What Type Of Treatment Can People Get For Addiction To Prescription Opioids
A range of treatments including medicines and behavioral therapies are effective in helping people with opioid addiction.
Two medicines, buprenorphine and methadone, work by binding to the same opioid receptors in the brain as the opioid medicines, reducing cravings and withdrawal symptoms. Another medicine, naltrexone, blocks opioid receptors and prevents opioid drugs from having an effect.
Behavioral therapies for addiction to prescription opioids help people modify their attitudes and behaviors related to drug use, increase healthy life skills, and persist with other forms of treatment, such as medication. Some examples include, cognitive behavioral therapy which helps modify the patient’s drug use expectations and behaviors, and also effectively manage triggers and stress. Multidimensional family therapy, developed for adolescents with drug use problems, addresses a range of personal and family influences on one’s drug use patterns and is designed to improve overall functioning. These behavioral treatment approaches have proven effective, especially when used along with medicines. Read more about drug addiction treatment in our Treatment Approaches for Drug Addiction DrugFacts.
What Is Drug Dependence
Drug dependence is when the way your body works changes because you have taken a drug for a long time. These changes cause you to have withdrawal symptoms when you stop using the drug. Withdrawal symptoms can be mild or severe, and may include:
If you have been taking a prescription opioid for a long time, work with your doctor. They can help you avoid withdrawal symptoms by gradually lowering your dose over time until you no longer need the medicine.
How Opioids Work In The Brain
Opioids are a powerful class of drugs used for the treatment of pain. Opioids also include illicit drugs that are not used to treat pain, such as heroin. In order to understand how opioids work, and what makes them so powerful, a little brain science is necessary.
Opioid and natural endorphin molecules compete to reach receptors on neurons.Once they attach to the receptors, pain signals are blocked.
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Ever Wondered How Opioids Affect The Brain
Perhaps youve wondered, how do opioids affect the brain? It seems like every time you turn around, you see news about opioids. You hear words like opioid epidemic and opioid crisis. The news talks a lot about addictions. They frequently mention the deaths. But how does a person get real information about opioid effects on the brain?
In this post, Harmony Treatment & Wellness assesses the following:
- What are opioids?
- How do opioids affect the brain?
- What is opioid use disorder?
- Do treatments exist for opioid use disorder?
- What if I want more information about opioids and the brain?
Definitions Of Key Terms
dopamine : A neurotransmitter present in brain regions that regulate movement, emotion, motivation, and the feeling of pleasure.
GABA : A neurotransmitter in the brain whose primary function is to inhibit the firing of neurons.
locus ceruleus : A region of the brain that receives and processes sensory signals from all areas of the body involved in arousal and vigilance.
noradrenaline : A neurotransmitter produced in the brain and peripheral nervous system involved in arousal and regulation of blood pressure, sleep, and mood also called norepinephrine.
nucleus accumbens : A structure in the forebrain that plays an important part in dopamine release and stimulant action one of the brains key pleasure centers.
prefrontal cortex : The frontmost part of the brain involved in higher cognitive functions, including foresight and planning.
ventral tegmental area : The group of dopamine-containing neurons that make up a key part of the brain reward system key targets of these neurons include the nucleus accumbens and the prefrontal cortex
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How Do Opiates Change The Brain
Opiate effects modify the way that the brain processes stress and pain. When the body becomes dependent on opioids, it can lose its ability to tolerate pain on its own. Research suggests that prolonged opiate use can reduce the bodys innate pain-fighting abilities. As a result, the person using opioids needs to rely on them to relieve pain. Due to this phenomenon, a person undergoing withdrawal can have increased feelings of pain.
When a person with an opioid dependence receives the normal amount of opioids for relieving pain, they dont experience the intended effects. Their brain needs an increased number of opioids to occupy all its receptors. Since opioid receptors regulate mood and emotion, prolonged opiate use can have a negative effect on these functions. The reliance on opioids to manage mood can make opiate use disorder more difficult to experience.
Opioid use may also have a link to mental health symptoms. People who have mental health conditions without knowledge of healthy coping skills have a higher chance of developing an addiction. When someone has an opioid use disorder because of their mental health, they are victims of a disease not a moral failure. They have an increased risk that we can address during treatment.
Why Do We Have Opioid Receptors
Morphine, an opioid naturally found in poppy plants, is chemically similar to a neurotransmitter in the brain called endorphins. Morphine was discovered in the 1800s. In the 1970s, scientists found a similar chemical in a cows brain and called it endorphins, which is short for endogenous morphine. Endorphins are responsible for regulating the bodys pain response. They bind to opioid receptors all over the body and block pain signals from being sent to and received by neurons.
This is designed to help you relax and recover from strain and injuries. Moderate-to-severe pain can get in the way of recovery, so more powerful opioids are used to manage it. Its unclear why poppy plants have chemicals that bind to receptors in humans and other animals. However, it is clear that these natural substances and the ones humans have created since can have a more profound effect on the human brain.
