Opiates – Withdrawal Symptoms, Addiction and Treatment

How do you build a Tolerance to Opioids?

A person who takes opiates for a long enough period will likely develop opioid (opiate) tolerance. The body adapts to the presence of the drug, resulting in a decrease in its effectiveness over time.

Tolerance is a desensitization of the opioid receptors leading to an increased feeling of pain and a need for a higher dose. Another cause of tolerance is when the opiate receptors have been internalized by the cell itself; this is called endocytosis, a condition marked by a decrease in opioid binding sites that are available to provide pain relief.

Long-term opiate use can be dangerous because it can lead to dependence, addiction, and overdose. Opiate-induced tolerance can underlie all of these issues because as tolerance develops, patients need increasingly higher doses of the drug to achieve analgesia. A person who is suffering from chronic pain just wants relief. They may not think about the effects of long-term opioid use and potential risks.

Another condition that may overlap with opioid tolerance is opioid-induced hyperalgesia. Prolonged use of opioids leads to a paradoxical increase in pain despite increases in drug dosage.

Increased sensitivity to pain can happen to anyone taking any dosage of an opioid. It’s important that patients not increase their dosage without talking to a doctor.

Symptoms of Addiction and Overdose

Opioids are unrivaled when it comes to pain management, but many risks accompany them. These narcotic drugs can be habit-forming and may lead to physical and/or psychological dependence. These are medications for moderate to moderately severe pain, or when discomfort that persists around the clock.

Abuse

The compulsive use of opiates or any purpose outside the label’s instructions can constitute abuse. Most people don’t set out to become addicted to their medication. In fact, most people become “accidental addicts” after taking prescription medication for a legitimate condition.

Oxycodone, Percocet, and Fentanyl are among the most prescribed drugs and also among the most abused. Once the regular use has caused a tolerance, the drug becomes ineffective at producing the intended effects. At this point, many people decide to escalate their use.

Other forms of abuse include breaking, crushing or otherwise disturbing the medication to cause rapid release of the medicine. Abuse can damage your health, ability to function in everyday life, while ruining careers and relationships.

What is an Opioid Addiction?

Opiate addiction is a central nervous system disorder, caused by continuous opiate intake. Opiates elicit their powerful effects by activating opiate receptors throughout the brain and body. Two significant results produced by opioids are the pleasure (or reward) effects and pain relief. The rush of pleasure and/or relief from pain is so strong and powerful; it can lead to opiate abuse and addiction.

The brain itself produces substances known as endorphins (the body’s natural painkiller) that activate the opiate receptors. They are involved in respiration, nausea, vomiting, pain modulation and hormonal regulation.  After prolonged opiate use, the nerve cells in the brain, which would otherwise produce these endogenous opiates, cease to function normally. The body stops producing endorphins because it is receiving opiates instead. The degeneration of these nerve cells causes a physical dependency on an external supply of opiates. Abrupt or sudden abstinence from opiates induces yet another traumatic disorder – withdrawal syndrome.

How do Opioids and Opiates Affect your Brain?

Findings from animal research indicate that, like cocaine and other abused drugs, opiates can also activate the brain’s reward system. When a person injects, sniffs or orally ingests heroin (or morphine), the drug travels quickly to the brain through the bloodstream.

Because of its chemical structure, heroin penetrates the brain more quickly than other opiates on the list, which is probably why many addicts prefer heroin.

Once in the brain, the heroin is rapidly converted to morphine, which then activates opiate receptors located in the VTA, nucleus accumbens and cerebral cortex. Once the pleasure circuit is activated, great amounts of dopamine are released within the nucleus accumbens. This phenomenon causes an intense euphoria, or rush, that lasts only briefly while relaxation and contented state can last longer. Furthermore, the excessive release of dopamine and the stimulation of the reward system can lead to opiate abuse and addiction.

Opioid Addiction VS Dependence

Although sometimes used interchangeably, the terms “addiction” and “dependency” describes two separate things. Opiate dependence does not always entail opiate addiction.

Compiling the research from The National Institute of Health, The American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine, one can create a general definition for each:

Addiction: Addiction is a primary, chronic, neurobiological disease. Genetic, psychosocial and environmental factors influence its development and manifestations. Opiate addiction is characterized by behaviors that include: impaired control over drug use, compulsive use, craving and continued use despite adverse and dangerous consequences.

