol

Dangerous slowing of heart rate and breathing leading to coma or death

Withdrawal Symptoms

Restlessness | anxiety | muscle and bone pain | insomnia | diarrhea | vomiting | cold flashes with goosebumps | muscle tremors

Medical Use

Used for pain relief
Methadone is also used to treat opioid use disorders

Treatment Options

Medications

Methadone
Buprenorphine
Naltrexone (oral and extended-release injectable)

Behavioral Therapies

Behavioral therapies that have helped treat addiction to heroin may be useful in treating prescription opioid addiction.

USA

Statistics as of 2015
Prevalence

Lifetime:            36 million persons aged 12 or older have misused pain relievers in their lifetime.

Past Year:         12.5 million persons aged 12 or older have misused pain relievers in the past year.

Average Age of Initiation

Prescription Opioids:  25.8 (10)

Common Prescription Opioids

  • Codeine
  • Fentanyl
  • Morphine
  • Oxycodone
  • Hydrocodone
  • Oxymorphone

Mis-use of Prescription Opioids   

  • Taking medicine in a way or dose other than prescribed
  • Taking someone else’s prescription medicine
  • Taking the medicine for the effect it causes to get high

When mis-using a prescription opioid, a person can –

  • Swallow medicine in its normal form
  • Crush pills
  • Open capsules
  • Dissolve the powder in water
  • Inject liquid into vein
  • Snort the powder (5)

If we just look at this section –

How are we mis-using prescription opioids and how serious is this?

Taking medicine that is for someone else – how can that be true?
Taking medicine that is different to what we are supposed to take
Taking medicine just to get the side effects – the buzz we need

We are willing to snort and inject it, as both of these will get into the body faster and quicker than just swallowing the normal way.

How serious is this?

Prescription Opioids – Side Effects on Brain and Body

Opioid misuse can cause slowed breathing, which can cause hypoxia – a condition that results when too little oxygen reaches the brain.

Hypoxia can have short and long-term psychological and neurological effects including coma, permanent brain damage or death.

Researchers are investigating the long-term effects of opioid addiction on the brain, including whether damage can be reversed.

Prescription Opioids Overdose

Opioid overdose occurs when a person uses enough of the drug to produce life-threatening symptoms or death.

When people overdose on an opioid medication, breathing often slows or stops

This can decrease the amount of oxygen that reaches the brain, which can result in coma, permanent brain damage or death. (5)

What is this section spelling out to us and do we get it ?

By mis-using opioids that are prescribed for us, it can affect our breathing because the brain has a lack of oxygen.

How serious is this?

ADD to that the ill effects of hypoxia and we have psychological and neurological effects.

While we wait for researchers to investigate long-term effects of opioid addiction on the brain and whether it can be reversed or not, can we re-read what this tablet of truth has presented thus far and start to ask some serious questions about our behaviour, which is leading some of us to mis-use prescribed drugs that are not designed for the human frame to assimilate long-term?

Treatment for Opioid Overdose

Naloxone is a medicine that can treat an opioid overdose when given right away

It works by rapidly binding to opioid receptors and blocking the effects of opioid drugs.

Available in the following forms:

  • Injectable needle solution
  • Hand-held auto-injector
  • Nasal spray (5)

How Intelligent are we really that we create a drug that can quickly block an overdose and yet we have not found a way to deal with why we have pain in the first place?

Imagine finding the root cause and nailing it, so that we do not end up with dependency, addiction and mis-use.

Could that be the very thing this world needs or are we going to continue demanding more Solutions to our ill ways of living that cause us pain?

Next – if we continue repeating this mis-using then we can end up with substance use disorder. Now it gets really serious…

Prescription Opioids Addiction

Repeated mis-use of prescription opioids can lead to substance use disorder (SUD), a medical illness which ranges from mild to severe and from temporary to chronic.

Addiction is the most severe form of a SUD

A substance use disorder develops when continued mis-use of the drug changes the brain and causes health problems and failure to meet responsibilities at home, work and school.

People addicted to an opioid medication who stop using the drug can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. These symptoms include severe cravings.

As the symptoms are extremely uncomfortable, many people find it very difficult to stop using opioids.

