When you’re injured, have surgery, or deal with chronic pain, the last thing you may think about is the risk associated with prescription pain medications. Those pills, tablets, patches, or injections are supposed to be safe and a trusted means of relief, right?
Not necessarily. Unfortunately, times have changed, and more and more Americans deal with opioid addiction. It’s important to understand prescription opioids aren’t automatically safe because they come from a doctor. Long-term use can get to a point where you feel like you can’t live without a drug. You’ll do anything to find that fix and satisfy the cravings. This compulsive behavior is prevalent even when users know of the potential dangerous — and deadly — consequences.
If you or a loved one is taking prescription opioids, it’s important to gain familiarity and understand how they operate. This guide on opioid addiction will help you comprehend how opioids work, how widespread the abuse is, the treatment options available, and new laws that could affect you in the future.
What are Opioids?
Opioids, in the prescription medication realm, treat severe pain. On a larger scale, opioids also include heroin and synthetic opioids like fentanyl. The drugs block opioid receptors in your body from signifying pain, while also helping you relax. In other words, they don’t heal pain, rather, they trick your brain into telling you there isn’t pain.
The euphoria, or high, it produces, when combined with feelings of relaxation, is what made it a popular recreational drug and one that you can abuse. Add in the fact that opioids are highly addictive, and it’s a potent combination that’s led to an ongoing opioid epidemic.
Not all opioids are the same. Some are natural alkaloids derived from opium in poppy plants. Others come from natural opiates manufactured in labs to produce the same type of reaction. Then there are man-made synthetic opioids.
The origin of opioids dates back thousands of years, although they gained traction in the 1800s when German pharmacist Friedrich Serturner created morphine from opium. It made its way to the United States during the Civil War to treat soldiers. The drug became popular with mainstream society, as the first signs of an opioid crisis manifested on U.S. soil. Then, during the Vietnam War, soldiers came in contact with opium overseas. Heroin addiction grew when they returned, resulting in another opioid crisis. Interestingly, heroin was originally marketed by Bayer as a cough remedy until the U.S. banned it in 1924.
The Centers for Disease Control and Prevention classifies the opioid epidemic timeline in three stages, beginning with increased prescription opioid use in the 1990s. In 2010, heroin addiction surged, and synthetic opioids, mainly fentanyl, added to the crisis in 2013.
Fentanyl is 50 times more potent than heroin and 100 times more powerful than morphine. You’ll see it in prescriptions, but it’s illegally made, sold, and abused either on its own or mixed with other drugs such as cocaine and heroin.
Here are some common opioid examples:
Opioid Addiction Statistics
More than 130 Americans die each day from opioid overdose, according to the National Institute on Drug Abuse. In 2017, more than 47,000 Americans died due to this ongoing crisis. That figure was six times higher than in 1999, according to the CDC (nearly 400,000 people died from opioid overdoses from 1999-2007). An additional 1.7 million people had opioid-related disorders.
What contributes to the widespread use? An estimated 11% of adults have daily pain, many of which experience chronic or severe discomfort. As a result, physicians handed out more than 191 million opioid prescriptions in 2017. More access to opioids leads to increased risks of addiction, as we’ll explain below. From July 2016 to September 2016, opioid overdoses increased in large metropolitan areas by 54%. During that same time, overdoses increased by 70% in the Midwest and by 30% in 52 areas in 45 states.
How long does it take to get addicted to opioids? The answer is full of ambiguity because there’s no clear-cut explanation. And we first need to define certain terms. It’s easy to use tolerance, dependence, and addiction interchangeably, but they carry different meanings.
Your body produces endorphins when taking opioids, which explains the mood-inducing feelings people can become dependent on. As your body builds up a tolerance, you need more drugs, more frequently, to achieve the same feeling. Dependency occurs when your body adjusts its regular functioning around the drug. The natural instinct is to crave the drug to function normally or to quell any adverse feelings. The side effects worsen as withdrawal symptoms begin. Cravings start to set in and you may experience cold flashes or uncontrollable movements.
A full-blown addiction occurs when you become tolerant and dependent on the drug, and you compulsively or uncontrollably use the drug despite being aware of the consequences.
