Imagine strapping yourself onto a new roller coaster ride, only to discover that you will never be able to get off of it. That is what heroin and prescription opioids can be likened to, and why they are so addictive and so potent that a one-time thrill ride can leave someone hooked for life.
How opioids interact with the body
Opioids are derived from opium and are a type of pain medication. They are essentially chemicals that bind to receptors in the brain, central nervous system and gastrointestinal tract. The receptors are called “opioid receptors” because they produce a bodily response to opioids. The human body has several opioid receptors in muscle tissue, as well. In fact, most of the body’s opioid receptors are found in muscle tissue, according to Dr. Kirk Luder, a psychiatrist at Washington and Lee. Luder said that once people start taking opioids, the number of opioid receptors multiplies very quickly and in turn, their tolerance also increases. As people’s tolerance grows, they need to take more opioids to achieve the same effect.
“If you stop taking [opioids] after a relatively short time, these opioid receptors that your body has created are empty and they start screaming at you,” Luder said. “They want to be filled with opioids.”
That is when nasty withdrawal symptoms like muscle cramping, abdominal pain and diarrhea occur. Cramping is a common symptom simply because of the prevalence of opioid receptors in muscle tissue.
With opioids, physical dependence occurs much more quickly than with any other substance, according to Luder. He said that withdrawal symptoms can bee seen in as little as three days after someone stops taking opioids. Dr. Jane Horton, director of student health and counseling services at W&L, said that once people’s tolerance levels reach a certain point, they feel as though they need to take opioids just to get through daily activities.
“You develop cravings for those drugs and the brain develops tolerance, so it takes higher doses for you to feel the high,” she said. “And eventually you have to take them just to feel normal.”
The spiral of addiction
Most medical professionals agree that heroin addiction usually stems from prescription opioids. People are often given narcotic prescription painkillers, like hydrodone or oxycodone, after a major surgery or an accident. After their pain subsides, some people continue to take the painkillers because they enjoy their euphoric effects. However, prescription opioids are often expensive and hard to obtain, so people switch to heroin because it is a cheaper alternative that delivers the same results.
Horton said that approximately 80 percent of heroin abuse stems from prescription opioids. She also said that heroin is much more dangerous than other opioids because its purity and strength are not regulated on the street. This puts people at an incredibly high risk of overdose because they don’t know how much heroin they are actually consuming.
Ann-Ashby McKissick, a member of the Rockbridge Area Community Services board and a licensed pharmacist, said that some drug dealers mix heroin with things like talcum powder in order to get more “bang for [their] buck.” She said that savvy drug dealers might still market their heroin as pure, even though it contains various additives.
“[Dealers] will get whatever they can to mix with [heroin] and they don’t care,” she said. “It’s just about the money.”
McKissick said that once people are addicted to heroin, they reach a point where they want to quit but cannot.
“They hate the withdrawal [and] they hate what they’ve become, but it has such a hold on them,” she said. “It’s a chemical disease, not an emotional disease.”
According to McKissick, pure heroin much stronger today than it was 40 or 50 years ago. In the 1960s and 1970s, heroin was less than 10 percent pure, whereas today it is usually close to 60 percent. Additionally, fentanyl, one of the most common additives in heroin, escalates its potency. Fentanyl is a synthetic opiate that is more powerful than morphine. It is typically used to treat patients with high levels of pain and depending on the amount, it can be lethal when combined with heroin.
Are some people more likely to become addicted than others?
Medical professionals warn that, just as with alcohol, some people might be more likely to become addicted to heroin or prescription opioids than others. However, according to Horton, it’s hard to predict who they will be. Luder agreed, but said that often the people drawn to heroin or prescription opioids are the ones who have anxiety and depression and who like the exhilarating effects of the drug.
“One of the risk factors of opioids is having mental health problems,” he said. “People who are feeling emotionally bad usually [take the drug to] feel better.”
Up until last November, Luder ran a private practice in the area, and he works at the Rockbridge Area Community Services for a few hours each week. In his work at these two locations, he said that the majority of heroin abusers he has treated have been young men.
Drugs used to treat heroin addiction
This drug is sold under the brand name of Narcan and is an opioid antidote. This means that it blocks the effects of opioids and can reverse an overdose. More specifically, once someone is given naloxone, the opioids will be removed from the opioid receptors in the brain. It essentially reverses the depression of the central nervous system and respiratory system as a result of opioids. After receiving naloxone, the overdose victim should be able to breathe more easily and it should be easier to wake him or her. It works in about two minutes when given intravenously and in about five minutes when injected into a muscle. Nalaxone also comes as a nasal spray. Multiple doses might be required, depending on the amount of opioids in one’s system. The Virginia Drug Task Force is working to make naloxone more accessible to first responders throughout the state. However, the drawback is that first responders must be trained in administering Nalaxone and some also view it as an enabler drug.
This drug is sold under the name Subutex and is a “partial opioid agonist.” An agonist is a drug that activates certain receptors in the brain. This means that Buprenorphine partially activates the opioid receptors in the brain, which results in a partial opioid effect. The FDA approved this drug in 2002, which has expanded access to treatment and has eliminated many people’s needs to go to a treatment clinic. According to Luder, this drug is controversial because of its dual properties.
“That’s a medication that simultaneously blocks and activates opioid receptors,” he said. “What’s controversial about it that it [has] opioid effects so that people who take it feel an opioid-like effect from it. A lot of people who are active in recovery believe it is not a legitimate way to recover.”
This drug is a slow-acting opioid agonist, meaning that its effects are not instant. It is taken orally and once it reaches the brain, it reduces the high that occurs from opioid consumption and it also prevents withdrawal symptoms. Methadone has been used since the 1960s and is only available through approved outpatient treatment programs.
Are prescription opioids the best way to treat pain?
Luder said that physicians need to be more educated about the negative effects of prescribing opioids and that they need to be more judicious in determining which patients truly need them. Horton also said that prescribers should think more “carefully about [using] opioid medication” and that they need to be mindful of how much they prescribe and when they prescribe it. She said that people should also receive more education about the risks of non-prescription opioid use. McKissick said that, in her opinion, prescription opioids are not the best way to treat pain initially.
She said that Tylenol, aspirin or Motrin would be the best first line of defense and then patients could switch to opioids if absolutely necessary. She also said that since most emergency rooms, physicians and nurse practitioners are incredibly busy, they might view opioids as a quick fix for patients’ pain. She also related that problem to patients in that some of them might not want to “start low and go slow with pain management.” Additionally, in 2014, the American Medical Association formed a drug task force that works to educate physicians about prescribing opioids and to enhance access to treatment for addicts.
What can be done?
Luder, Horton and McKissick all stressed the importance of educating the public and especially youth about the consequences of opioids. They said that most college-aged students don’t fully understand the gravity of any drug, much less opioids.
“Teens really don’t discriminate the risks between weed and painkillers,” Luder said.
However, he conceded that the majority of teens view drug education as “propaganda” and that talking with teens in a more candid way would be most beneficial. McKissick echoed Luder’s ideas by saying that society needs to use a more empathetic approach in talking to teens about drugs instead of using a judgmental one. Horton also said that she has found peer-to-peer messaging to be an effective tool in educating teens about the dangers of prescription opioids and heroin.
During their time at W&L, both Luder and Horton said that heroin abuse among students has been rare. They each said that they have only seen a couple of students who have struggled with heroin abuse. Alcohol, they agreed, is by far the most abused drug on campus, and it is followed by marijuana. They said that more attention must be given to those two drugs, since their consequences can be just as detrimental as those of heroin.