There are medicines being developed to help with the withdrawal process and the U.S. Food and Drug Administration (FDA) approved sale of a device that can help ease withdrawal symptoms; a small electrical nerve stimulator placed behind the person’s ear that can be used for up to five days during the acute withdrawal phase.

The FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms.

Buprenorphine and methadone work by binding to the same opioid receptors in the brain as the opioid medicines, reducing cravings and withdrawal symptoms.

Another medicine, naltrexone, blocks opioid receptors and prevents opioid drugs from having an effect. (5)

DSM-5

Opioid-Related Disorders

Opioid Use Disorder
Opioid Intoxication
Opioid Withdrawal
Other Opioid-Induced Disorders
Unspecified Opioid-Related Disorder

 

Opioid Use Disorder

Diagnostic Criteria

A. A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Opioids are often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.

3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.

4. Craving, or a strong desire or urge to use opioids.

5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school or home.

6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.

7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.

8. Recurrent opioid use in situations in which it is physically hazardous.

9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

10. Tolerance, as defined by either of the following:

       a. A need for markedly increased amounts of opioids to achieve intoxication or desired effect.

       b. A markedly diminished effect with continued use of the same amount of an opioid.

       Note:  This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.

11. Withdrawal, as manifested by either of the following:

       a. The characteristic opioid withdrawal syndrome (refer to Criteria A and B of the criteria set for opioid withdrawal)

       b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.

       Note:  This criterion is not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

Specify if:
In early remission:
After full criteria for opioid use disorder were previously met, none of the criteria for opioid use
disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use opioids,” may be met).

In sustained remission:
After full criteria for opioid use disorder were previously met, none of the criteria for opioid use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use opioids,” may be met).

Specify if:
On maintenance therapy:
This additional specifier is used if the individual is taking a prescribed agonist medication such as
Methadone or buprenorphine and none of the criteria for opioid use disorder have been met for
that class of medication (except tolerance to, or withdrawal from, the agonist). This category also
applies to those individuals being maintained on a partial agonist, an agonist/antagonist, or a full
antagonist such as oral naltrexone or depot naltrexone.

In a controlled environment:
This additional specifier is used if the individual is in an environment where access to opioids is restricted.

Specifiers 

The “on maintenance therapy” specifier applies as a further specifier of remission if the individual is both in remission and receiving maintenance therapy.

“In a controlled environment” applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sustained remission in a controlled environment).

Examples of these environments are closely supervised and substance-free jails, therapeutic communities, and locked hospital units.

Diagnostic Features

Opioid use disorder includes signs and symptoms that reflect compulsive, prolonged self-administration of opioid substances that are used for no legitimate medical purpose or, if another medical condition is present that requires opioid treatment, that are used in doses greatly in excess of the amount needed for that medical condition. (For example, an individual prescribed analgesic opioids for pain relief at adequate dosing will use significantly more than prescribed and not only because of persistent pain). Individuals with opioid use disorder tend to develop such regular patterns of compulsive drug use that daily activities are planned around obtaining and administering opioids.

Opioids are usually purchased on the illegal market but may also be obtained from physicians by falsifying or exaggerating general medical problems or by receiving simultaneous prescriptions from several physicians.

Health care professionals with opioid use disorder will often obtain opioids by writing prescriptions for themselves or by diverting opioids that have been prescribed for patients or from pharmacy supplies. Most individuals with opioid use disorder have significant levels of tolerance and will experience withdrawal on abrupt discontinuation of opioid substances.

Individuals with opioid use disorder often develop conditioned responses to drug-related stimuli (e.g., craving on seeing any heroin powder-like-substance) – a phenomenon that occurs with most drugs that cause intense psychological changes. These responses probably contribute to relapse, are difficult to extinguish, and typically persist long after detoxification is completed. 

Associated Features Supporting Diagnosis

Opioid use disorder can be associated with a history of drug-related crimes (e.g., possession or distribution of drugs, forgery, burglary, robbery, larceny, receiving stolen goods).

Among health care professionals and individuals who have ready access to controlled substances, there is often a different pattern of illegal activities involving problems with state licensing boards, professional staffs of hospitals, or other administrative agencies.

Martial difficulties (including divorce), unemployment and irregular employment are often associated with opioid use disorder at all socioeconomic levels.

Development and Course

Opioid use disorder can begin at any age, but problems associated with opioid use are most commonly first observed in the late teens or early 20s.

