How To: Understanding Opioid Abuse in America

Why do people addicted to prescription painkillers start using? What could push a person to decide “this is something I want to do, despite the risks.” This is a question I find myself asking all the time. It sits in my head constantly. Maybe because of the work I do, but maybe also because my brain likes to fixate on things. This question ranks quite high on the list, right up there next to “Who thought mixing eggs, oil and vinegar together to create mayonnaise would be delicious? That sh*t is NASTY!” and “Why would anyone decide to jump out of a perfectly good airplane?” I would say that these are questions most people have, but I’ve met too many people (my husband included) that adore mayonnaise to ever assume that other people share the same brainwaves as myself. I will, however, go so far as to say that I do believe that a lot of people are wondering how addicts get their start.

So, I researched.

Of course, not all addicts are the same. Alcoholics are not necessarily meth heads and pill-poppers have little in common with Cheech or Chong.

The one thread that binds is addiction. How they get their start is quite subjective. Because of the recent increase in deaths related to heroin use- a potent opioid akin to the prescription pain medications being copiously abused- across the country, I decided to start there. What makes someone take that first illegal pill, knowing it’s wrong? What leads them to the dark door of opioid addiction or heroin and compel them to knock?

At this point, I’ve read hundreds of articles, watched videos, combed the internet for stories, even asked those I know who stood at the edge of that precipice- some that even ventured into it- and came back from the edge alive. I talked to everyone. And here’s what I learned:

It’s not a heroin problem. It’s an opioid problem. People don’t wake up and say “today I’m going to use heroin!” It just doesn’t happen. What does happen is dad falls off the roof while cleaning gutters. Mom takes him to the ER where they take some x-rays, determine he’s got a broken rib and some severe bruising, give him some morphine while they wrap him all up and send him home with some OxyContin for the pain.

Maybe he’s got a broken leg, too. The rib hurts. The leg hurts. But the drugs help. His head gets heavy, the pain drifts away, and he’s floating on a bed of clouds covered in virgin alpaca wool from undiscovered remote highland villages deep in the Andes- yeah. They’re good drugs. There’s only one problem. He keeps waking up and feeling pain. So he takes more drugs. One day, the pain isn’t so bad… but the drugs make him feel. So. Good. What’s a guy to do? He takes them anyway. He doesn’t really need them anymore, but he takes them. After a while, the drugs run out. The leg is healed, the rib is fine, but there’s no more alpaca-covered clouds. Crap. So he finds a way to get more- Grandma’s arthritis medications, maybe the neighbor, Bill, had an accident a while back- maybe he’s got some extras for the “back pain” that has mysteriously surfaced. Eventually, Bill runs out and Grandma catches on. No more alpaca clouds. They still sell those fancy pills on the street, though. Dean from work said he’s got a friend’s brother’s nephew with some OxyContin that he’d sell. Well now we’ve developed a full-blown opioid addiction. Great. But OxyContin costs money. A lot of money. Sometimes more than $80 per pill. What happens when Dad’s addiction grows larger than his expendable income? What happens when Mom notices all the money is gone and she can’t put gas in the car to take the kids to soccer practice? No more money. So he gets something cheaper.

This is how it happens. Maybe it’s not Dad. Maybe one of the teenagers your son had over for a party found Dad’s OxyContin prescription and decided to take some. Maybe your daughter got talked into taking some of Grandma’s pills to see what they would do.

It happens so quickly and so nonchalantly. Once the opioid addiction starts, it’s hard to kick. Once the drugs are in the system, you have to keep them in your system or face nasty, painful withdrawal symptoms. When you run out of money for the prescription drugs, the only way left to get the drug is heroin. It’s cheap, (in the beginning it may take as little as $10 for a really good high) it’s easy to find, and it stops the withdrawal symptoms.

With that in mind, let’s talk numbers. The stories we spin are relatable, yes, but they mean nothing without cold hard facts to back them up. They mean nothing if you can’t see the damage that can happen.

First- opioids. What are they?

Opioids are substances that act on opioid sensors in the brain. That sounds easy enough. What kind of substances are those? The first category are opiates- chemicals derived from the opium poppy. These include Morphine and Codeine. There are also semi-synthetic opiates like Hydrocodone, oxycodone, and oxymorphone; and synthetic opiates such as methadone and fentanyl that are derived from other chemicals and do not contain any of the naturally-occurring chemicals/ alkaloids of the opium poppy.

