130 people each day. That’s the rate of death stemming from the opioid crisis.
That translates to a little over 5 people every hour, or one death every twenty minutes. So in the time, it takes to watch the newest episode of your favorite Netflix show, another person dies from an opioid overdose.
It’s a grim reality, and one the United States is only just coming to grips with. After all, it was only in 2017 that the federal government declared Opiates a public health emergency. But the opiate crisis has been ongoing since the 1990’s.
But how could this happen? In a country that calls itself the greatest in the world, how is it possible that so many are dying from a preventable addiction?
It’s a complicated answer, and the history is long. But to understand how painkiller addiction happens, it’s necessary to first understand how opiates work, why they are so addictive, and how we got here in the first place.
Only then will you be able to recognize the signs of prescription drug abuse. Keep reading to learn more.
The Beginning of a Crisis
In the 1990’s, pharmaceutical companies wanted to cash in on the miracle of opioid painkillers.
After all, here was this miraculous solution to pain management. They could make the pain simply go away, making it a medical marvel.
And it meant huge dollar signs for pharmaceutical companies, who began aggressive marketing campaigns to get the drugs in the hands of patients.
Prior to 1991, most opioid drugs were for pain management in cancer patients. There was no research suggesting benefits for non-cancer patients, but pharma companies saw a financial opening and a new market. So they started pushing, offering doctors huge perks and benefits for prescribing opioids to non-cancer patients.
The campaign was so successful that pharma companies saw opioid revenue grow from $48 million in 1996 to more than $1 billion four years later.
Worries About Addiction
Medical organizations and doctors raised concerns about the possible addictive properties of these new drugs. After all, they were modeled on opium, the main ingredient in heroin and morphine, both highly addictive.
But the pharma industry brushed aside these fears, assuring doctors that this was part of the miracle: powerful pain relief with no chance of addiction.
Proving them wrong didn’t take long. Deaths from opiate overdose began skyrocketing in the mid-90’s and only got higher as time went on. Pharma companies began producing newer drugs. As Fentanyl hit the market, it produced a new wave of addicts.
And as prescriptions ran out, some patients turned to heroin, which was cheaper and readily available.
But how do these drugs work? How have they ensnared so many?
It’s important here to understand the verbiage. Opiates are a type of narcotic.
Now, narcotic has become an umbrella term for all drugs. But when we say narcotic in reference to opioids, it refers to drugs of a specific type.
Before it became an umbrella term, a narcotic was defined as a drug that “…dulls the senses, relieves pain and produces a profound sleep…”
The original opiates were morphine and heroin and were common during medical procedures. Originally, scientists developed morphine as an aid for those with heroin addiction, since when it was first isolated, no one bothered to test its own addictive properties.
So what do they do to the body?
Opiates are “downers”, meaning that they depress the functioning of the central nervous system. This relieves pain, but also can cause euphoria, as well as a whole slew of other side effects, from dry mouth to constipation.
So with the side effects, why would anyone take opiates longer than they had to?
First, it’s important to understand how people get addicted.
Addiction is a disease, and it’s one that isn’t well understood, even within professional circles. Often, people who don’t understand addiction frame it as a lack of moral fortitude or willpower.
In other words, the perception is that only “bad people” or “weak people” become addicts. The reality, however, is far more complicated.
Addiction is a cyclical illness. A person takes a drug, which feeds the pleasure center of the brain by flooding it with dopamine.
Now, the brain produces dopamine anyway as a natural reaction to eating, drinking, or having sex. The brain rewards activities necessary to sustain life in order to make you keep doing them.
But when you introduce drugs, they flood the brain with high levels of dopamine, which throws the system out of alignment. Instead of rewarding healthy behaviors, the drugs force the bran to reward unhealthy behaviors.
The secondary effect here is that, as more dopamine enters the brain on a regular basis, the brain shuts down the cells used to receive it, in an attempt to regulate its functioning. This means that more and more levels of drug use are necessary to maintain the same high.
It’s also vital to understand that not every person who uses painkillers will get addicted. Millions of people every year use them without getting addicted. Whether or not a person becomes addicted depends on several factors, but none of them is ethics or moral fiber.
Because addiction is a psychiatric disease, it stands to reason that there is a genetic component, like any other psychiatric disease. The children of people with depression are more likely than the general public to suffer from depression. In the same way, the children of addicts are more likely to become addicts themselves.
Researchers at the National Institue of Drug Abuse have a theory for this.
The brain contains a finite number of dopamine receptors that help the brain regulate its pleasure center. Brain imaging suggests that individuals with fewer of these receptors are more likely to struggle with addiction. And, like with much else in the body, how many receptors are present is largely determined by genetics.
