Anatomy of Opioid Addiction

Anatomy of Opioid Addiction

Learn how addiction happens and how to stay clean.

In 2016, the most recent year for which we have data, the number one cause of accidental death wasn’t drownings, falls or even car accidents—it was drug overdoses. It’s estimated there were about 64,000 that year, with around 42,000 related to fentanyl, heroin or another opioid painkiller. That’s a significant spike from the year prior, when just over 33,000 died from overdosing on opioids.

From government agencies to national network news, many are calling the US opioid problem an epidemic. Children learn at a young age to stay away from heroin, so how did this happen? And what’s to be done?

How opioid addiction usually starts
“Between 75 and 85 percent of people started out with a prescription from a healthcare provider,” says Mark Cardillo, LCSW, program director for behavioral health and addictions at Tampa Community Hospital in Tampa, Florida. In a 2014 study published in JAMA, three quarters of the 1,600 people who began abusing opioids in the 2000s and two thirds of the 286 who’ve been using since 2010 started with a prescription.

Another 2017 study looked at 13,000 Medicaid recipients aged 64 and under who died of an opioid overdose between 2001 and 2007. More than 60 percent were diagnosed with chronic pain in the year leading up to their deaths, and about half of those people filled prescriptions for opioids in the month prior.

Healthcare providers wrote 259 million opioid prescriptions in 2012, according to the Centers for Disease Control and Prevention (CDC)—that’s enough for every adult in the US. While doctors have been urged to prescribe fewer painkilling narcotics—and prescriptions have fallen somewhat in recent years—the CDC says they still roughly tripled between 1999 and 2015.

“There may be some genetic predisposition,” says Cardillo. “You also have a segment that may turn to drugs and alcohol because they have some issue, like trauma or their upbringing. In order to escape they turn to drugs. Another group has some sort of mental disorder, and use drugs to deal with that. Usually there’s some component in their lives that pushes them to addiction.”

Why opioids are so addictive—and deadly
Snorting, swallowing or shooting heroin or another opioid not only dulls the sensation of pain, but also causes a feeling of intense euphoria. That's not all; opioids affect parts of the brain that influence a number of body functions beyond pain sensation and pleasure, including the breathing instinct. If you take too many opioids, you may stop breathing.

Your body naturally produces opioids, but when you flood it with opioids from an outside source, it adapts to having extra from that outside source. When you stop putting outside opioids into your body, the body’s natural levels of opioids are no longer enough, and you go through withdrawal. That’s called dependence.

Withdrawal symptoms include agitation, anxiety, muscle aches, insomnia, diarrhea, nausea and vomiting, among others. Many people, even those with the best of intentions, will go right back to using opioids once withdrawal symptoms hit.

Getting clean and staying clean
According to Cardillo, the first stage of recovery is detox, or getting the drug out of the system and going through withdrawal. “You just have to get the drug out of your system, so you can think clearly.” Detox takes between five and seven days, says Cardillo, but it could take up to a month before you start feeling normal.

“Once you tackle that, you work on the psychological part,” Cardillo says. “You’re educating the person on the importance of 12-step programs, changing people, places and things.”

Cardillo says that the biggest mistake people recovering from an opioid addiction make is “not changing the people, places and things that will put them in situations where they’re going to use again.” Not embracing therapy is another stumbling block. “Therapy can be painful, so the first instinct is to go back to using. The reality is that drugs and alcohol work. You take them and you don’t have to think about your trauma.”

"You have to be extremely diligent to maintain sobriety”, says Cardillo. “Most people say you go into recovery, not necessarily that you’re cured. People may have been in recovery for 30 years, but they’re not cured. Any day something could trigger them and make them start using again. They have to take it one day at a time.”

Medically reviewed in January 2019.

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