Once opioid use disorder develops, it usually continues over a period of many years, even though brief periods of abstinence are frequent. In treated populations, relapse following abstinence is common. Even though relapses do occur, and while some long-term mortality rates may be as high as 2% per year, about 20% – 30% of individuals with opioid use disorder achieve long-term abstinence. An exception concerns that of military service personnel who became dependent on opioids in Vietnam; over 90% of this population who had been dependent on opioids during deployment in Vietnam achieved abstinence after they returned, but they experienced increased rates of Alcohol or Amphetamine use disorder as well as increased suicidality.

Increasing age is associated with a decrease in prevalence as a result of early mortality and the remission of symptoms after age 40 years (i.e., “maturing out”). However, many individuals continue to have presentations that meet opioid use disorder criteria for decades.

Risk and Prognostic Factors

Genetic and physiological

The risk for opiate use disorder can be related to individual, family, peer and social environmental factors, but within these domains, genetic factors play a particularly important role both directly and indirectly. For instance, impulsivity and novelty seeking are individual temperaments that relate to the propensity to develop a substance use disorder but may themselves be genetically determined. Peer factors may relate to genetic predisposition in terms of how an individual selects his or her environment.

Diagnostic Markers

Routine urine toxicology test results are often positive for opioid drugs in individuals with opioid use disorder. Urine test results remain positive for most opioids (e.g., heroin, morphine, codeine, oxycodone, propoxyphene) for 12 – 36 hours after administration.

Fentanyl is not detected by standard urine tests but can be identified by more specialized procedures for several days.

Methadone, buprenorphine (or buprenorphine/naloxone combination), and LAAM (L-alpha-acetylmethadol) have to be specifically tested for and will not cause a positive result on routine tests for opiates. They can be detected for several days up to more than 1 week. Laboratory evidence of the presence of other substances (e.g., cocaine, marijuana, alcohol, amphetamines, benzodiazepines) is common. Screening test results for hepatitis A, B and C virus are positive in as many as 80% – 90% of injection opioid users, either for hepatitis antigen (signifying active infection) or for hepatitis antibody (signifying past infection). HIV is prevalent in injection opioid users as well. Mildly elevated liver function test results are common, either as a result of resolving hepatitis or from toxic injury to the liver due to contaminants that have been mixed with the injected opioid. Subtle changes in cortisol secretion patterns and body temperature regulation have been observed for up to 6 months following opioid detoxification.

Suicide Risk

Similar to the risk generally observed for all substance use disorders, opioid use disorder is associated with a heightened risk for suicide attempts and completed suicides.

Particularly notable are both accidental and deliberate opioid overdoses. Some suicide risk factors overlap with risk factors for an opioid use disorder. In addition, repeated opioid intoxication or withdrawal may be associated with severe depressions that, although temporary, can be intense enough to lead to suicide attempts and completed suicides.

Available data suggest that nonfatal accidental opioid overdose (which is common) and attempted suicide are distinct clinically significant problems that should not be mistaken for each other.

Functional Consequences of Opioid Use Disorder

Opioid use is associated with a lack of mucous membrane secretions, causing dry mouth and nose. Slowing of gastrointestinal activity and a decrease in gut motility can produce severe constipation. Visual acuity may be impaired as a result of pupillary constriction with acute administration. In individuals who inject opioids, sclerosed veins (“tracks”) and puncture marks on the lower portions of the upper extremities are common.

Veins sometimes become so severely sclerosed that peripheral edema develops and individuals switch to injecting in veins in legs, neck or groin.

When these veins become unusable, individuals often inject directly into their subcutaneous tissue (“skin-popping”), resulting in cellulitis, abscesses and circular appearing scars from healed skin lesions. Tetanus and Clostridium botulinum infections are relatively rare but extremely serious consequences of injecting opioids, especially with contaminated needles.

Infections may also occur in other organs and include bacterial endocarditis, hepatitis and HIV infection. Hepatitis C infections, for example, may occur in up to 90% of persons who inject opioids. In addition, the prevalence of HIV infection can be high among individuals who inject drugs, a large proportion of whom are individuals with opioid use disorder. HIV infection rates have been reported to be as high as 60% among heroin users with opioid use disorder in some areas of the United States or the Russian Federation.

