Opioid and Heroin Addiction

As determined by the National Institute on Drug Abuse and the Centers for Disease Control and Prevention, the U.S. is in the midst of an ongoing opioid epidemic. Whether you’re concerned about the health and well-being of yourself or a loved one, it’s important to understand some basic information about how opioids work, why they’re so addictive and which treatment approaches are most effective. 

Let's start with some basic definitions. 

What are opioids? 

"Opioid" is an umbrella term for both natural and synthetic painkiller drugs derived from or based on the poppy plant. Physicians often prescribe opioid medications to relieve acute pain—from injuries, surgeries, toothaches, or other medical and dental procedures—or to alleviate chronic pain. However, studies show that long-term opioid use for chronic pain can be ineffective and comes with the risk of addiction. 

You might recognize some of the more well-known opioid drugs prescribed for pain, including: 

• Morphine 
• Codeine 
• Diacetylmorphine 
• Hydromorphone (Dilaudid) 
• Hydrocodone (Vicodin, Lortab) 
• Isotonitazene 
• Opium 
• Oxycodone (OxyContin, Percocet) 
• Oxymorphone 
• Meperidine (Demerol) 
• Methadone 
• Fentanyl (Sublimaze, Actiq) 
• Tramadol 

Heroin is opioid that’s illegally produced, distributed and substituted for prescription painkillers because it’s less expensive and more readily available—which factors into the heightened risk for overdose. 

Whether regulated or unregulated, prescription or illicit, all opioids have the potential for misuse and addiction. Also, when used in combination with alcohol, cocaine or other drugs, different reactions and effects are produced.  

How do opioids work and why are they so addictive? 

When opioid molecules travel through the bloodstream and into the brain, they attach to receptors on the surface of certain cells. The chemical response triggered in the brain's reward center is the same as the reaction to intense pleasure and reinforces acts such as eating, drinking fluids, caring for babies and having sex—all necessary for survival of the species. These reward-and-survival-based activities result in the release of dopamine. But opioid use, like the use of any drug of abuse, triggers the release of dopamine in excess amounts, far beyond what is needed to provide pleasure or keep us alive. 

Opioid addiction is defined as the compulsive and uncontrollable use of opioids despite adverse consequences. Dependence occurs when the body adapts to the presence of the drug, causing withdrawal symptoms when use is reduced or discontinued. 

Prolonged and increasingly higher doses of opioids change the brain so that it functions more or less normally when the drug is present and abnormally when the drug is removed. 

What are the signs, symptoms and side effects of opioid addiction? 

Every person's situation is different, but in general, opioid use disorder is a condition that involves both physical and psychological processes. Progression of the disease can be so incremental that it's not recognized as such until a crisis occurs. Here are eight potential warning signs of opioid or heroin abuse: 

• Taking the drug in larger amounts or over a longer period than intended or prescribed 
  
• A persistent desire or unsuccessful efforts to cut down or control drug use 
  
• An excessive amount of time and effort spent getting, using and recovering from the effects of use 
• Intense cravings or a strong desire or urge to use 
• Failure to fulfill obligations at work, school or home due to drug abuse 
• Continued use despite persistent or recurrent social or personal problems caused by usage 
• Continued use despite situations that could be physically hazardous, including overdose risk 
• Continued use despite awareness of potential physical or mental health problems 

As with all types of drug or alcohol addiction, having a family history of substance abuse increases your risk of developing dependence. 

Other signs, symptoms or side effects of prescription opioid abuse or heroin use include: 

• Problematic mental health, behavioral or psychological changes such as agitation, poor judgement or apathy 
• Drowsiness or coma 
• Impaired mental functioning 
• Slurred speech 
• Constricted pupils 
• Euphoria 
• Slowed-down respiration 
• Dry mouth 
• Nausea 
• Constipation 
• Abdominal cramping 
• Skin rashes and infections 
• Weight gain 
• Menstrual problems 
• Depression 
• Headaches 
• Bad dreams 
• Loss of libido, sexual dysfunction 
• Mood swings 
• Collapsed veins 
• Risk of HIV, hepatitis B or C 
• Miscarriage 
• Infections of the heart lining and valves 

What are the warning signs of an opiod overdose? 

Taking a large, single dose of heroin or any opioid drug can cause severe respiratory depression (where breathing slows or even stops) with the potential for accidental drug overdose and death. Opioid abuse is also associated with a higher risk of suicide. Signs of overdose may include: 

• Shallow breathing 
• Pinpoint pupils 
• Convulsions 
• Coma 
• Nervous system changes 
• Decreased vital signs 
• Cold or clammy skin, or bluish lips 

The strength of heroin is unpredictable because other drugs, such as fentanyl, are sometimes added to increase volume or enhance potency. Heroin is one of the substances most frequently reported by medical examiners in drug abuse deaths.  

What is opioid withdrawal? 

Opioid withdrawal occurs as the body adjusts to a decrease or discontinuance in drug use. If you suddenly quit using the drug without medical supervision and support, the withdrawal effects can be difficult to manage. Withdrawal effects can even prevent some people with addiction from seeking help.  Opioid withdrawal symptoms include: 

• Restlessness 
• Muscle aches, pain, stiffness, spasms or bone pain 
• Insomnia 
• Diarrhea 
• Vomiting 
• Cold flashes with goose bumps 
• Involuntary leg movements 
• Agitation 
• Anxiety, panic 
• Itching 
• Irritability 
• Rapid heart rate 
• Mild hypertension 
• Runny nose 
• Sweating, shaking 
• Flu-like symptoms, fever 
• Yawning 
• Seizures 
• Sleep difficulties 
• Fear, paranoia 

What is the most-effective treatment for opioid addiction? 

Given the unique treatment and recovery issues associated with opioid use disorder—including challenging withdrawal symptoms and increased vulnerability to relapse and accidental death—Hazelden Betty Ford clinicians developed an evidence-based protocol that combines the use of certain medications, an extensive level of recovery support and follow-up care, and close monitoring of medication use. 

Known as Comprehensive Opioid Response with Twelve Steps (COR-12™), the approach is designed to provide you with a long enough time in treatment to begin forming healthy new practices and taking in new information essential to your recovery. This treatment program is delivered within the context of Twelve Step Facilitation and other evidence-based therapies (including integrated care for co-occurring mental health disorders, as appropriate), with abstinence from drug use as the ultimate goal. 

As part of our COR-12 treatment protocol, Hazelden Betty Ford physicians will work with you to determine the treatment course that best fits your clinical needs. What might this look like for you? 

• You could be admitted to inpatient drug rehab or outpatient drug rehab. 
• You could receive Suboxone®, a combination of buprenorphine and naloxone, during detox to ease withdrawal symptoms. 
• You could receive a recommendation for a monthly, extended-release injection of the medication Vivitrol®, also known as naltrexone, to block cravings and help prevent relapse. 

Although methadone is commonly used to ease opioid and heroin withdrawal, Hazelden Betty Ford provides buprenorphine instead, for a number of important reasons. Buprenorphine has been deemed a better medication for our patient population, in keeping with the goal of transitional use of medication-assisted treatment versus long-term medication maintenance. Learn more about methadone vs Suboxone (buprenorphine with naloxone) for treatment of opiate addiction and withdrawal. 

Here’s more background about our medication-assisted treatment program for opioid use disorder. 

For a deeper dive, you may also be interested in Prescription Painkillers: History, Pharmacology, and Treatment by Marvin D. Seppala, MD (Hazelden Publishing, 2010). You and your loved ones can also learn more about opioid addiction treatment and recovery in our What You Need to Know series.