What are Opiates?
Opiates definition: Opiate is a classical term used to describe substances synthesized from opium. Opiates are a group of alkaloid compounds that occur naturally in the opium poppy plant. This plant, known scientifically as Papaver somniferum, has been in use as a narcotic since the ancient Sumerians began documenting history.
Today, opiates are a class of both naturally-occurring and restricted synthetic drugs widely used as prescription drugs for the management of a broad range of conditions. Opiates are also the most abused prescription drugs on the market today. The Substance Abuse and Mental Health Services Administration in a National Survey on Drug Use and Health found that in 2016, over 11 million Americans abused prescription opioids. Opiate addiction has also risen to become an epidemic not only in the United States but across the developed world.
What are the Types of Opiates?
Opioid vs. Opiates
While both terms are frequently used interchangeably, the difference between opiates and opioids is worth noting. While the term opiate is a classical term used to refer to substances derived directly from opium, the opioid is a more modern term that describes drugs that have a similar action to that of opium as opposed to their origin. Opioids have therefore come to refer to any drug that binds to opioid receptors in the brain, both agonists and antagonists, regardless of how they are synthesized. Opioids and opiates are classified as narcotics, although drug enforcement agencies around the world have adopted the term to mean any illegal drugs.
Types of Opiates
While opiates started off as a class of strictly naturally-occurring substances, today the term is used widely to refer to all kinds of opiate-like drugs that have the same effect on the opioid receptors of the person taking them. This effect is a general depression of the Central Nervous System, a hallmark feature of most abused drugs. The synthesis of multiple drugs around the central effect of opiates has been occasioned by the numerous medical advantages of manipulating opioid receptors across various centers of the body including Central Nervous System (CNS) and the Autonomic Nervous System (ANS), both of which encompass structures such as the brain, spinal cord and the gastrointestinal tract (GIT).
Following are some of the most popular opiate drugs in circulation today.
First synthesized in 1832, codeine is the most widely-taken opiate in this list. On the World Health Organization’s List of Essential Medicines, the drug is mostly used for the treatment of mild to moderate pain, coughs, and diarrhea.
Technically known as dextropropoxyphene, this analgesic drug also in the opiate family has been taken off the European and US markets due to its propensity to result in fatal overdoses. The drug has antitussive and local anesthetic effects and is also sold under the trade names of Darvon, Di-Gesic, Darvocet-N, among others.
Also known as pethidine or meperidine, Demerol is the tradename for a type of drugs belonging to the phenylpiperidine class of synthetic opiate drugs. The analgesic is used to treat moderate to severe pain and is administered either as tablets or by injection.
Trade name for hydromorphone, Dilaudid is a morphine-based drug used as pain medication and administered in hospital settings. Also known as dihydromorphinone, the substance is typically taken as a sublingual dose (under the tongue) and shares the same effects as those of its more-potent analogs heroin and morphine.
Fentanyl is another potent drug in the opiate family that has potent analgesic and anesthetic effects. Dose-to-dose, Fentanyl is about 75 times more potent than morphine. Some Fentanyl analogs have been found to be as much as 100,000 more potent than morphine.
Technical term dihydrocodeinone, this semi-synthetic drug is synthesized from codeine. The drug is primarily used in the United States with up to 99% of all word supplies being consumed in the country. Hydrocodone is used in the treatment of moderate to severe pain, as well as cough suppression.
Sold as Dolophine, methadone is one of the opiates used as a therapeutic drug in opiate addiction rehabilitation. This is due to its relatively short half-life and quick synthesis and elimination in the liver. Methadone is primarily taken orally and rarely via intravenous administration.
Morphine is a naturally-occurring opiate taken for the treatment of both acute and chronic pain. After taking morphine, effects typically take 20-60 minutes to kick in and last for between 3 and 7 hours. The depressive effect of the drug on the CNS make it a respiratory failure risk factor in people who take it.
