Opiates, like morphine and codeine, occur naturally and are extracted from the opium poppy, while the term opioid covers drugs that are either partially synthetic (e.g. heroin and oxycodone) or wholly synthetic (e.g. methadone and fentanyl). However, for convenience and because they work in the same way on the brain’s receptors, opioid is the term now generally used to encompass all three types.
A person’s first encounter with an opioid is often when it is medically prescribed for them to relieve symptoms of pain. While many people who experience effective pain relief from taking opioid painkillers do so without ill effects, there is always a degree of risk of dependence, misuse and addiction due to the properties of the drug. Dependence may develop gradually and many patients are initially unaware that they are affected. They may have become unwittingly attached to the other effects of the drug such as its ability to induce drowsiness or euphoria. People may go on to find themselves developing a tolerance; needing to take more to achieve the same effect. They may then begin exceeding the prescribed dose, seeking repeat prescriptions and turning to other sources of opioids, including those that are illegal.
One characteristic of addiction is continued consumption despite harmful consequences. As opioid addiction takes hold, the person may end up going to any lengths to secure the drug, including theft, even from friends and family, buying from illegal online pharmacies, forging prescriptions or dealing with unscrupulous doctors, nurses and pharmacists. The craving for increased dosage or ever more potent opioids to stave off unpleasant withdrawal symptoms, can all too frequently result in fatal overdose. In the meantime, they will no doubt have experienced significant mood swings, become anxious and depressed and withdrawn from friends and family. The ability to function at home, at work and also socially will be impaired. If dependence is not picked up as early as possible the person becomes more vulnerable to developing addiction. It behoves opioid-prescribing physicians to be vigilant to this possibility.
As opioid dependence often develops from prescribed treatment for a legitimate health need, it is difficult for some people to accept and acknowledge that they may have become dependent or even addicted. While this is an inherently self-protective psychological component of addiction, it is also due to stigma. Invariably consumed with shame at their loss of control, people fear being identified with those individuals who became addicted primarily through illicit use of drugs.
Treatment begins with the safe and sensitive management of withdrawal in a positive and optimistic environment. The recovery pathway needs to factor in the conditions for which the person was originally prescribed opioid medication and any other physical and psychological health needs. It may be essential for specialists in pain management and addiction to work closely together on the patient’s behalf.