However, the incidence may also be 10% or less in other areas, especially those where access to clean injection material and paraphernalia is facilitated.

Tuberculosis is a particularly serious problem among individuals who use drugs intravenously, especially those who are dependent on heroin; infection is usually asymptomatic and evident only by the presence of a positive tuberculin skin test. However, many cases of active tuberculosis have been found, especially among those who are infected with HIV. These individuals often have a newly acquired infection but also are likely to experience reactivation of a prior infection because of impaired immune function.

Individuals who sniff heroin or other opioids into the nose (“snorting”) often develop irritation of the nasal mucosa, sometimes accompanied by perforation of the nasal septum. Difficulties in sexual functioning are common. Males often experience erectile dysfunction during intoxication or chronic use. Females commonly have disturbances of reproductive function and irregular menses.

In relation to infections such as cellulitis, hepatitis, HIV infection, tuberculosis and endocarditis, opioid use disorder is associated with a mortality rate as high as 1.5% – 2% per year. Death most often results from overdose, accidents, injuries, AIDs or other general medical complications. Accidents and injuries due to violence that is associated with buying or selling drugs are common. In some areas violence accounts for more opioid-related deaths than overdose or HIV infection.

Physiological dependence on opioids may occur in about half of the infants born to females with opioid use disorder; this can produce a severe withdrawal syndrome requiring medical treatment. Although low birth weight is also seen in children of mothers with opioid use disorder, it is usually not marked and is generally not associated with serious adverse consequences.

Differential Diagnosis

Opioid-induced mental disorders
Opioid-induced disorders occur frequently in individuals with opioid use disorder.
Opioid-induced disorders may be characterized by symptoms (e.g., depressed mood) that resemble primary mental disorders (e.g., persistent depressive disorder (dysthymia) vs. opioid-induced depressive disorder, with depressive features, with onset during intoxication). Opioids are less likely to produce symptoms of mental disturbance than are most other drugs of abuse. Opioid intoxication and opioid withdrawal are distinguished from the other opioid-induced disorders (e.g., opioid-induced depressive disorder, with onset during intoxication) because the symptoms in these latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.

Other substance intoxication
Alcohol intoxication and sedative, hypnotic or anxiolytic intoxication can cause a clinical picture that resembles that for opioid intoxication. A diagnosis of alcohol or sedative, hypnotic or anxiolytic intoxication can usually be made based on the absence of pupillary constriction or the lack of a response to naloxone challenge. In some cases, intoxication may be due both to opioids and to alcohol or other sedatives. In these cases, the naloxone challenge will not reverse all of the sedative effects.

Other withdrawal disorders
The anxiety and restlessness associated with opioid withdrawal resemble symptoms seen in sedative-hypnotic withdrawal. However, opioid withdrawal is also accompanied by rhinorrhea, lacrimation and pupillary dilation, which are not seen in sedative-type withdrawal.

Dilated pupils are also seen in hallucinogen intoxication and stimulant intoxication. However, other signs or symptoms of opioid withdrawal such as nausea, vomiting, diarrhea, abdominal cramps, rhinorrhea, or lacrimation, are not present.

Comorbidity

The most common medical conditions associated with opioid use disorder are viral (e.g., HIV, hepatitis C virus) and bacterial infections, particularly among users of opioids by injection. These infections are less common in opioid use disorder with prescription opioids.

Opioid use disorder is often associated with other substance use disorders especially those involving Tobacco, Alcohol, Cannabis, stimulants, and benzodiazepines, which are often taken to reduce symptoms of opioid withdrawal or craving for opioids, or to enhance the effects of administered opioids.

Individuals with opioid use disorder are at risk for the development of mild to moderate depression that meets symptomatic and duration criteria for persistent depressive disorder (dysthymia) or, in some cases, for major depressive disorder.

These symptoms may represent an opioid-induced depressive disorder or an exacerbation of a pre-existing primary depressive disorder. Periods of depression are especially common during chronic intoxication or in association with physical or psychosocial stressors that are related to the opioid use disorder.

Insomnia is common, especially during withdrawal.

Antisocial personality disorder is much more common in individuals with opioid use disorder than in the general population.

Post-traumatic stress disorder is also seen with increased frequency.