Synthesized from thebaine, oxycodone is a moderately potent semisynthetic opiate that is one of the drugs currently at the center of the opiate epidemic in the United States. The easy availability of its constituent compounds makes it easy to synthesize without sophisticated equipment.
A popular pain medication that comes combined with paracetamol, Tramadol is useful in the treatment of moderate to moderately severe pain. The drug does, however, come with serious side effects with prolonged use. These include seizures, serotonin syndrome and drug addiction.
The Signs and Symptoms of Opiates Use
Opiates abuse is a major concern in the United States today. Owing to the legal status of most prescription opiate drugs, ease of abuse and subsequent addiction, the drug has been classified as an epidemic by the U.S. Department of Health and Human Services. The DHHS found that 11.5 million people in the US misused opiates in 2016. Of this number, 42, 249 died from an opiate overdose. To understand the problem better, signs of opiate use must be better recognized and better identified in people at risk of forming the habit. Signs and symptoms of opiate abuse can be classified into psychological signs and physiological signs.
Psychological and Behavioral Signs
A person abusing opiates will over time develop drug-seeking tendencies. These are characterized by actions the person is willing to take to obtain the drugs. One of the primary ways this is achieved is through multiple prescriptions from different doctors. People with this tendency will travel great distances to find a doctor who can prescribe the drug to them.
This refers to an unnatural appetite for opiates. Persons struggling with opiates abuse symptoms will often have intense cravings for the drug. When this happens, they will take any drug that is of the opiate family, regardless of the type or purpose. These cravings are magnified when the person is unable to get the drugs and can lead to the next sign, criminal behavior.
When legal avenues of getting the drug are exhausted, a person hooked to the drug will begin employing illegal means of obtaining the drug. These may start as misrepresenting symptoms to the doctor and gradually progress to more dangerous forms of criminal behavior. Also, such persons may also resort to more violent means of acquiring money to purchase the drugs.
Physiological and Physical Signs
Starting off, low doses will induce the necessary high the person using is seeking. However, tolerance quickly builds up and the dose needed begins to spike. Recognizing a person’s need for higher doses of opiates is a sure sign that they have formed a habit. This habit is technically known as opioid use disorder and is the anchor sign of opiate addiction.
When a person takes an opiate, they experience euphoria and a sense of tranquility or what is known as a high. Once the drug wears off, they resort to sadness and a feeling of lethargy. Persons who alternate between being euphoric and moody with lethargic tendencies may be abusing opiates.
Suddenly stopping the drug will in short order give rise to withdrawal symptoms. However, because it is relatively easy to get even low doses of the substance, persons abusing the drug may find it easy to hide this sign. Admission to a rehab center is the only sure way to bring out these symptoms and establish the level of addiction.
Long-term and Short-term Side Effects
Dangers of Opiate Abuse
Opiate abuse develops when a person using the drug either recreationally or as a prescription medication develops a tolerance to the drug. It leads to the need for higher doses of the drug to achieve the same effect. While most people think addiction happens to those using it recreationally, statistics show that prescription-level doses can have the same physical effects of opiates being taken recreationally. With prolonged use, the physiological effects of opiates become magnified, leading to addiction and concomitant opiates side effects.
Short-term Side Effects
When a person takes opiates, the resulting euphoria may be accompanied by a sense of altered reality. That will frequently exhibit as a disassociation with the environment and a general sense of confusion. This is dangerous especially in hazardous situations where the person may be in danger and cannot perceive this danger.
Opiates cause nausea and in hospital settings, are frequently given together with anti-nausea medication. A person taking the drug covertly may not have the luxury of taking these add-on drugs and so will have to endure debilitating nausea. An outcome of this is the people on the drug will also suffer from a lack of appetite, leading to reduced eating habits and subsequent malnutrition.
If unable to control nausea, the person will suffer from vomiting. Opiate-related vomiting is caused by gastric stasis or the lack of standard movement in the gut. This is preceded by nausea and desire to relieve that nausea through vomiting. The substance has also been shown to act directly upon the vomiting center of the brain, triggering this symptom.
