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Opiates and Opiate Addiction
Source: National Institute on Drug Addiction
Opioids are commonly prescribed because
of their effective analgesic, or pain-relieving, properties. Medications
that fall within this class - sometimes referred to as narcotics - include
morphine, codeine, and related drugs. Morphine, for example, is often
used before or after surgery to alleviate severe pain. Codeine, because
it is less efficacious than morphine, is used for milder pain. Other
examples of opioids that can be prescribed to alleviate pain include
oxycodone (OxyContin), propoxyphene (Darvon), hydrocodone (Vicodin),
and hydromorphone (Dilaudid), as well as meperidine (Demerol), which
is used less often because of its side effects. In addition to their
pain-relieving properties, some of these drugs - for example, codeine
and diphenoxylate (Lomotil) - can be used to relieve coughs and diarrhea.
How do opioids affect the brain and body?
Opioids act by attaching
to specific proteins called opioid receptors, which
are found in the brain, spinal cord, and gastrointestinal
tract. When these drugs attach to certain opioid receptors,
they can block the transmission of pain messages to
the brain. In addition, opioids can produce drowsiness,
cause constipation, and, depending upon the amount
of drug taken, depress respiration. Opioid drugs also
can cause euphoria by affecting the brain regions that
mediate what we perceive as pleasure.
What are the possible consequences of opioid use and abuse?
Chronic use of opioids
can result in tolerance for the drugs, which means
that users must take higher doses to achieve the same
initial effects. Long-term use also can lead to physical
dependence and addiction - the body adapts to the presence
of the drug, and withdrawal symptoms occur if use is
reduced or stopped. Symptoms of withdrawal include
restlessness, muscle and bone pain, insomnia, diarrhea,
vomiting, cold flashes with goose bumps ("cold turkey"),
and involuntary leg movements. Finally, taking a large
single dose of an opioid could cause severe respiratory
depression that can lead to death. Many studies have
shown, however, that properly managed medical use of
opioid analgesic drugs is safe and rarely causes clinical
addiction, defined as compulsive, often uncontrollable
use of drugs. Taken exactly as prescribed, opioids
can be used to manage pain effectively.
Is it safe to use opioid drugs with other medications?
Opioids are safe
to use with other drugs only under a physician's supervision.
Typically, they should not be used with other substances
that depress the central nervous system, such as alcohol,
antihistamines, barbiturates, benzodiazepines, or general
anesthetics, as such a combination increases the risk
of life-threatening respiratory depression.
Treating addiction to prescription opioids
Several options are available for effectively
treating addiction to prescription opioids. These options are drawn from experience
and research regarding the treatment of heroin addiction. They include medications,
such as methadone and LAAM (levo-alpha-acetyl-methadol), and behavioral counseling
approaches.
A useful precursor to long-term treatment of opioid addiction is detoxification.
Detoxification in itself is not a treatment for opioid addiction. Rather, its
primary objective is to relieve withdrawal symptoms while the patient adjusts
to being drug free. To be effective, detoxification must precede long-term
treatment that either requires complete abstinence or incorporates a medication,
such as methadone, into the treatment plan.
Methadone is a synthetic opioid that blocks the effects of heroin and other
opioids, eliminates withdrawal symptoms, and relieves drug craving. It has
been used successfully for more than 30 years to treat people addicted to opioids.
Other medications include LAAM, an alternative to methadone that blocks the
effects of opioids for up to 72 hours, and naltrexone, an opioid blocker that
is often employed for highly motivated individuals in treatment programs promoting
complete abstinence. Buprenorphine, another effective medication, is awaiting
Food and Drug Administration (FDA) approval for treatment of opioid addiction.
Finally, naloxone, which counteracts the effects of opioids, is used to treat
overdoses.
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