A history of conduct disorder in childhood or adolescence has been identified as a significant risk factor for substance-related disorders, especially opioid use disorder. 

Opioid Intoxication

Diagnostic Criteria

A. Recent use of an opioid.

B. Clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that developed during, or shortly after, opioid use.

C. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs or symptoms developing during, or shortly after, opioid use:

       1. Drowsiness or coma.
       2. Slurred speech.
       3. Impairment in attention or memory.

D. The signs of symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

Specify if:
With perceptual disturbances:
This specifier may be noted in the rare instance in which hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium.

Diagnostic Features

The essential feature of opioid intoxication is the presence of clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that develop during, or shortly after, opioid use (Criteria A and B).

Intoxication is accompanied by pupillary constriction (unless there has been a severe overdose with consequent anoxia and pupillary dilation) and one or more of the following signs: drowsiness (described as being “on the nod”), slurred speech, and impairment in attention or memory (Criterion C); drowsiness may progress to coma. Individuals with opioid intoxication may demonstrate inattention to the environment, even to the point of ignoring potentially harmful events.

The signs and symptoms must not be attributable to another medical condition and are not better explained by another mental disorder (Criterion D).

Differential Diagnosis

Other substance intoxication
Alcohol intoxication and sedative-hypnotic intoxication can cause a clinical picture that resembles opioid intoxication.

A diagnosis of alcohol or sedative-hypnotic intoxication can usually be made based on the absence of pupillary constriction or the lack of a response to a naloxone challenge. In some cases, intoxication may be due both to opioids and to alcohol or other sedatives. In these cases the naloxone challenge will not reverse all of the sedative effects.

Other opioid-related disorders
Opioid intoxication is distinguished from the other opioid-induced disorders (e.g., opioid-induced depressive disorder, with onset during intoxication) because the symptoms in the latter disorders predominate in the clinical presentation and meet full criteria for the relevant disorder.

Opioid Withdrawal

Diagnostic Criteria                                                                                                       
292.0 (F11.23)

A. Presence of either of the following:

  1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e., several weeks or longer).

       2. Administration of an opioid antagonist after a period of opioid use.

B. Three (or more) of the following developing within minutes to several days after Criterion A:

       1. Dysphoric mood.
       2. Nausea or vomiting.
       3. Muscle aches.
       4. Lacrimation or rhinorrhea.
       5. Pupillary dilation, piloerection, or sweating. 
       6. Diarrhea.
       7. Yawning.
       8. Fever.
       9. Insomnia.

C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

Diagnostic Features

The essential feature of opioid withdrawal is the presence of a characteristic withdrawal syndrome that develops after the cessation of (or reduction in) opioid use that has been heavy and prolonged (Criterion A1).

The withdrawal syndrome can also be precipitated by administration of an opioid antagonist (e.g., naloxone or naltrexone) after a period of opioid use (Criterion A2). This may also occur after administration of an opioid partial agonist such as buprenorphine to a person currently using a full opioid agonist.

Opioid withdrawal is characterized by a pattern of signs and symptoms that are opposite to the acute agonist effects. The first of these are subjective and consist of complaints of anxiety, restlessness, and an “achy feeling” that is often located in the back and the legs, along with irritability and increased sensitivity to pain. Three or more of the following must be present to make a diagnosis of opioid withdrawal: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation, piloerection, or increased sweating; diarrhea; yawning; fever; and insomnia (Criterion B).

Piloerection and fever are associated with more severe withdrawal and are not often seen in routine clinical practice because individuals with opioid use disorder usually obtain substances before withdrawal becomes that far advanced…

Meeting diagnostic criteria for opioid withdrawal alone is not sufficient for a diagnosis of opioid use disorder, but concurrent symptoms of craving and drug-seeking behavior are suggestive of comorbid opioid use disorder.

The speed and severity of withdrawal associated with opioids depend on the half-life of the opioid used. Most individuals who are physiologically dependent on short-acting drugs such as heroin begin to have withdrawal symptoms within 6 – 12 hours after the last dose.

Symptoms may take 2 – 4 days to emerge in the case of longer-acting drugs such as methadone, LAAM (L-alpha-acetylmethadol), or buprenorphine.