Physical dependence: Physical dependence is a state of adaptation that is manifested by withdrawal syndrome. It can be produced by abrupt cessation, rapid dose reduction, decreasing the blood level of the drug and/or the administration of an antagonist. Physical drug dependence means a person needs the substance to function and can have intense cravings.

Opiate addiction is a disorder often caused by an untreated condition. It is known to have a strong potential for relapse because if the real issue does not receive the adequate treatment,  a person may fall back into old patterns of drug use and abuse. Opiates are extremely potent drugs with a particularly high relapse rate. Strong cravings and withdrawal symptoms can trigger relapse when not well managed, even after a period of abstinence.

Symptoms of an Opioid Overdose

One should always be cautious when using prescription medications. Warnings and precautions are available on the label or through your pharmacist. Labels often spell out risks, including overdose, and give guidelines for avoiding further risks. Opiate overdose can be fatal, so it’s important to take these medications exactly as prescribed. Patients who overdose on opiates almost always do so accidentally after one escalates use due to tolerance to the drug.

However, overdose can also be intentional for those using it recreationally to achieve a state of euphoria. The risk of fatal overdose is high among this group, especially those people who combine opioids with other substances to heighten effects.

Opioids are central nervous system depressants. They slow respiration, which can lead to serious health complications including cardiac arrest, coma, and death. All users must be aware of overdose symptoms and how to obtain emergency medical assistance.

Symptoms of overdose can include:

• Dizziness
• Faintness
• Nausea
• vomiting
• Feeling of cold
• Clammy skin
• Slowed heart rate
• Difficulty breathing

If the overdose is recent, doctors may induce vomiting, pump the stomach or use, activated charcoal so the body doesn’t absorb the drug. An antidote may also be given to counteract the effects of an opioid overdose.

Opioid Withdrawal Symptoms and Risks

One of the most challenging aspects of recovery from opiate addiction is the withdrawal process. Many of our patients want to know what to expect from the opiate withdrawal process. However, no two people have the same withdrawal experience. The timeline for opiate withdrawal depends on a variety of factors and differs between individuals. That is why effective treatments for opiate addiction cannot take a “one size fits all” approach. Understanding the typical symptoms of opiate withdrawal can help you make informed decisions about your treatment.

Drug addiction does not develop overnight. Opiates — whether heroin or prescription painkillers — exert their effects by crossing the blood-brain barrier and acting on specific brain areas. The opiate molecules bind to particular receptors in the limbic system of the brain, which is responsible for processing rewards and emotional information. When these receptors are activated, they trigger the “rush” or euphoric sensations experienced by opiate users.

Over time, however, the brain becomes numb to the effects of opiates and tolerance is built. It takes more and more of the drug to achieve the same effect. When the drug is no longer present, and the body does not get its usual dose, the result is a collection of physical and psychological symptoms.

Withdrawal Symptoms

Opiate withdrawal symptoms typically start within a few hours of the drug leaving the bloodstream. They peak between 5 and 10 days. The severity and duration of the opiate withdrawal symptoms can depend on the length of opiate dependence, dosage, metabolism, the drug of choice and other factors.

Most people have no residual symptoms after a few weeks, although some people have reported experiencing a post-acute withdrawal syndrome (PAWS) that lasts up to a few months. Many individuals in the recovery community have commonly described PAWS. However, the Diagnostic and Statistical Manual of Mental Health Disorders, or any other significant medical association, do not recognize it.

Withdrawal Risks

Going “cold turkey” can be dangerous for some opiate users. Patients run the risk of severe dehydration or elevated blood pressure. Furthermore, opiate withdrawal can cause heart irregularities that may be dangerous for patients with certain chronic medical conditions. Professional medical attention is suggested to keep one safe during the opiate withdrawal process. For example, medical detox protocols help remove opiates from your system and safely manage withdrawal symptoms.

Perhaps one of the most prominent disadvantages of going “cold turkey” is the high likelihood of relapse, and due to the extreme discomfort of withdrawal, some might not even complete the process. Professional medical detox is more likely to result in a positive, safe, and effective way to obtain an opiate-free life. The Waismann Method ® located exclusively in Southern California has successfully treated thousands of patients and medically assisted them in overcoming opiate withdrawal symptoms.