Studies on twins have also shown that identical twins, who share a genome that is 100% indistinguishable, are highly likely to share addictions. So much so that identical twins are often assumed to be concordant, or to either both be addicts or neither.
Genetics account for about half of a person likelihood for addiction. But what about external factors?
Genetics accounts for about half of individuals likely to become addicted. The other half is external, or environmental.
Keep in mind that opiates, in particular, offer easy relief from pain. There are other methods of pain management available, but they often take a great deal more effort.
Now, faced with that explanation, many explain it away. “Oh,” they say, “this is just proof that addicts are lazy and unwilling to try other things to reduce their pain!”
But the reality is that debilitating pain is just that: debilitating. Often, it becomes so all-consuming that sufferers just want it to go away so that they can function. The idea of trying anything else is so exhausting as to seem nearly impossible.
It can also be an issue of withdrawal. Even very limited use of painkillers can induce unpleasant withdrawal symptoms when the prescription runs out. And if there is still pain from the original problem, the withdrawal symptoms may prove to be too much, especially for those without adequate support systems.
The Process of Addiction
Let’s take a look at how addiction happens in a practical sense.
It starts, perhaps obviously, with pain. Let’s call our patient Claire. She is 19, and a gymnast at her university.
Claire requires surgery for a torn ACL. Surgery goes well, and her surgeon prescribes her a week’s worth of oxycontin for pain the week following surgery. She knows her uncle struggled with addiction years ago, but she doesn’t know him well and assumes his issues stemmed from elsewhere.
The meds keep her pain under control, but she is frustrated by her limited mobility. Her teammates are at a competition, and she is still in recovery. At the end of the week, her meds run out, and the pain returns. It isn’t as bad as it was in the beginning, but she’s had a week of perfectly controlled pain, and the return is unbearable.
She is also feeling sick as the effects of the medication wear off. The narcotics have made her digestion slow, and she is still struggling with her limitations.
She calls her doctor and asks for a refill. They give her five more days worth, at a lower dose.
She takes two at a time to combat the pain at the same levels and begins to test her boundaries at physical therapy. Taking the pills makes the pain go away, which lets her go further in her mobility.
She keeps pushing her injured leg too far, necessitating more rest.
The setbacks cause more frustration, more pain, and more pills. She “borrows” an old prescription from her mother when she is home for Thanksgiving.
She is now buying pills from a cook at her job at a local restaurant because even though her ACL is mostly healed, the euphoria goes away every time she comes down. Coping with the stress of finals is getting impossible.
Only until finals are over, she promises herself.
But the pills are expensive. Her friend at work mentions that heroin is cheaper, and is basically the same thing. In a moment of desperation at the end of finals, she gives in.
In a matter of months, she has gone from promising young gymnast to an addict who can only think of her next pill. And it happened without her ever realizing what was happening.
Signs of Prescription Drug Abuse
The signs of prescription drug abuse come in four categories: behavioral, cognitive, physical, and psychosocial. Recognizing them in a loved one is crucial for recovery.
Addicts may hide behavioral signs, such a preoccupation with getting more pills or illegally acquiring more pills. Often, addicts are able to cover their tracks until things become too out of hand to hide.
Cognitive signs include disorientation, confusion, and an inability to focus.
Physical signs, which are among the easiest to spot. These can include itchiness, hypersomnia, constipation, irregular heartbeat, pinpointed pupils, and excessive sweating.
Psychosocial symptoms may manifest as mood swings, irritability, anxiety, and depression. Addicts may begin stealing pills or money and withdrawing from personal relationships in order to avoid detection.
The Road out of Addiction
Addiction is a chronic disorder. Someone who is an addict will remain an addict for the rest of their life. This does not mean, however, that they must remain in a harmful cycle of abusing pills forever.
Most recovery programs agree that the first step to recovery is simply the addict realizing that they have a problem. They then must realize that there is a way out. Often, addicts try and fail to quit and become discouraged, convinced they will be trapped in the cycle of addiction forever.
They must move past this mindset before recovery can begin.
Once they are ready, ongoing treatment and support are crucial. They will need an unwavering support system, ready to help in moments of crisis. An inpatient treatment program may be necessary, and meetings will a local Narcotics Anonymous can help connect them with others who can empathize with their struggle.
After ninety days of sobriety, their risk of relapse decreases, but vigilance will always be necessary, especially because prescription drugs are the first resource in the event of surgery or major injury.
There is hope for those affected by opiate addiction. And once you know how to recognize the signs of prescription drug abuse, you can help support loved ones as they navigate their way to freedom.
But you don’t have to navigate the waters of recovery alone. We are here to help, connecting your loved ones with the best resources and treatment options.
To help your loved one begin their journey, contact us today.