Acute withdrawal symptoms for a short-acting opioid such as heroin usually peak within 1 – 3 days and gradually subside over a period of 5 – 7 days. Less acute withdrawal symptoms can last for weeks to months. These more chronic symptoms include anxiety, dysphoria, anhedonia, and insomnia.

Associated Features Supporting Diagnosis

Males with opioid withdrawal may experience piloerection, sweating and spontaneous ejaculations while awake. Opioid withdrawal is distinct from opioid use disorder and does not necessarily occur in the presence of the drug-seeking behavior associated with opioid use disorder.

Opioid withdrawal may occur in any individual after cessation of repeated use of an opioid use disorder, whether in the setting of medical management of pain, during opioid agonist therapy for opioid use disorder, in the context of private recreational use, or following attempts to self-treat symptoms of mental disorders with opioids.

Prevalence 

Among individuals from various clinical settings, opioid withdrawal occurred in 60% of individuals who had used heroin at least once in the prior 12 months. 

Development and Course

Opioid withdrawal is typical in the course of an opioid use disorder. It can be part of an escalating pattern in which an opioid is used to reduce withdrawal symptoms, in turn leading to more withdrawal at a later time. For persons with an established opioid use disorder, withdrawal and attempts to relieve withdrawal are typical.

Differential Diagnosis

Other withdrawal disorders
The anxiety and restlessness associated with opioid withdrawal resemble symptoms seen in sedative-hypnotic withdrawal. However, opioid withdrawal is also accompanied by rhinorrhea, lacrimation, and pupillary dilation, which are not seen in sedative-type withdrawal.

Other substance intoxication
Dilated pupils are also seen in hallucinogen intoxication and stimulant intoxication.

However, other signs or symptoms of opioid withdrawal, such as nausea, vomiting, diarrhea, abdominal cramps, rhinorrhea, and lacrimation, are not present.

Other opioid-induced disorders
Opioid withdrawal is distinguished from the other opioid-induced disorders (e.g., opioid-induced depressive disorder, with onset during withdrawal) because the symptoms in these latter disorders are in excess of those usually associated with opioid withdrawal and meet full criteria for the relevant disorder. (15)

Key Terms
Agonist – a chemical substance that binds to and activate certain receptors on cells, causing a biological response. Fentanyl and methadone are examples of opioid receptor agonists.

Antagonist – a chemical substance that binds to and blocks the activation of certain receptors on cells, preventing a biological response. Naloxone and naltrexone are examples of opioid receptor antagonists. (16)

The above section from the DSM manual is complex and that means not simple reading for most of us.

Complicated reading and does it make sense and is it really needed and if so, how come things are getting worse with the opioid epidemic worldwide?

Surely a manual spelling it all out should be helping those who read it but is seems not to be the case, as we are now aware of how bad things are getting with opioid use and nothing seems to be working to turn the tides.

GLOBAL

Opioid Overdose

Key Facts

2016

275 million worldwide used drugs

34 million used opioids

19 million used opiates

27 million suffered opioid use disorders

Majority dependent on opioids used illicitly cultivated and manufactured heroin but an increasing proportion used prescription opioids.

118,000 people died with opioid use disorders in 2015

Overdose deaths contribute to between third and a half of all drug-related deaths, which are attributable in most cases to opioids.

An opioid overdose can be identified by a combination of 3 signs and symptoms referred to as the “opioid overdose triad”

  • pinpoint pupils
  • unconsciousness
  • respiratory depression (17)

What are Pinpoint Pupils

In normal conditions, the pupils change size to let in the right amount of light

In the dark, they open wider or dilate to let in more light; in bright light, they get smaller or constrict to prevent too much light from getting in.

However, some medical conditions and the use of certain drugs can cause the pupils to shrink to a pinpoint size.

The medical term for pinpoint pupils is myosis, from an ancient Greek word muein meaning “to close the eyes.”

Other Symptoms of an Opioid Overdose:

  • pale or clammy face
  • blue or purple fingernails
  • slow breathing
  • slow heartbeat (7)

Combinations of Opioids, Alcohol and Sedatives are often present in fatal drug overdoses

Because of their capacity to cause respiratory depression, opioids are responsible for a high proportion of fatal drug overdoses around the world. The number of opioid overdoses has increased in recent years, in part due to the increased use of opioids in the management of chronic non-cancer pain.

