Written by Gabriella Ip, Edited by Han Trieu, Edited by Courtney Coleman
Introduction
Opioid drugs are a class of narcotic pain medication that doctors prescribe when an over-the-counter pain reliever is not enough to make a patient feel better. Doctors usually prescribe opioids for patients who have pain after surgery or cancer treatment, an incurable illness, severe trauma, or chronic pain conditions. Since these prescription drugs are strong to treat severe pain, they pose significant health risks when misused.¹
Causes of Opioid Use Disorder
Opioid addiction/opioid use disorder (OUD) often starts with a prescription.¹ People can misuse prescriptions by: taking the medicine in a different way or dosage other than instructed, taking someone else’s prescription, or taking the medicine to get a high feeling.² The most commonly known prescription opioids are morphine and fentanyl.² To put the severity of opioids in perspective, the law makes it illegal to possess any fentanyl, unless a doctor administers it in a clinic with a prescription.⁷ The misuse of opioids, whether it be legal, illegal, stolen, or shared, is the reason why an average of 90 people in the U.S. die daily. OUD is a feeling to continue using opioids, even if it causes harm to the body. Opioids are highly addictive, especially since they trigger the release of endorphins (feelings of euphoria). This disorder is fairly common since the more a person uses opioids, the stronger their tolerance is. It becomes harder for their body to feel the pleasure, so users find a way to supply themselves with higher and more doses.³
Risks of Opioid Use Disorder
Opioids are dangerous when users take them in a different way other than instructed, such as crushing a pill for it to be snorted or injected into the body. These rapid delivery methods will lead to significantly increased risks of accidental overdose.³ After five days of taking opioids, anyone is susceptible to addiction. In the short term, opioids can alleviate pain for patients. But, like any other medication, there are normal side effects such as drowsiness, confusion, nausea, constipation, and slowed breathing. With opioid misuse, however, there are greater concerns with slowed breathing–such as hypoxia, which is when there is too little oxygen reaching the brain. Hypoxia can have psychological and neurological effects, including a coma, permanent brain damage, or death as an extreme.² There are also risks for recovering users since there are withdrawal symptoms. There’s not only fever and diarrhea, but elevated heart rate, high blood pressure, and insomnia. Users who are recovering after a long period of opioid misuse can experience worse chronic pain as a withdrawal symptom.⁴
Medication-Assisted Treatment (MAT) for Opioids
Users recovering from opioid substance abuse can use medications in order to reduce the withdrawal symptoms and cravings of euphoria from the opioid. The most popular prescription medications approved for recovery are methadone, buprenorphine, and naltrexone.⁵ These medications reduce any risks of infectious disease transmission while lowering the chances of overdose mortality.⁶
Methadone
Methadone is an opioid agonist, meaning it works by activating the same receptors in the brain that opioids do. However, they do this in a safer and controlled way, since it only provides enough stimulation to reduce cravings and withdrawal symptoms without causing the same euphoric effects as other opioids. This helps people manage their addiction while lowering misuse.⁵ This medication has been used since 1947 as a reliable form of treatment. Previous research proved how methadone was effective in reducing opioid use, opioid use-associated transmission of infectious disease, and crime. There were other positive statistics from studies that showed how patients on methadone had 33% fewer opioid positive drug tests and were 4.44 times more likely to stay in treatment.⁶
Buprenorphine
Buprenorphine is similar to methadone since it can also reduce cravings and withdrawal symptoms without producing any further euphoria. Previous research has found it to be as effective when given with the right dose and duration. It comes in a tablet and film form, after being approved in 2002.⁵ All the different forms of buprenorphine are effective for treatment, but studies show higher relapse rates for patients gradually taken off of the medication compared to those who remain on the drug for a longer period. However, some doctors are cautious and prescribe lower doses for short treatment times, which can lead to treatment failure. So, in order to be effective, this medication must be given at a sufficiently high dose.⁶ Despite this, doctors still prescribe this medication since it has been proven that buprenorphine and methadone are equally effective at reducing opioid use; there were no differences in opioid-positive drug tests when treated with methadone or medium/high doses of buprenorphine.⁵
Naltrexone
Naltrexone is slightly different from methadone and buprenorphine since it is an opioid antagonist; it attaches to the same receptors, but doesn't activate them, which prevents opioids from working properly. As a result, a person taking opioids while taking naltrexone won’t feel the same euphoria as they would before medications. This helps stop the craving and reduces relapses.⁶ After being approved in 2010, naltrexone became accessible as an injection. This injection form became ideal for patients who don’t have access to health care or struggle taking medications on a regular basis, as its effects last for weeks. It is also an option for doctors to prescribe a combination of multiple medications. The NIDA (National Institute on Drug Abuse) conducted a study that showed that a combination of buprenorphine with another drug commonly known as narcan (used to reverse opioid overdoses) are just as effective as naloxone in treating opioid use disorder. ⁵
Conclusion
In conclusion, Medication-Assisted Treatment (MAT) is essential for treating opioid use disorder. Abundant evidence supports how methadone, buprenorphine, and naltrexone are all effective in reducing opioid use, withdrawal symptoms, and risks of infectious disease transmission related to drug abuse. These three treatments also increase retention rates, which is essential. These are the preferred methods of recovery in the eyes of healthcare providers.
References
Watson S. Opioid Drugs: Dosage, Side Effects, and More. WebMD. Published September 22, 2023. https://www.webmd.com/pain-management/narcotic-pain-medications
National Institute on Drug Abuse. Prescription opioids drugfacts. National Institute on Drug Abuse. Published June 2021. https://nida.nih.gov/publications/drugfacts/prescription-opioids
Mayo Clinic. How Opioid Addiction Occurs. Mayo Clinic. Published November 29, 2023. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372
Cleveland Clinic. Opioid Use Disorder: What It Is, Symptoms & Treatment. Cleveland Clinic. Published October 4, 2022. https://my.clevelandclinic.org/health/diseases/24257-opioid-use-disorder-oud
Medications to Treat Opioid Use Disorder.; 2018. https://irp.nida.nih.gov/wp-content/uploads/2019/12/NIDA-Medications-to-treat-opioid-use-disorder_2018.pdf
National Institute on Drug Abuse. How Effective Are Medications to Treat Opioid Use disorder? National Institute on Drug Abuse. Published 2021. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder
Angeles L. Fentanyl Laws in California. Cronisraelsandstark.com. Published 2024. https://www.cronisraelsandstark.com/fentanyl-laws-california
This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on December 24, 2024.
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