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Opiods
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Definition
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The Opioids are a class of controlled pain-management drugs that contain natural or synthetic chemicals based on morphine, the active component of opium. These narcotics effectively mimic the pain-relieving chemicals that the body produces naturally.
Opioids are the most often prescribed pain-relievers because they are so effective. Moreover, many studies have shown that opioid analgesic drugs are safe and rarely cause clinical addiction or compulsive usage if taken as directed.
Morphine, heroin, codeine and related drugs are among the opioids. Morphine is frequently prescribed to alleviate severe pain after surgery. Codeine can be helpful in soothing somewhat milder pain, as are oxycodone (OxyContin, an oral, controlled-release form of the drug), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid) and meperidine (Demerol), which is used less often because of its side effects. Diphenoxylate or Lomotil can also relieve severe diarrhea, and codeine can ease severe coughs.
Opioids act by attaching to a group of proteins called opioid receptors, found in the brain, spinal cord and gastrointestinal tract. When these drugs link to certain opioid receptors in the brain and spinal cord they can block the transmission of pain messages to the brain.
Medication for pain may be taken in a variety of ways. The preferred method is by mouth, since medication taken orally is convenient and usually inexpensive. When this method cannot be used, medication may be taken rectally or through patches placed on the skin. Intravenous methods are used only when easier and cheaper methods are not available. Patient-controlled analgesia (PCA) pumps are sometimes used to allow the patient to deliver the drug into veins, skin or the spine. Intraspinal administration is especially helpful for patients who do not respond to pain medications delivered by the other methods or who experience extreme side effects.
Patients may find that they develop tolerance to opioid pain medications and may need to have their doses increased in order to be effective. Tolerance has not been shown to lead to drug addiction in patients who take opioid drugs for medical reasons. Physical dependence on opioid pain medications does not seem to occur in cancer patients. Once the pain disappears (usually through the effective treatment of cancer), these patients can discontinue the pain medicine without difficulty.
Steady use of opioids can result in tolerance to the drugs so that higher doses must be taken to achieve the same effects. Long-term use also can lead to physical dependence—the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly.
Symptoms of withdrawal can include muscle and bone pain, insomnia, vomiting, cold flashes with goose bumps ("cold turkey"), involuntary leg movements, diarrhea and restlessness.
Adjuvant Drugs: Other drugs may be given with the pain medication for increased effectiveness. These drugs include corticosteroids, anticonvulsants, antidepressants, local anesthetics and stimulants.
Opioids are only safe to use with other drugs under a physician's supervision. It is wise to avoid using them with alcohol, barbiturates, antihistamines or benzodiazepines. These drugs slow down breathing, and their combined effects could result in life-threatening respiratory depression.
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Symptoms
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In addition to relieving pain, opioid drugs can affect regions of the brain that mediate what we perceive as pleasure, resulting in the initial euphoria that many opioids produce. Taking a large single dose could cause severe respiratory depression or be fatal.
Common side effects of opioids include constipation, sleepiness, nausea and vomiting, clouded thinking, respiratory problems, gradual overdose, sexual dysfunction. Some of the milder side effects may be avoided by adjusting the time when doses are taken, such as taking them after a meal, or at bedtime if a person is experiencing nausea or sleepiness. Constipation may be lessened by drinking more fluids, eating high-fiber foods, or taking a laxative (which should be approved or prescribed by the patient's doctor). Patients should talk to their doctor if side effects become too troubling.
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Causes
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Many people view drug abuse and addiction as strictly a social problem. Parents, teens, older adults and other members of the community tend to characterize people who take drugs as morally weak or as having criminal tendencies. They believe that drug abusers and addicts should be able to stop taking drugs if they are willing to change their behavior.
These myths are damaging for individuals with drug-related problems, their families, their communities and the health-care professionals who work with them.
Addiction does begin with drug abuse, but addiction is not just "a lot of drug use." Recent research provides strong evidence that not only do drugs interfere with normal brain functioning by creating powerful feelings of pleasure, but they also have long-term effects on brain metabolism and activity. At some point, changes occur in the brain that can turn drug abuse into addiction. Those addicted to drugs suffer from a compulsive craving and need treatment to end the compulsive behavior.
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Treatment
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Drug addiction is a treatable disorder. Through treatment that is tailored to individual needs, patients can learn to control their condition and live normal, productive lives. Those in treatment for drug addiction, like people with diabetes or heart disease, learn behavioral changes and often take medications as part of their recovery program.
Behavioral therapies can include counseling, family therapy, psychotherapy or support groups. Treatment medications help to suppress withdrawal symptoms and drug cravings and to block the effects of drugs. In addition, studies show that treatment for heroin addiction using methadone at an adequate dosage level combined with behavioral therapy reduces death rates and many health problems associated with heroin abuse.
