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Health and Disease

Understanding the Opioid Crisis in the United States

Opioids are a group of psychoactive chemicals which affect our body in various ways. Find out about their side effects and get a brief overview of the history of their use in the United States.

By Rhoda Kasin

Published 3:09 PM EST, Wed May 12, 2021

What are Opioids? 

The term ‘opioids’ is used to describe a large group of psychoactive chemicals. There are 3 major forms of opioids; Natural Opiates, Semi-Synthetic Opioids, and Fully Synthetic Opioids. 

Opiates are natural because they are created by the opium Poppy Plant. Opiates include morphine, thebaine, and codeine. Semi-Synthetic Opioids such as hydromorphone, hydrocodone, oxycodone, and heroin are made in laboratories from the natural opiates. Fully Synthetic Opioids like fentanyl, pethidine, levorphanol, methadone, tramadol, and dextropropoxyphene are completely man-made in the lab.

How do they work? 

When taken, opioids flow through your blood and attach themselves to opioid receptors located on nerve cells in the brain, spinal cord, and other neural body parts. Once secured, they block pain transmissions sent from the body into the brain. When the receptors are activated however, they also produce hormones such as dopamine which decrease pain and increase pleasure feelings. 

The regular use of opioids over a long period of time increases the body’s tolerance and dependence, equating to higher and frequent doses. Generally they are safe pain relievers when taken for a short period of time, but since they reduce pain and generate feelings of euphoria, they are easily misused. These euphoric feelings cause a drive build up to constantly chase the pleasure which causes addiction. 

History of Opioids in the US

According to the CDC, opioid overdoses have been grouped into 3 waves. First wave being the Prescription Opioid Wave, followed by the second Heroin Wave, then the third Synthetic Opioid Wave. 

The first wave started in the late 1990s, with reassurance by pharmaceuticals to the medical community, claiming that opioids were not addictive. Of course this led to an increase in its prescription and therefore a rise in misuse and abuse of prescribed and non-prescribed opioids. Making it clear that they were in fact, extremely addictive. The second wave began in 2010, where there was an abrupt increase in overdose deaths involving the opioid drug Heroin, which is made from morphine, an opiate. Significant increases in deaths that involved synthetic opioids in 2013 marked the start of the third wave. This was also the start of illicit manufactured fentanyl (IMF), one of the main causes of the wave’s deaths. 

Drug overdose death count still remains high today in the United States. The year 2019 alone, saw close to 71,000 drug overdose deaths which involved an opioid. Meaning that more than 70% of all drug overdoses in the country, a majority, involved the use of an opioid. Of these 70% overdose deaths, close to 73% included Synthetic Opioid use. 

Side Effects of Opioids 

As stated before, opioids are types of drugs which help to reduce pain. However, they are easily misused when prescribed to a patient for treatment. The patient may take the drug in an unprescribed way such as a higher dosage. Another person may take the patient’s prescription medication. The drug may also be taken for the purpose of attaining a ‘high’. Feelings of drowsiness, nausea, constipation, confusion and slow breathing are among the negative effects opioids have on the body. Slowed breathing could cause Hypoxia; where only a small amount of oxygen gets to the brain. This could lead to permanent brain damage, coma or death. 

Withdrawal symptoms that are experienced by those addicted to opioids include cold flashes and goosebumps, severe cravings, muscle pain, bone pain, etc. Since these are uncomfortable symptoms to go through, it makes the process of trying to stop opioid use difficult. 

Pregnant women taking prescription opioids may cause their babies to develop Neonatal Abstinence Syndrome. The syndrome occurs when the baby is exposed to a specific drug during pregnancy. When they are born, they experience withdrawal symptoms such as tremors, seizures, breathing problems, blotchy skin, diarrhea, vomiting, stuffy nose and others. Babies born with NAS are also at risk for other complications such as Jaundice, low birthweight or SIDS (sudden infant death syndrome). Long-term problems such as developmental delays, behavior and learning difficulties, sleep problems, vision problems, ear infections, and more are also possible due to NAS. 

Types of Addiction Treatment 

Naloxone, a type of medicine that when given right away can treat an opioid overdose. Other medications such as Methadone and Buprenorphine help reduce cravings and withdrawal symptoms. Naltrexone, another medication, helps to prevent the opioid drug from achieving an effect . Behavioral therapies such as Cognitive Behavioral Therapy alters drug use expectations and behaviors of the patient as well as managing their stress and triggers. Proven effective when used with medicines is Multidimensional Family Therapy. It was developed for adolescents and helps address personal and family influences on the patient’s drug use patterns, thus allowing an improvement in their overall functioning.

Rhoda Kasin, Youth Medical Journal 2021

References

American Society of Anesthesiologists. “What are Opioids.” American Society of Anesthesiologists, https://www.asahq.org/madeforthismoment/pain-management/opioid-treatment/what-are-opioids/. Accessed 27 April 2021.

CDC. “Opioid Overdose : Opioid Basics.” Center for Disease Control and Prevention, 16 March 2021, https://www.cdc.gov/drugoverdose/opioids/index.html. Accessed 28 April 2021.

CDC. “Opioid Overdose : Understanding the Epidemic.” Center for Disease Control and Prevention, 17 March 2021, https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed 28 April 2021.

HHS. “What is the US Opioid Epidemic.” US Department of Health and Human Services, US Department of Health and Human Services, 19 February 2021, https://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed 27 April 2021.

Johns Hopkins Medicine. “Opioid Addiction.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/opioids/what-are-opioids.html. Accessed 27 April 2021.

March of Dimes. “Neonatal Abstinence Syndrome (NAS).” March of Dimes, 2019, https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx. Accessed 30th April 2021.

Mayo Clinic, and Carrie Krieger. “What are opioids and why are they dangerous?” Mayo Clinic, 21 March 2018, https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/expert-answers/what-are-opioids/faq-20381270. Accessed 27th April 2021.

NIH. “Opioids.” National Institutes on Drug Abuse, https://www.drugabuse.gov/drug-topics/opioids. Accessed 28 April 2021.

NIH. “Prescription Opioids DrugFacts.” National Institute on Drug Abuse, May 2020, https://www.drugabuse.gov/publications/drugfacts/prescription-opioids. Accessed 28 April 2021.

NIH, and Sara Bellum. “Real Teens Ask : What are the Different Types of Opioids?” NIH : National Institutes on Drug Abuse, 16 July 2014, https://archives.drugabuse.gov/blog/post/real-teens-ask-what-are-different-types-opioids-0. Accessed 27 April 2021.

By Rhoda Kasin

Rhoda Kasin is a dual enrolled student at Northwood High School in Silver Spring, MD and Montgomery College in Rockville, MD. She has not finalized which areas of health she would want to get into, however she is currently interested in radiology and neurology.

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