A person taking the drug will find there are details they cannot remember from when they were on the drug. These memory gaps are especially problematic when they involve vital information such as that pertaining to a crime. The person may also forget less critical but equally essential information like an assignment due date or an appointment.
The action of depressing the CNS gives the person a sense of calm and quiet. An adjacent effect is a feeling of sleepiness and a lack of awareness of what is going on around them. This can be dangerous if the person is operating heavy machinery or is driving. Drowsiness also reduces the overall productivity of the person.
Long-term Side Effects
Opiate-induced constipation (OIC) affects 90-95% of long-term users. Owing to persistent gastric stasis, a person on the drug for prolonged periods will suffer from illness with no improvement over time. This often means that long-term users must also take laxatives to stimulate a bowel movement.
Persons will experience impaired sexual function as a long-term side effect of taking opiates. Because of the impact the drug has on hormonal balance in the body, the healthy sexual function becomes affected resulting in sexual dysfunction. This symptom can result in impaired sex life and other social problems.
Depletion of serotonin levels, also known as serotonin syndrome can lead to persistent depression even after going off the drug. Owing to the repeated and abnormal release of serotonin and other neurotransmitters, brain reward pathways can get scrambled leading to an inability to naturally regulate these mood-regulating neurotransmitters, with the outcome becoming clinical depression.
Addiction is a broad term that relates to psychosocial reliance on the drug. When addiction sets in, a person will adjust their lifestyle to accommodate the habit. The result may be increased financial spending on the drug, reclusiveness and social separation and isolation, etc. Dependence is the precursor for addiction, which is a chemical addiction on a drug.
Persons abusing opiates also expose themselves to immunodeficiency with long-term use. This results from malnutrition, frequent mixing of the drug with other drugs, and a general lack of focus on healthy lifestyle habits. The result is a depressed immunity, which may lead to infections such as TB and HIV.
Opiate Overdose: What is Next?
Increases in opiate abuse have resulted in an increase in overdose cases. According to the Centers for Disease Control, in 2015, opiate overdose was responsible for 33,091 deaths in the United States. That represented an increase of 15.6 percent from the previous year. Most of these cases were related to a heroin overdose as well as the use of synthetic opiates besides methadone. These include drugs such as Fentanyl and Tramadol. The leading factor here is that this class of synthetic opiates are many orders higher in potency than traditional opiates. The result is rising overdoses and related fatalities.
How Much Is Too Much?
Opiate abuse symptoms often begin with prescription level doses of the drug being administered by a healthcare worker. These are mostly for the treatment of an ailment. What happens next is the person taking the pills soon develops a tolerance for the drug. Naturally, the person will seek to increase the dose to get the required effects. When this happens, they may seek to bump up their dose either through diverted or illicit drugs. In either case, what happens is they come to a point where they ingest quantities of the drug that overwhelm the body’s regulatory mechanisms. The result is a clinical drug overdose.
Signs and Symptoms
An opiate overdose almost always presents in what is known as a medical triad. A set of three clear and predictable symptoms that point to one cause. In this case, these three symptoms are a depressed Central Nervous System (CNS), respiratory depression and excessively constricted pupils (pupillary miosis.) Of these three, respiratory distress or difficulty in breathing is the surest sign of an opiate overdose. While these three signs are present at the pinnacle of a drug overdose, other signs that may point to an overdose before these kick in include confusion, unresponsiveness, vomiting and constricted pupils. A person experiencing these symptoms must be immediately rushed to the hospital for emergency care.
When a person presents with an opiate overdose medical triad, the first line of action is to reestablish normal breathing. If the person has not yet reached the hospital, those nearby must initiate the first line of treatment, which is aggressively clearing the airway to prevent asphyxiation. This prevents the brain from going into shock from a lack of oxygen. What is otherwise known as oxygen deficit brain necrosis. At the hospital, the person may need to be intubated if they do not have spontaneous respiration. To further mitigate respiratory depression, naloxone must be administered intravenously or via a recently FDA-approved intranasal spray. These initial interventions should be sufficient to stabilize the person until they can receive posthospital care.