In general, as with most things, your risk of developing an opioid addiction increases the longer you’re on the drug. But even using opioids for five days can increase your long-term use, according to the Mayo Clinic. This means your usage should be limited to only a few days, as 21-29% of patients misuse opioids when taking them for chronic pain (defined as lasting more than three months). For example, doctors may prescribe new patients less than a week’s worth of opioids to treat pain following a surgery or accident.
Things like poverty, unemployment, mental health issues, and family history can increase your chances of opioid addiction. Gender plays a role, too. Women are more at risk because they are more likely to have chronic pain, leading to dependency.
Opioid Addiction Medication
While prescription opioids are effective in reducing pain, they don’t come without risks and side effects. Even when you take them as directed and for a short period of time, you can still experience constipation, drowsiness, confusion, slowed breathing, and nausea.
Large doses of opioids slow down your breathing, which can reduce the amount of oxygen to your brain and lead to brain damage or death, with the latter having a tendency to occur while you sleep.
A 2016 study found more than 11.5 million Americans admitted to misusing prescription opioids in the past year. Despite that high figure, only 17.5% received treatment. The road to recovery is an uphill battle. The National Institute on Drug Abuse mentions how relapse is likely even after detox and staying abstinent.
On the surface, it may not seem practical to use more medication to treat an addiction that originates from other medications. However, buprenorphine, lofexidine, methadone, and naltrexone are options to manage opioid addiction.
In severe, emergency cases of opioid addiction that result in an overdose, doctors and first responders use naloxone as a first-line treatment option. Classified as an opioid antagonist, a naloxone injection (also available as a nasal spray under the trade name Narcan) reverses and blocks opioid effects.
Methadone and buprenorphine block the effects you feel from painkillers to help reduce cravings and withdrawal symptoms. In opioid addiction treatment, these medications produce a similar feeling as other painkillers without the typical euphoria. Methadone is an opioid agonist, while buprenorphine is a partial opioid agonist. Much like methadone, buprenorphine binds to opioid receptors, but it does so at a weaker level. This explains why methadone is a Schedule II substance and buprenorphine is a Schedule III substance.
Methadone, while still an addictive substance, is much weaker in its effects compared to other opioids. Its use under the care of a physician is helpful to wean patients from their opioid addiction. Its use, along with other treatment methods, are necessary to control deadly effects. You can’t quit cold turkey because opioid withdrawal can be a life-threatening event.
Lofexidine comes from a group of alpha-2-adrenergic agonists, which works in the brain on the receptors that regulate blood pressure. In this case, rapid heart rate and anxiety occur during withdrawal. Taking the medication lowers blood pressure and heart rate, thus alleviating the symptoms.
Naltrexone is an opioid antagonist that blocks opioid receptors from giving you a high or sense of euphoria. A single dose of this injectable medication lasts up to a month.
It’s important to consider these aren’t miracle drugs that can reverse addiction at the drop of a hat. They can take months or years before you can wean yourself off these medications. You may need the medication for an indefinite amount of time in certain cases of long-term abuse. There are risks with methadone and buprenorphine since you can misuse them to treat pain.
Alternatively, or used in conjunction with medication, addiction treatment specialists use cognitive behavioral therapy to better manage triggers and stress. You can also use behavioral therapy to alter aspects of your life that may lead you toward opioids.
Options exist for pain relief in the event you want to avoid opioids. Acetaminophen and NSAIDs, such as aspirin, ibuprofen, and naproxen, can help relieve pain or inflammation that causes daily problems. Celecoxib (Celebrex) is a popular nonsteroidal anti-inflammatory to treat arthritis.
New Laws on Opioid Prescriptions
Gone are the days when you could get a 100-plus-count pill bottle of opioids from the pharmacy or show up to a shady establishment run under the guise of so-called “pill mills,” where doctors would distribute prescriptions without proper examination and oversight to users or addicts in exchange for money.
Nowadays, a majority of states (at least 33, as of 2018) have cracked down with some type of opioid restrictions through either new or updated policies and guidelines.
For example, Oklahoma recently introduced Senate Bill 1446 that limits opioid prescriptions to seven days at the lowest dose. You would then need a follow-up visit for any extra scripts in an attempt for doctors to limit abuse or addiction. Not all patients are subject to these restrictions. They don’t apply to patients receiving cancer treatment, patients in hospice, or patients in long-term facilities.