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How Does Chronic Opioid Use Affect The Brain
Opioids are a class of drugs that work by binding the opioid receptors in the central nervous system. Opioids fall into three categories: prescription opioids, heroin, and synthetic opioids. Due to the way opioids interact with the brain, they can have serious side effects. Unfortunately, these risks only increase the longer a person takes them.
Over time, a person taking opioids can develop tolerance, dependence, and addiction. Although these consequences are often misunderstood as the fault of the person taking the drug, they are actually the result of physiological changes in the brain. They can happen to anyone, even to those who take opioids as prescribed by a physician.
Brain Recovery From Opiates
Opioid use disorder acts as a chronic brain disease like depression or ADHD, meaning that it can become manageable with the right care. People with opioid addiction may need to manage their condition for the rest of their lives. However, like any other chronic disease, the symptoms can improve with treatment.
Doctors use methods like medication-assisted treatment to help the brain recover from opioid use disorder. MAT aims to satisfy the brains need for extra opioids and taper off its reliance over time. The MAT medications, methadone and buprenorphine, activate the opiate receptors. Since they take a longer time to absorb into the bloodstream than other opioids, they dont cause euphoria. These medications can also block the effects of opioid drugs, discouraging the patient from using them. As the patient recovers, their brain can heal from opioids effects.
MAT also involves counseling that helps the patient learn coping skills. During their therapy sessions, the patient challenges their thoughts and behaviors about opioids. Counseling lets the patient retrain their focus on lifes difficulties and fighting drug abuse. They can craft healthy methods to manage stress, emotions, and difficulties.
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Testing How Addiction Medicine Helps
Volkow aims to test 80 people, a mix of untreated heroin users and patients using different medication-based treatments, inside brain scanners at the National Institutes of Health’s research hospital. Her team is measuring differences in the brain’s ability to release dopamine as treatment progresses, and how the functioning of other neural networks changes in response as study participants do various tasks.
For example, does a patient’s brain remain fixated on “cues” related to drug use like seeing a picture of heroin or start reacting again to normal stimuli like the sight of a cupcake?
Another test: Ask if a patient would take an offer of $50 now, or $100 if they could wait a week, checking how much motivation and self-control they can muster.
Can The Brain Swing Back
As an opioid disorder progresses, a person needs a higher quantity of the drugs to keep withdrawal at bay. A person typically overdoses when they take so much of the drug that the brain stem slows breathing until it stops, Kosten said.
Many physicians have turned to opioid replacement therapy, a technique that swaps highly potent and addictive drugs like heroin with compounds like methadone or buprenorphine .
These substitutes outcompete heroin when they reach the opioid receptors, but do not activate the receptors to the same degree. By doing so, they reduce a persons chances for overdosing. These replacement medications also stick to the receptors for a longer period of time, which curtails withdrawal symptoms. Buprenorphine, for instance, binds to a receptor for 80 minutes while morphine only hangs on for a few milliseconds.
Science correspondent Miles OBrien discovers future pain treatments may rely on virtual reality.
For some, this solution is not perfect. The patients need to remain on the replacements for the foreseeable future, and some recovery communities are divided over whether treating opioids with more opioids can solve the crisis.
Plus, opioid replacement therapy does not work for fentanyl, the synthetic opioid that now kills more Americans than heroin. Kostens lab is one of many working on a opioid vaccine that would direct a persons immune system to clear drugs like fentanyl before they can enter the brain. But those are years away from use in humans.
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Can Opioid Addiction Be Prevented Or Avoided
Many people are able to use opioids safely without becoming addicted to them. But their potential for addiction is high. This is especially true if you use them for long-term pain management.
In general, you are more likely to avoid addiction if you can use opioid drugs no longer than a week. Research shows that using them for more than a month can make you dependent on them.
Contact Us Today To Overcome Opioid Abuse
Even though opioids can help relieve pain, they can also lead to addiction, change your brain, and cause several physical disorders and ailments. Our opioid treatment program can help you overcome opioid addiction and effectively manage pain. In addition to that, our unique approach to recovery can also help you:
- Revive your spirit
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Opioid Addiction Occurs When Dependence Interferes With Daily Life
An opioid use disorder is a clinical term used when a person develops a problem with opioids.
The term opioid addiction also refers to problematic opioid use. Addiction happens when a person keeps using substances even though they are causing problems in their lives. People who have an opioid use disorder are often addicted as well.
Tolerance Vs Dependence Vs Addiction
Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.
Drug dependence occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug.
Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs.
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Pharmacological Interventions And Treatment Implications
In summary, the various biological models of drug addiction are complementary and broadly applicable to chemical addictions. Long-term pharmacotherapies for opioid dependence and addiction counteract or reverse the abnormalities underlying those conditions, thereby enhancing programs of psychological rehabilitation. Short-term treatments for relieving withdrawal symptoms and increasing abstinence are beyond the scope of this article instead, we refer readers elsewhere for detailed neurobiological explanations of the various nonopioid-based abstinence initiation approaches such as clonidine and clonidine-naltrex-one for rapid detoxification .