If the person survives the overdose, several complications may arise. These include pulmonary edema, permanent brain damage due to oxygen deficit, rhabdomyolysis, and compartment syndrome. All these are life-threatening conditions that may reduce the chances of survival even after the immediate effects of the overdose have been dealt with. If a person is fortunate also to escape these effects, relapse is the next dangerous hurdle that arises. As the person has already ingested a sufficiently large dose and survived, this serves as a new benchmark for the next dose. Deaths from overdose almost always occur after several near-misses, something that treatment options must take into consideration during the rehab and recovery period.
Withdrawal Symptoms, Timeline and Detox
Opiate Withdrawal Symptoms
- Intense cravings for the drug
- Aches and pains
- Nausea and vomiting
- High blood pressure
- Agitation and Irritability
The detox process is aimed at weaning the body off the drug and reintroducing drug-free homeostasis of bodily functions. The detox process, depending on the level of addiction, will involve the use of opiates detox medication plus behavioral counseling. These drugs are used to mitigate the effects of withdrawal and to prevent relapse.
Detox timelines vary from person to person for several reasons. The first is the level of addiction. If the addiction is severe, extended detox periods of a few weeks to months must be instituted. During this period, the person will have to undergo physical as well as psychosocial adjustments to curtail any relapse. If the addiction is mild, then a shorter process will be employed. The availability of opiates detox medications has made it extremely viable to get off the drug quickly and with tempered down withdrawal effects.
The recovery period of any addiction is a crucial time. Relapses often happen at this stage, undoing weeks, months, or even years of rehab work. As opiates are easily available, the recovery period usually involves psychosocial reprogramming to eliminate the psychological cravings for the drug. This will involve the person attending recovery programs that offer support for recovering addicts. While there does exist stigma towards such people and programs, this is an essential step of locking down a hard-won victory against drug abuse.
For most persons coming from an opiate addiction, full recovery may take years. While the effects of the drug may wear off and bodily functions restored to normal, the ongoing temptation may need stronger resilience, which takes years to build. While this may seem like a terrible thing, the reality is it helps the person keep their guard up always. Feeling like they have reached their destination is a sure way of letting down their guard. Focusing on one day at a time is the best approach to sustainable recovery.
How Opiates are Made?
Pharmacology and Pharmacokinetics
Opiates are powerful agonists that act on opioid receptors in the brain, spinal cord, and GIT. What makes opiates so effective is their ability to interfere with pain initiated by nociceptive stimuli without affecting other sensations such as temperature, touch and position sense. They do this by activating a pain-modulating system made up of endogenous opioid peptides and associated receptors. The result is a numbing of various CNS centers giving rise to the sensations of euphoria and tranquility. This modulation of pain, when activated repeatedly, provides an altered sense of reality, a key ingredient in the formation of an addiction.
How to Make Opiates
Before looking at how to make opiates, the first question to answer is, what are opiates made of? Traditionally, opiates were only made from the synthesis of opium, derived from the opium poppy plant. This is still a widespread method of making drugs and utilizes naturally occurring opiates ingredients. Modern versions of opiates, also known as opioids, are made using synthetic compounds and come with a higher potency than the natural release of the compound. Making drugs, while legal for medicinal purposes, is an illegal undertaking if a person does not have the necessary licensing for the activities. This has given rise to the illicit manufacture and trade in opiates.
From the Opium Poppy Plant
Opium derivation from the opium poppy plant represents the traditional means of synthesizing the drug. As the plant naturally contains morphine at levels between 8-14% of dry weight, extraction of this primary alkaloid to make opiates is easy. This can be achieved in several ways. One involves making incisions in the capsule of the plant. Out of this incision seeps raw opium as a milk-white resin. This opium can then be processed to manufacture other drugs. Another method involves drying and grinding the capsules then using this powder as a base to synthesize opiates.