In bordering Texas, House Bill 2174 opioid prescriptions can’t exceed 10 days and don’t include refills. Again, this law doesn’t apply to chronic patients, cancer treatment patients, or patients receiving hospice care.
The same goes for New York, which limits prescription opioids to treat acute pain to seven-day scripts. Massachusetts became the first state to do this in 2016, when it enacted legislation limiting new patients to a seven-day opioid script.
Many of these changes began when organizations like the CDC placed a magnified lens on opioid misuse and began distributing literature to help new patients better understand the effect of certain dosages. In this graphic, a new patient (as we referenced earlier, chronic users have a higher tolerance and, therefore, may not apply) taking more than 50 morphine milligram equivalents (MME) is two times more at risk of overdosing versus someone taking less than 20 MME. The kicker is research found higher dosages doesn’t equate to more pain relief.
What is an MME? It’s a formula to calculate your daily dosage of opioids. There’s a conversion chart you can find here that allows you to see if you are at risk. Not all drugs are equal since each opioid has a different conversion factor.
For example, 50 MME a day is equal to 10 5-mg tablets of hydrocodone/acetaminophen or two 15-mg extended-release oxycodone tablets. It may not seem like much, but taking 20 MME of hydrocodone/acetaminophen is equal to one 5-mg/325-mg tablet four times a day. These figures are even higher for drugs like hydromorphone, fentanyl, and methadone.
Using the MME conversion factor is one way to limit opioid abuse and overdose. The CDC developed the Guideline for Prescribing Opioids for Chronic Pain, which covers when to initiate or continue opioids for chronic pain; opioid selection, dosage, duration, follow-up, and discontinuation; and assessing risk and addressing harms of opioid use.
While the CDC’s guidelines served as non-mandatory guidelines, many states and lawmakers took it upon themselves to crack down. Though helpful, the reality is not all opioid addiction comes from prescription drug users taking medication for its intended purpose. In other words, this doesn’t account for people who use prescription opioids recreationally or buy them off the street without a prescription.
Unintended consequences have come about as prescription monitoring programs and other laws have worked to clean up opioid addiction. Heroin became a popular alternative since it’s cheaper and easier to buy than prescription opioids. Nearly a half-million Americans were using heroin in 2017, which led to more than 15,000 deaths that year. An estimated 80% of heroin users first misused prescription opioids.
More recently, fentanyl spiked in popularity due to its powerful effects. Initially created to treat severe pain in cancer patients, it played a large role in the 57% increase in opioid overdose deaths from 2010-15.
The Cost of Opioid Addiction
Not only are prescription opioids powerful and highly addictive, they aren’t cheap, either. The same applies for treatment options if you become addicted to opioids.
Treatment options, which include medications and other therapeutic support services, range from $5,980 per year for buprenorphine, $6,552 per year for methadone, and $14,112 per year for naltrexone, according to the U.S. Department of Defense. A box of two Narcan sprays will cost you at least $100, and Lucemyra, the brand name for lofexidine, will run several thousands of dollars for a seven-day supply of 0.18-mg tablets with your Community Cares Rx Prescription Discount Card.
While generic opioids are more affordable, the cost, especially with prolonged use, adds up. For example, your doctor may provide you a seven-day opioid script after surgery or to treat an illness. Generally, you’ll take 1-2 tablets of hydrocodone/acetaminophen (sold under the brand names Lortab, Norco, and Vicodin) every 4-6 hours, and this could run anywhere from $23 to $46 for 70 5-325 mg tablets (taking, on average, 10 a day) using your Community Cares Rx Prescription Discount Card.
In another example, that same script for oxycodone/acetaminophen (sold under the brand name Percocet) would range from $38 to $78 for 70 5-325 mg tablets. Oxycodone extended release tablets treat more severe, chronic pain. A seven-day script could cost around $60 for 14 15-mg tablets (twice a day).
Using a short-term cost analysis, these price tags may not seem like much. But price those figures out over many more weeks or months, and you’re looking at hundreds and hundreds of dollars in drug costs.
You shouldn’t take any prescription opioids without being under the guidance of a physician. Talk to your doctor if you or a loved one is struggling with opioid addiction. As mentioned above, there are many treatment options to consider. If a prescription drug treatment plan is recommended, you can download your free Community Cares Rx card and research our partner pharmacies near you to compare prices and save you up to 70% on generics and up to 20% on brand name medications.