Results tend to be better when more treatment is given. Many patients require other services as well, such as medical and mental health services and HIV prevention services. Patients who stay in treatment longer than three months usually have better outcomes than those who stay less time. Patients who go through medically assisted withdrawal without any further treatment perform about the same in terms of their drug use as those who were never treated. Studies over the last 25 years have shown that treatment reduces drug intake and crimes committed by drug-dependent people. Researchers also have found that drug abusers who have been through treatment are more likely to have jobs.
Medication
Methadone, a synthetic opioid that blocks the effects of heroin and other opioids, has been used for more than 30 years to eliminate withdrawal symptoms and relieve drug craving.
Other medications include LAAM (levo-alpha-acetyl-methadol), an alternative to methadone that blocks the effects of opioids for up to 72 hours. Naltrexone is a long acting opioid blocker often used with highly motivated individuals in treatment programs promoting complete abstinence, and also to prevent relapse.
Naloxone counteracts the effects of opioids and is used to treat overdoses.
Types of Treatment Programs
The ultimate goal of treatment is lasting abstinence, but the immediate goals are reduction of drug use, improvement of the patient's ability to function, and diminishing the medical and social complications of drug abuse.
There are several types of drug abuse treatment programs. Short-term methods last less than six months and include residential therapy, medication therapy and drug-free outpatient therapy. Longer-term treatment may include, for example, methadone maintenance outpatient treatment for opiate addicts and residential therapeutic community treatment.
In maintenance treatment for heroin addicts, patients are given an oral dose of a synthetic opiate, usually methadone hydrochloride or levo-alpha-acetyl methadol (LAAM), administered at a dosage sufficient to block the effects of heroin and yield a stable, noneuphoric state free from physiological craving for opiates. In this stable state, the patient is able to disengage from drug-seeking and related criminal behavior and, with appropriate counseling and social services, become a productive member of his or her community.
Outpatient drug-free treatment encompasses a wide variety of programs for patients who visit a clinic regularly. Most of the programs involve individual or group counseling. Patients entering these programs are abusers of drugs other than opiates or are opiate abusers for whom maintenance therapy is not recommended, such as those who lead well-integrated lives and have only brief histories of drug dependence.
Therapeutic communities (TCs) are highly structured programs in which patients stay at a residence, typically for 6 to 12 months, where the focus is on the resocialization of the patient to a crime-free, drug-free lifestyle. Patients in TCs include those with relatively long histories of drug dependence, involvement in serious criminal activities and seriously impaired social functioning.
Short-term residential programs, often referred to as chemical dependency units, are often based on the "Minnesota Model" of treatment for alcoholism. These programs involve a 3- to 6-week inpatient treatment phase followed by extended outpatient therapy or participation in 12-step self-help groups, such as Narcotics Anonymous or Cocaine Anonymous. Chemical dependency programs for drug abuse arose in the private sector in the mid-1980s with insured alcohol/cocaine abusers as their primary patients. Today, as private provider benefits decline, more programs are extending their services to publicly funded patients.
Methadone maintenance programs are usually more successful at retaining clients with opiate dependence than are therapeutic communities, which tend to have greater success than outpatient programs that provide psychotherapy and counseling. Within various methadone programs, those that provide higher doses of methadone (usually a minimum of 60 mg) have better retention rates. Those that provide other services, such as counseling and medical care, along with methadone, generally achieve better results than the programs that provide minimal services.
Drug treatment programs in prisons can succeed in preventing a return to criminal behavior, particularly if the patient is involved in a community-based program that continues treatment after he or she has left prison. Some of the more successful programs have reduced the re-arrest rate by one-fourth to one-half. For example, the "Delaware Model," an ongoing study of comprehensive treatment of drug-addicted prison inmates, shows that prison-based treatment including a therapeutic community setting, a work release therapeutic community\ and community-based aftercare reduces the probability of re-arrest by 57 percent and reduces the likelihood of returning to drug use by 37 percent.
Drug abuse has a high economic impact on society—an estimated $67 billion per year. This figure includes costs related to crime, medical care, treatment programs, social welfare programs and time lost from work. Treatment of drug abuse can reduce those costs. It costs approximately $3,600 per month to leave a drug abuser untreated, and incarceration costs approximately $3,300 per month. In contrast, methadone maintenance therapy costs about $290 per month. Overall, studies have shown that from $4 to $7 are saved for every dollar spent on treatment.
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Sources
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- National Cancer Institute National Institutes of Health
- U.S. Department of Health and Human Services National Institute on Drug Abuse
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Copyright © 2003-2010. Cognode, Inc.
All Rights Reserved .
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