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The Opioid Crisis in America
The opioid epidemic has been ravaging America for nearly 30 years. Everywhere you turn, there’s another tragic headline detailing the horrors of opioid abuse and addiction. While deaths are skyrocketing lately due to easy access to opiates, there has been a dark side to these pain-killing substances throughout American history. This latest epidemic is but one in a series of troubling periods of human suffering and death in America resulting from the abuse of opiates, going as far back as the arrival of the Mayflower in the 1620s.
History and Prevalence of Opiates
While it might feel like this crisis is new, opiate use and addiction is, in many ways, as American as apple pie. It goes as far back as the Pilgrims, who brought over a substance known then as laudanum; a substance derived from the opium in poppy plants. Since then, opiates have been commonplace in the medical care due to their potent pain-relieving properties. Beginning in the 19th century, most opiates became controlled substances at the federal level, although the drugs remained in common usage both medically and recreationally. In the 60’s and 70’s, there was a resurgence of opiate addiction as new synthetic opioids began to enter the market and, later, as a result of heavy illegal heroin importation from Asia.
While opiate addiction has always tugged at the frayed edges of American culture, it has recently entered official “epidemic” territory. An estimated 30 million people abuse opiates worldwide, with approximately 2.1 million addicts living within the U.S. As a result of a recent growing numbers of users, overdose deaths are surging, having quadrupled since 1999. This surge in opiate use and overdose affects many sectors of our population, especially adolescents and women. In young people, this surge is often attributed to the volume of prescriptions being written for opioids, nearly doubling over the past decade. Women are far more likely to be prescribed pain relievers in higher doses and they tend to use them for longer periods than men. 48,000 women died of prescription pain reliever overdoses in the past decade.
Outward Symptoms of Opiate Use
Opiate addiction is often a highly visible condition and includes patterns of both physical symptoms and aberrant behavior which are easily detected. Physical symptoms include:
Obvious elation and/or euphoria.
Significant sedation and sleepiness.
“Nodding off” or losing consciousness unexpectedly, or at inappropriate times.
When people begin to abuse opiates, there are also a number of changes in the way they act. In order for addicts to continue to stay high and support their habit, they will likely begin to engage in any of the following behaviors:
Doctor shopping, i.e. visiting different doctors to get several prescriptions.
Moodiness; rapidly and dramatic shifts in temperament.
Paraphernalia, including pill bottles, spoons, foil, needles, etc.
Withdrawing from social settings, friends, and family.
Financial difficulties, which can lead to stealing or asking for money frequently.
Typical Cost to the Opioid Addict
When measuring the total “cost” of an opiate addiction, one must account for much more than the monetary cost of the drugs themselves. While supporting an opiate habit is expensive and can cause addicts extensive problems, the price of addiction costs much more than money.
Many addicts begin using opiates with a prescription. During this time, if they have insurance, the drugs are often relatively inexpensive. Once their addiction goes beyond the scope of a doctor’s supervision, however, the street price causes the drug’s price to jump significantly. On the street, an addict’s supply can go up by 10-13 times. For drugs which can cost $40-100 per bottle with a prescription, these pills rapidly become unaffordable. As a result, many addicts will switch to the more dangerous heroin, which, while still costly, can be purchased for much less, closer to $20 per dose.
Effect of Opiates on the Addict
Opiates are extremely powerful drugs with a singular clinical purpose. Obviously, they should never be used outside of a medical setting or without professional supervision. Once an addict begins to self-medicate with opiates, the impact of these drugs can be extremely dangerous. When an opiate addict is inebriated, the primary effects will be a sensation of profound calm and euphoria, along with insensitivity to pain, sleepiness, and a slowed respiratory system.
Opiates also affect the brain. One of the primary actions of opiate painkillers (and heroin) is to prevent the brain from releasing a naturally occurring chemical called GABA. This chemical is responsible for controlling the flow of dopamine (the pleasure signal). When this chemical can flow freely, it creates the powerful rush of euphoria for which opiates are known. On the other side of this, particularly after prolonged periods of addiction, this begins to change the brain chemistry and can lead to issues like depression and other mood disorders.
The longer an addict abuses opiates, the more likely they are to experience severe and potentially deadly side effects. Users may begin to experience agitating symptoms like muscle spasms, cardiovascular problems (heart attacks, etc.), and even death. Opiates are the leading cause of overdose in the United States, with more people dying from opiates than any other drug.
Permanence and Relapse of Opioid Use
Opiate addiction is one of the most difficult substance problems to treat effectively. More than 90% of opiate addicts can be expected to experience at least one relapse during the course of recovery. Most of these relapses occur early on in the recovery process, but relapses can occur at any point in a person’s life.
There is no one reason for relapse among heroin and opiate addicts. Addicted individuals have altered and damaged what is called the mesolimbic system of the brain. This area of the brain is responsible for pleasure and reward. As opiates warp this area of the brain, most addicts find that they need the drug to experience any kind of pleasure or well-being at all. Without the drug, they suffer from an ongoing sense of depression or anxiety. Given enough time, most addicts are able to fully overcome this change in their brain chemistry, but it is often a long and challenging process.
Most addicts are unable to recover without a defined period of abstinence and separation from their drug of choice. This can occur within a hospital or a dedicated rehab facility. Many medical professionals consider this necessary for the intense cravings of early recover to subside. After this, most addicts find that therapeutic sessions, 12-step programs and religious programs can be very helpful.
Opiate withdrawal is a well-documented phenomenon and is the stuff of legends and nightmares among the addict community. As always, the severity of these symptoms is dictated by how long and how much a person was using.
Withdrawal symptoms include:
In particularly severe withdrawal episodes, addicts will also suffer more pronounced symptoms, which include:
Withdrawal from heroin and other opiates is not inherently medically dangerous, and many addicts attempt to detox in their own home. While this may technically be “safe”, the cravings often make this an inadvisable course. During withdrawal, cravings can become so intense that addicts find themselves unable to follow through with the recovery process. Medical settings offer other advantages, namely opiate detox drugs (e.g. methadone, suboxone, etc.) which can moderate some of the withdrawal symptoms and prevent some of the cravings.
Physical and Mental Difficulty of Recovery from Opiates
Recovering from most severely addictive drugs, like opiates, is a long and difficult road. Once the opiate addict is clear of the initial phase of withdrawal and detox, they will almost always require a great deal of recovery and support thereafter.
Relapse rates for opiate users are very high. Throughout much of their early recovery, most addicts will experience overwhelming cravings which become nearly impossible to ignore on their own. To ease this, some opiate recoveries include a tapering protocol during which addicts will use diminishing doses of methadone, buprenorphine, naltrexone, or naloxone.
These drugs reduce an addict’s cravings without producing the euphoric and debilitating high of opiates themselves.
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