More modern ways of synthesizing opiates exist today that involve a wide variety of base ingredients not related to the opium poppy plant. These methods yield several types of opiates that make up the bulk of drugs on the market today. They are classified as follows:
- Morphine opiate esters: These are slightly chemically-modified and are represented as morphine prodrugs. Morphine diacetate and heroin fall under this category.
- Semi-synthetic opiates: These are synthesized from morphine esters and include hydrocodone, buprenorphine, and oxycodone.
- Synthetic opiates: Fentanyl, methadone, and tramadol are examples of synthetic drugs manufactured in a lab from fully synthetic compounds.
According to the Drug Enforcement Administration, opiates, classified as narcotics, represent one of the largest threats to society compared to other drug classes. The easy manufacture of the compounds makes it easy for malefactors to run underground labs that churn them out. While in the past production required the crucial ingredient of the opium poppy plant, today, persons seeking to manufacture the substance can do so without it.
Opiate Addiction Treatment and Rehabs
The Center for Behavioral Health Statistics and Quality in 2014 found that over 2.5 million Americans had an opioid use disorder, and this resulted in 28,000 overdose fatalities. Rehab centers play a crucial role in lowering these numbers and reducing the number of deaths that result from an overdose. Persons affected by this scourge can also gain hope from the availability of medications that treat the habit efficiently. These drugs include methadone, buprenorphine (Suboxone®, Subutex®) and extended-release naltrexone (Vivitrol®). A person interested in these opiates treatment options can gain them either as an inpatient at a treatment facility or as an outpatient.
Inpatient Opiates Rehab
Inpatient rehab facilities are rehab treatment facilities that provide a residential environment for persons recovering from drug addiction. They are founded on the premise that taking a person out of a potentially drug-habit-fostering environment is a potentially useful way of treating the sickness. Drug centers that offer inpatient treatment will provide a suite of options that allow the patient to go through the rehab process in a manner that meets their needs.
Inpatient rehab is typically targeted at persons with severe addictions and who need intensive treatment programs. Before undertaking inpatient rehab, it is essential for the person to make the necessary preparations first. These include speaking to their employer, planning for their children and/or pets, and financial arrangements to pay for their stay at the center. The person must also be aware that an inpatient program requires they relinquish a part of their lives to live within the rules and confines of the rehab center. Typical inpatient rehab stays will last anything from 4 weeks to six months.
Outpatient Opiates Rehab
Finding opiates addiction help can also come in the form of an outpatient rehab program. For a person with a mild addiction, this may be a suitable option. Outpatient rehab programs involve less restrictive programs that allow a person to visit the treatment center a few times a week while making a time commitment of 10-12 hours a week. This option also favors those that may choose to do combination treatments like visiting the hospital for assessment after undertaking a rehab regimen at a rehab center. Outpatient programs also work well with 12-step programs that blend mandatory treatment options with voluntary treatment options.
Persons that opt for outpatient treatment must, however, do so while aware of the dangers beset this type of treatment. The principal of these is a drug-habit-enabling environment. If the person is still in such a situation, any progress made can be instantly undone over a weekend of partying with friends. Besides, this form of treatment requires strong social support, which if absent, can also lead to relapse. Ideally, the rehab center will provide an evaluation of the person’s condition and circumstances before recommending an outpatient treatment program.
The Road to Recovery
Why are opiates addictive? What is opiate dependence? These are questions that have hopefully been exhaustively addressed in this article. The road to recovery from opiates may be fraught with challenges, but it is paved with hope. Persons with such an addiction must not lose hope. Accepting the problem and understanding opiate addiction is the first step to recovery and a new life. Finding the right treatment method and facility is the next step. Finally, seeing that flicker of hope within is all that is needed to create the impetus to spur the person in the right direction, the direction of rehabilitation and recovery.