This is not an extensive list. There are all kinds of opioids used for all different purposes: cough suppressant, anti-diarrheal, constipation, pain, and more. Some of the stronger ones are used exclusively to sedate large animals.

Great. How do they work?

Opioids work by attaching to opioid receptors in the brain. Usually, the body’s own endomorphic opioids- you’ve heard of them before- endorphins. These are also known as the body’s own “feel-good” drug. “Exercising releases endorphins!” “Comfort food releases endorphins!” “Sex releases endorphins!” Endorphins are what make you feel good. Opiates do the same thing. They bind to the receptors in your brain to give you that same good feeling, except on a much higher level. Think of it this way: Your body’s own endorphins are like riding on cloud 9- it’s fluffy and exciting. You can still see everything below you and interact with other people about your excitement. Opiates, however, are the equivalent of riding cloud 9000- super soft and covered in virgin alpaca wool from those far-off villages we talked about earlier. You’re so high up you’re on a completely different level. It’s like being on a beach in Tahiti all alone or like a kid let loose in six flags with no lines!

So the endorphins make you feel good- they are a combination of anti-stress, anti-anxiety, and pain relief drugs rolled all into one. They can do anything. That’s why a doctor will tell someone with depression to exercise more or why a person who sustains an injury while doing something they enjoy may not feel the pain right away (that and adrenaline).

This endorphin rush is also the reason they are addictive. You’ve seen those people- addicted to working out- lifting weights, running, playing soccer. The rush of endorphins they feel from these activities keep them coming back for more.

In the same way, the drugs keep you coming back for more. Unfortunately, not only do they feel so good, but the opioids actually change the way the nerve receptors in the brain work. This physical change with prolonged use is what causes the severe withdrawal symptoms that addicts fear. You see, the body adapts to the levels of chemicals that are absorbed into the body. The body begins to compensate for the chemicals. In the case of opioids, that means the body builds up a tolerance- just like with alcohol. Over time, it takes more of the drug to make an impact just like the more you drink, the higher tolerance you have and the more it takes for you to feel drunk or buzzed. In the same way again, after a while, the body becomes physically dependent on the opioids to function because those nerve receptors have been changed. When this happens, the withdrawal symptoms begin to show up when a user quits using.

Some people who begin using these drugs legally- like for the aforementioned broken leg- become dependent without realizing it and continue to use the drugs to avoid the painful withdrawal symptoms.

I’d like to point out that while we’re talking about prescription drugs here, opioids as a class also include Heroin. Withdrawal symptoms are the same, though sometimes more severe since Heroin is often cut with other drugs or substances that may be unknown to the user. We don’t see Heroin very often in the workplace, however, because of the severity of the addiction that leads someone to begin using heroin. Usually, by the time a person starts resorting to heroin, they have lost everything else- money, car, spouse, children- Heroin is usually a rock bottom drug, though it has recently been affecting many of the nation’s youth. We’ll talk about that in another post.

As far as withdrawal symptoms go, are pretty severe. The duration of withdrawal and severity depends on the addiction and dependency level on the drug, but generally speaking, an addict going through withdrawals can expect to experience the following:
• 12-24 hours after last dose
o flu-like symptoms including fever, chills, nausea, sweating
o insomnia
o diarrhea
o vomiting
o anxiety
• Week 1
o Flu-like symptoms
o Irritability
o Cramps- abdominal and legs
o Vomiting
o Shaking
o Tachycardia (fast heartbeat)
o High Blood Pressure
• Week 2
o Anxiety
o Nausea
o Physical symptoms begin to subside

Part of the reason for withdrawals is that the body has to relearn the appropriate amount of endorphins to produce. The cramping and pain reported during withdrawal is a result of the addict feeling again instead of being constantly numbed by the opioids.

Lastly, life after an opioid addiction is much more difficult than life for you or I. In the words of Mad-Eye Moody, “Constant Vigilance!”

An addict must be aware at all times of the situations they put themselves in and the people they surround themselves with. One slip could mean another round of full-blown addiction. This time, they may not be so lucky. Certain medications will no longer be options in medical situations. Certain changes will need to be made by their loved ones to ensure a home free of addiction temptations. Everything changes.