The medications most commonly used to treat opioid abuse attach to the brain cells mu opioid receptors, like the addictive opioids themselves. Methadone and LAAM stimulate the cells much as the illicit opioids do, but they have different effects because of their different durations of action. Naltrexone and buprenorphine stimulate the cells in ways quite distinct from the addictive opioids. Each medication can play a role in comprehensive treatment for opioid addiction.
The Opioid Pendulum: When Feeling Good Starts To Feel Bad
Opioid addiction becomes entrenched after a persons neurons adapt to the drugs. The GABAergic neurons and other nerves in the brain still want to send messages, so they begin to adjust. They produce three to four times more cyclic AMP, a compound that primes the neuron to fire electric pulses, said Thomas Kosten, director of the division of alcohol and addiction psychiatry at the Baylor College of Medicine.
That means even when you take away the opioids, Kosten says, the neurons fire extensively.
The pendulum swings back. Now, rather than causing constipation and slowing respiration, the brain stem triggers diarrhea and elevates blood pressure. Instead of triggering happiness, the nucleus accumbens and amygdala reinforce feelings of dysphoria and anxiety. All of this negativity feeds into the prefrontal cortex, further pushing a desire for opioids.
While other drugs like cocaine and alcohol can also feed addiction through the brains pleasure circuits, it is the surge of withdrawal from opioids that makes the drugs so inescapable.
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How Do Opioids Work
Opioids work by attaching themselves to proteins in the body called opioid receptors in the brain, spinal cord, intestinal tract, and other parts of the body. There are 3 types of opioid receptors in the human body:
- Mu receptors, which help regulate mood, pain, and reward triggers. When opioids attach themselves to mu receptors, they can relieve pain, provoke mood changes, trigger physical dependence, and cause respiratory changes.
- Delta receptors, which help regulate mood. When activated delta receptors produce analgesia, or the inability to feel pain.
- Kappa receptors, which help manage mood and reward responses. When opioids activate kappa receptors, they can relieve pain and increase urination. At the same time, kappa receptors can trigger dysphoria, a state of uneasiness and dissatisfaction, which can trigger the desire for more opioids.
As opioids attach themselves to opioid receptors in the body, they can block pain messages sent from the brain to the body. By doing this, opioids diminish the perception of pain, which is how opioids seemingly relieve pain. Unfortunately, opioids also interfere with the brains reward system, disrupting many of the brains delicate processes and vital functions.
Living With Opioid Addiction
The first step toward recovery is recognizing that you have a problem with opioids. If you think you are addicted to them, know that there is help for you. The first step in breaking addiction is realizing that you control your own behavior.
The following steps will help you fight your addiction:
- Commit to quitting. Take control of your behavior and commit to fighting your addictions.
- Get help from your doctor. They can be your biggest ally, even if youre trying to quit a drug they prescribed. Your doctor may be able to prescribe medicine that will help ease your cravings for the addictive drug. Talking with your doctor or a counselor about your problems and your drug use can be helpful, too.
- Get support. Certain organizations are dedicated to helping people who have addictions. They want you to succeed and will give you the tools and support you need to quit and move on with your life. Ask your family and friends for support, too.
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Prescription Opioids And Heroin
Prescription opioids and heroin are chemically similar and can produce a similar high. In some places, heroin is cheaper and easier to get than prescription opioids, so some people switch to using heroin instead. Data from 2011 showed that an estimated 4 to 6 percent who misuse prescription opioids switch to heroin1,2,3 and about 80 percent of people who used heroin first misused prescription opioids.1,2,3 More recent data suggest that heroin is frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported heroin as the first opioid they used regularly to get high.4
This suggests that prescription opioid misuse is just one factor leading to heroin use. Read more about this intertwined problem in our Prescription Opioids and Heroin Research Report.
Cognitive Emotional & Social Issues
Chronic opioid abuse leads to damage that will affect other areas of life.
- Potential cognitive issues can occur associated with the effects of the drug and the alterations occurring in the CNS. These can include problems with attention, memory, judgment, and even physical movement due to brain damage.
- Individuals with opioid use disorders are often diagnosed with some other co-occurring mental health disorder, such as major depressive disorder, trauma- and stressor-related disorders, and anxiety disorders.
- Issues with relationships, employment, school, finances, and freedom can result from chronic opioid use.
Research has suggested that individuals who have chronic opioid use disorders:
- Demonstrate lower levels of achievement in life
- Report lower levels of overall life satisfaction
- Have far lower life expectancies
- Have higher rates of criminal convictions and incarceration
- Demonstrate significantly higher rates of serious medical problems
- Have higher rates of divorce, unemployment, and suicide attempts
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