Opioids: The Pathway from Prescription to Addiction

Anyone prescribed an opioid pain reliever medication is at risk for developing an addiction. The opioid epidemic continues to ravage rural and metropolitan communities alike across the United States, even as various government agencies, such as the Department of Health and Human Services (HHS), invest billions of dollars toward research, prevention, and treatment.

Commonly Prescribed Opioids

Opioids are so named because of the active chemical structure of these medications, which bind to opioid receptors on neurons and other cells that make up the Central Nervous System (CNS). Opioids initiate chemical signaling between cells in the CNS that blocks pain signals, fosters a sense of relaxation, and can produce euphoria.

The primary indication for prescribing opioid medications is to treat severe and chronic pain, but physicians may also prescribe opioids to treat coughing and diarrhea associated with the flu or pneumonia. Among the most commonly prescribed medications are:

  • Hydrocodone (Vicodin, Lortab, TussiCaps). Tablets, capsules, syrups that are typically combined with acetaminophen
  • Codeine (Tylenol with Codeine or Brontex). Tablets, capsules, syrups that are typically combined with acetaminophen combined with aspirin or acetaminophen
  • Morphine (Kadian, Roxanol, or Avniza). Capsules or oral solution
  • Oxycodone (OxyContin). Tablets
  • Fentanyl (Actiq, Fentora, or Duragesic). Lozenges, nasal sprays, sub-lingual tablets, or transdermal patches

Physicians typically prescribe morphine, oxycodone, and fentanyl – medications far more potent than opioids mixed with acetaminophen or aspirin – for serious conditions, such as cancer or end of life care. They prescribe hydrocodone and codeine – as well as oxycodone combined with acetaminophen (Percocet) – for short periods of time after surgery, typical injuries (more than a sprain, less than a broken bone or torn ligament/tendon), sports injuries, or severe coughs associated with the flu or pneumonia.

The Pathway from Use to Misuse of Prescribed Opioid Medications

Opioid medications play a valuable role in healthcare when prescribed by physicians for short-term use and dosages suitable for ameliorating mild, moderate, or severe pain. In some case, opioids are the only treatment for individuals with severe, chronic pain, and require long-term use.

Whether a physician prescribes opioid medications for short or long-term, patients can nonetheless develop an opioid addiction. Following a physician’s prescription -including the proper dose – does not safeguard anyone from becoming addicted. The decision to prescribe or not prescribe opioid pain relievers – or to taper or discontinue use – should be made on a case-by-case basis, after consultation between the prescribing physician and the patient.

Individuals become chemically dependent on medications once the body develops tolerance, which in turn requires higher dosages for the same effects. Dependency to medication, or chemical substances, can be detected in withdrawal symptoms that emerge when they stop taking the drug. For example, many Americans who consume coffee, tea, or other caffeinated beverages are likely to develop withdrawal symptoms, including headaches, irritability, and sleepiness, when they do not consume caffeine for a few days.

Those symptoms tell people they’re physically addicted to caffeine.

Opioid medication withdrawal functions the same way, but the withdrawal symptoms can be far more dramatic and painful. Some common symptoms of opioid withdrawal include:

  • Muscle cramps and spasms
  • Nausea and vomiting
  • Anxiety
  • Insomnia
  • Excessive sweating

Addiction to a medication occurs when individuals become not only physically dependent but also begin to engage in obsessive behavior related to seeking the medication despite risks to their job, family, or health.

Part of the explanation for how and why people move from proper opioid medication use to misuse lies in the fact that these medications release the neurotransmitter dopamine, which motivates and reinforces goal-seeking behavior directed either toward achieving pleasurable states or avoiding painful ones.

Opioid misuse is a pleasure-seeking behavior insofar as the medications block pain, alleviate stress and painful emotions, and produce powerful feelings of well-being or euphoria. Opioid addiction, on the other hand, may emerge in cases where individuals take opioids not to relieve injury or illness related pain, but to avoid the unpleasant symptoms of withdrawal.

Role of Prescription Opioids in the Opioid Crisis

Over the past two decades, public health scientists, policymakers, law enforcement, and mental health providers have identified an opioid epidemic because of the high opioid-related overdose rates deaths. The drivers of this epidemic are in fact prescription opioid medications, specifically newer synthetic opioid medications, such as fentanyl, which be up to 100 times more potent than older, naturally occurring opiates.

The Center for Disease Controls and Prevention (CDC) reports that the rate of overdose deaths from prescription opioid medications increased 5 times from 1999 to 2017.  47,600, or 67.8%, of all overdose deaths in 2017 involved opioids.  The CDC further reports that every day 1,000 people are treated by emergency rooms for opioid overdoses and every day 42 people die from opioid overdoses.

This steady increase in overdose deaths has continued despite decreasing prescription rates for opioid medications since 2012 when 259 million opioid prescriptions were written. That year, that was enough for every American to have two prescription opioid medications in their home at any given time.

Getting on a Pathway to Recovery

Continued investment in awareness campaigns concerning the highly addictive nature of opioid medications – even in cases where patients strictly follow physicians’ advice – are critical to addressing the opioid epidemic. So too are investments in treatment, especially any funds allocated toward providing greater access to treatment of opioid use disorder (OUD).

For those worried about the pathway to addiction, understanding risk factors is a smart first step. Among risk factors associated with the development of OUDs that begin with prescription opioid medications are:

  • Getting prescriptions from more than one physician treating the same pain issue
  • Taking larger doses of prescription medications than prescribed
  • Taking recreational drugs alongside prescription medications
  • Drinking alcohol at the same time as taking prescription opioids

For those who currently live with an OUD, seeking treatment and support is the best option. An opioid treatment program can help break the cycles of addiction, restore balance, and return to a life of their choosing.