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Opioid Pain Relievers: The Basics 

August 07, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

This is the first in a series of articles about opioid painkillers. Although opiate overdoses (especially heroin) are frequently in the news, how much do you actually know about these medications? Over the next several weeks, the Risky Business column will outline basic information about these helpful and potentially dangerous drugs.

Pain is the most common reason people seek medical treatment. In fact, 100 million Americans have chronic pain and many are treated with opioid painkillers, some for long periods of time.

Every year nearly 15,000 people in the United States die from an overdose involving prescription painkillers such as hydrocodone and oxycodone, the main narcotic ingredients in Vicodin, Percocet, and Oxycontin. 

During the past decade the misuse and abuse of opioid pain medications has been the fastest growing drug problem in the United States. This epidemic parallels the huge increase in the number of prescriptions written for opioid medications during the same time period.

Opioid painkiller misuse/abuse is defined as the use of an opioid medication different than the way for which it was prescribed (for example, in higher doses) or for reasons other than why it was prescribed (for example, to get high).

The following is from the National Institute on Drug Abuse and is appropriate information to share with your teen and preteen. 

If you’ve ever seen The Wizard of Oz, then you’ve seen the poppy plant—the source opioids. When Dorothy lies down in a field of poppies, she falls into a deep sleep. No wonder the Latin name of this plant—papaver somniferum—means “the poppy that makes you sleepy.”

Opioids can be made from opium, which comes from certain poppy plants (that mainly grow in Southeast Asia and the Middle East), or they can be made in a lab. Either way, they can be helpful medications—they are used as powerful painkillers, they are sometimes prescribed to control severe diarrhea, and they can also be found in cough medicine. 

Commonly used opioid medications include hydrocodone, oxycodone, morphine, codeine, and related drugs. Hydrocodone and oxycodone products are the most commonly prescribed drugs for a variety of painful conditions, including dental and injury-related pain. Morphine is often used before and after surgical procedures to alleviate severe pain. Codeine, on the other hand, is often prescribed for mild pain. In addition to their pain-relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) for example—can be used to relieve coughs and severe diarrhea.

What’s in a name? The following are the brand and generic names of some opioids commonly prescribed locally:

  • Percocet is oxycodone + acetaminophen (Tylenol)
  • Vicodin is hydrocodone + acetaminophen (Tylenol)
  • Oxycontin is long-acting oxycodone 

But opioids used without a prescription, or taken in other ways or for different reasons than the doctor prescribed, can be dangerous and addictive. Many people who use heroin first became addicted to an opioid painkiller. Heroin is a powerful opioid that is not used as a medication; it’s used to get high.

How Do Opioids Work?

Opioids look like chemicals in your brain and body that attach to tiny parts on nerve cells called opioid receptors. Scientists have found three types of opioid receptors: mu, delta, and kappa (named after letters in the Greek alphabet). Each of these receptors plays a different role. For example, mu receptors are responsible for opioids’ pleasurable effects and their ability to relieve pain. 

Opioids act on many places in the brain and nervous system, including:

  • The limbic system, which controls emotions. Here, opioids can create feelings of pleasure, relaxation, and contentment
  • The brainstem, which controls things your body does automatically, like breathing. Here, opioids can slow breathing, stop coughing, and reduce feelings of pain.
  • The spinal cord, which receives sensations from the body before sending them to the brain. Here too, opioids decrease feelings of pain, even after serious injuries.

Whether it is a medication like Vicodin or a street drug like heroin, the effects of opioids (and many other drugs) depend on how much you take and how you take them. If they are injected, they act faster and more intensely. If opioids are swallowed as pills, they take longer to reach the brain and are much safer.

Generally, peak effects of opioids are reached in 10 minutes if the medication is given intravenously—30-45 minutes with an intramuscular injection, and 90 minutes by mouth.

How Does Someone Become Addicted to Opioids?

Long-term use of opioid drugs changes the way nerve cells work in your brain. This could happen to if you take opioids for a long time to treat pain, as prescribed by your doctor. Your nerve cells grow used to having opioids around, so that when they are taken away suddenly, the you can have lots of unpleasant feelings and reactions. These are known as withdrawal symptoms. Many teens and young adults who become addicted to opioids were treated for pain caused by a sports injury or following a significant dental procedure, such as having their “wisdom” teeth pulled.

Have you ever had the flu? You probably had aching, fever, sweating, shaking, or chills. These are similar to withdrawal symptoms, but withdrawal symptoms can be much worse.

That is why use of opioids should be carefully watched by your health care provider—so that a you know how much to take and when, as well as how to stop taking them to lessen the chances of withdrawal symptoms. Eventually, your cells will work normally again, but that takes time.

Someone who is addicted to opioids has other symptoms as well. For example, they cannot control how much drug they take, even though it may be having harmful effects on their life and their health. They have strong urges to take the drug—called cravings—and they no longer feel satisfied by natural rewards (like eating a fresh lobster roll, watching a movie, or a walking on the beach at sunset).

Your brain makes its own versions of opioids, called endogenous opioids. These chemicals act just like opioid drugs, attaching to opioid receptors in your brain. Endogenous opioids help your body control pain. If you’ve ever felt pleasantly relaxed after exercising a lot, that feeling was probably caused by the release of these natural chemicals (sometimes called “endorphins”) in your brain.

Upcoming articles will look at ways that you can interact with your doctor and dentist when dealing with pain; how to communicate with your kids about the subject of prescription pill misuse and abuse; and prevention and early intervention of opioid addiction.

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