USA | 2016

63,632 deaths due to drug overdose | 21% increase from previous years

This was largely due to a rise in deaths associated with prescription opioids. This group of opioids (excluding methadone) was implicated in 19,413 deaths in the country – more than double the number in 2015.

Pharmaceutical opioids, in particular strong opioids of the type that are typically involved in opioid overdoses, have been restricted in the past to the management of acute pain and cancer pain, such as is recommended in the WHO Cancer Pain Ladder. There has been a trend in the last 10 years to use opioids in the management of chronic non-cancer pain such as back pain.

45% of drug users experience non-fatal overdose

70% witness drug overdose (including fatal) during their lifetime

People at higher risk of opioid overdose:

  • Diagnosed with opioid dependence, in particular following reduced tolerance (following detoxification, release from incarceration, cessation of treatment)
  • Injectors of opioids
  • Users of prescription opioids, in particular those taking higher doses
  • Users of opioids in combination with other sedating substances
  • Opioids users who have medical conditions such as HIV; liver or lung disease; or suffer from depression
  • Household members of people in possession of opioids (including prescription opioids)

Risk factors for overdoses with prescribed opioids include:

  • History of substance use disorders
  • High prescribed dosage (over 100mg of morphine or equivalent daily)
  • Male gender
  • Older age
  • Multiple prescriptions including benzodiazepines
  • Mental health conditions
  • Lower socioeconomic status

USA – 50,000 naloxone kits distributed through local opioid overdose prevention programmes had resulted in more than 10,000 uses to reverse overdoses.

A number of countries and jurisdictions have started to adopt this approach – a policy of providing naloxone to people at risk of opioid overdose as well as to people likely to witness an opioid overdose has been in place in Scotland since 2011 and in a number of jurisdictions in the USA.

An evaluation of the impact of the policy in Scotland, which included people leaving prison as a target population, found that the proportion of opioid overdoses occurring within four weeks of leaving prison had halved since the introduction of naloxone. (17)

Opioids are not sleep aids and can actually worsen Sleep | New Study

Evidence that taking opioids will help people with chronic pain to sleep better is limited and of poor quality, according to an interdisciplinary team of psychologists and medics from the University of Warwick in partnership with Lausanne Hospital, Switzerland.

Many people suffering from long-term chronic pain, use opioids as a sleep aid to take away pain and stop their sleep being disrupted.

However, a new study led by the Department of Psychology at the University of Warwick with Warwick Medical School suggests that not enough research has been done to assess the benefits and risks of using painkillers for the purpose of improving sleep quality. 

The study, a systematic review of existing research on the effects of opioids on sleep, has been published in Sleep Medicine Reviews.

Long-term chronic pain has a debilitating impact on people’s life. Sleep disruption is a particularly frequent issue for patients with chronic pain, with a vicious cycle building between bad nights and increased pain. Patients with chronic pain are often empirically prescribed opioids to reduce their pain enough to get a good night’s sleep but there has been little investigation of whether this is a safe and effective intervention.

The researchers conducted a comprehensive systematic review of existing literature that examined the effects of opioids on sleep quality. As part of this, they conducted a meta-analysis of data from these studies, combining the results of 18 studies which were then narrowed down to 5 comparable data.

They found that research on opioid effects on sleep quality was limited and of poor quality, often with potential publication bias and conflicts of interest and rarely testing patients for sleep apnoea prior to and during the study.

Patients reported a small improvement in sleep quality when using opioids but that was not consistent with results derived from sleep assessment technologies, such as the total time and the percentage of time in deep sleep, which did not show an improvement.

Certain studies reported calmer sleep with less movement but the examined articles frequently did not examine the wider effects of opioid therapy such as subsequent functioning during the day. Where they did, reports of sedation and daytime sleepiness were very frequent.

Opioids are known to affect the brain mechanism that controls breathing. This can potentially create sleep apnoea events where individuals experience pauses or obstructions in breathing, like a choking sensation, resulting in snoring, gasping for air, dry mouth and headache in the morning.

42% – insomnia likely in people with chronic pain prescribed opioids than controls without opioids.

Despite this, there was some evidence that low-medium dosed opioids could help improve sleep quality in some patients in the short term but the effect was small and requires more investigation.

Researchers are calling for better quality research into the effects of painkillers on sleep quality as well as better information for patients from clinicians when considering opioid therapy. (18)

Dear World

So here we have it – a clear presentation to start our Real Truth about Opioids series.

So what is this article telling us

What is it spelling out to us all

Can we agree it is Complicated

Can we agree it is not Simple

Can we join the dots

Can we agree SOMETHING IS NOT RIGHT

Can we get Real and Honest that our world is needing more and more Drugs to deal with our pain.

Can we be truth-full and admit our pain is getting worse and our Solutions are not working.

Have we ever considered how we got the pain in the first place and where it has come from.

Are we ready to ponder deeply on the Questions presented in this tablet of Truth, as it may just get us to the root cause of why we have pain that is not going away.

Are we ready to admit that in Truth, nothing is really working and our Solutions are simply not cutting it, so could there be Another Way?

Part 2 – More on Opioids and Pain

Part 3 – Stats | Facts | News on Opioids

 

References

(1) (n.d). Opioid. National Cancer Institute. Retrieved June 18, 2019 from
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/opioid

(2) Nutt, D. (2012). Drugs Without the Hot Air. Cambridge, England: UIT

(3) Nemo, L. (2018, August 30). How Did Opium Poppies Get their Painkilling Properties? Live Science. Retrieved June 22, 2019 from
https://www.livescience.com/63471-opium-poppy-painkiller-genome.html

(4) Conrad Stoppler, M. (2018, June 13). Endorphins: Natural Pain and Stress Fighters. MedicineNet. Retrieved June 24, 2019 from
https://www.medicinenet.com/endorphins_natural_pain_and_stress_fighters/views.htm

(5) (2018, June 7). Prescription Opioids. NIDA. Retrieved June 24, 2019 from
https://www.drugabuse.gov/publications/drugfacts/prescription-opioids

(6) Opiates or Opioids – What’s the Difference? Oregon.gov. Retrieved June 24, 2019 from
https://www.oregon.gov/adpc/pages/opiate-opioid.aspx

(7) Weaver, B. (2018, March 15). Seven Causes of Pinpoint Pupils. Medical News Today. Retrieved June 19, 2019 from
https://www.medicalnewstoday.com/articles/321209.php

(8) Bellum, S. (2014, June 16). Real Teens Ask: What are the Different Types of Opioids? NIDA for Teens. Retrieved June 22, 2019 from
https://teens.drugabuse.gov/blog/post/real-teens-ask-what-are-different-types-opioids-0

(9) Bai, N., & Smith, D. (2018, May 10). Body’s ‘Natural Opioids’ Affect Brain Cells Much Differently than Morphine. UCSF. Retrieved June 24, 2019 from
https://www.ucsf.edu/news/2018/05/410376/bodys-natural-opioids-affect-brain-cells-much-differently-morphine

(10) (2016). Facing Addiction in America: Surgeon General’s Report on Alcohol, Drugs and Health. U.S. Department of Health & Human Services. (HHS). Washington DC (pp. 73 – 74)

(11) (n.d). Fentanyl. DEA. Retrieved June 24, 2019 from
https://www.dea.gov/factsheets/fentanyl

(12) (n.d). Sublingual and Buccal Medication Administration. Healthline. Retrieved June 19, 2019 from
https://www.healthline.com/health/sublingual-and-buccal-medication-administration

(13) (n.d). Methadone, Oral Tablet. Healthline. Retrieved June 19, 2019 from
https://www.healthline.com/health/methadone-oral-tablet#highlights

(14) (2018, April 12). Analgesics. Drugs.com. Retrieved June 19, 2019 from
https://www.drugs.com/drug-class/analgesics.html

(15) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, V A, American Psychiatric Association, 2013 (pp. 540 – 549) 

(16) Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. U.S. Department of Health & Human Services (HHS). (pp. 18, 23). Retrieved June 22, 2019 from
https://addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-Opioids_09192018.pdf

(17) (2018, August). Information Sheet on Opioid Overdose. World Health Organization. Retrieved June 19, 2019 from
https://www.who.int/substance_abuse/information-sheet/en/

(18) (2019, June 4). Opioids are Not Sleep Aids and Can Actually Worsen Sleep Research Finds. Neurosciencenews.com Retrieved June 25, 2019 from
https://neurosciencenews.com/sleep-opioids-14167/

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