Opioid Analgesics | Pain Management Vs. Abuse Potential

In recent decades, the potential for abuse of opioid analgesics has been thrown into sharp relief in the United States. Yet, opioids continue to play a key role in medical anesthesiology and both short- and long-term management of moderate to severe pain.

So, how should we think of opioids and their role in pain management, relative to their potential for abuse?

What Are Opioid Analgesics?

Opioids, or opiate drugs, are a chemically related family of drugs that provide analgesia (pain relief) and central nervous system sedation. Opium, the first known opioid drug, is produced from the heroin poppy plant, but more synthetic and semi-synthetic opioids have been developed.

Opioid pain medicines are produced as delayed or immediate-release pills, intravenous solutions, transdermal medications, and nasal sprays.

Many opioids that are abused are also used in medical care, including well-known opioid medications used for various levels of pain management:

• hydrocodone (Vicodin®)
• oxycodone (OxyContin®, Percocet®)
• oxymorphone (Opana®)
• hydromorphone (Dilaudid®)
• morphine (Kadian®, Avinza®)
• meperidine (Demerol®)
• codeine
• tramadol
• fentanyl

Opioid Dependence & Tolerance

Dependence is an unfortunate side-effect of long-term use of opioids, including legitimate use. The longer an opioid drug is taken, the more the body naturally begins to compensate for its effects. 

This means that over time, those who take opioids will need to take higher doses or switch to a more potent opioid in order to achieve the same level of pain relief (or euphoria). This process is known as tolerance.

Once tolerance progresses, if an individual stops taking a drug it can cause the body to overcompensate, producing unpleasant withdrawal symptoms opposite to the effects of opioid drugs:

•  hypersensitivity to pain (hyperalgesia)
•  depression or dissatisfaction (dysphoria)
•  nausea
•  vomiting
•  restlessness
•  sweating
•  anxiety
•  fast heart rate
•  insomnia
•  muscle tremors

This condition is known as opioid dependence, and opioid prescriptions should be carefully monitored by pain physicians to control dependence and, once the drug is no longer needed, to taper individuals off the drug slowly.

Withdrawal symptoms can be severe or even dangerous in extreme cases.

Opioid Addiction

Physiological dependence and addiction to opioids are not the same, though they are often related.

Opioid addiction, also known as opioid use disorder, is a condition in which an individual isn’t able to control their opioid use, even if the drugs cause severe adverse effects to their relationships, livelihood, or health.

Opioid addiction occurs because opioids, at high doses, activate and overload the brain’s reward centers, releasing dopamine and reinforcing the behavior (drug use) responsible for feelings of pleasure and euphoria. 

This results in destructive cravings and compulsions to keep abusing the drug.

Are Opioids Worth The Risk?

America’s opioid epidemic occurred, in large part, because opioid prescribing clinicians in the mid-1990s and early 2000s did not respect the power and danger of new long-acting opioid formulations. 

Physicians were advised to prescribe new “safe” opioid pain relief medications freely to treat long-term pain, without considering risk factors.

This practice swiftly led to a massive increase in the availability of black-market opioids, a horrifying spike in overdose emergencies and deaths in rural and suburban America. 

However, following recent regulatory actions, the risks and calculus behind opioid therapies have come under far more scrutiny. 

And when used properly, these drugs remain vital tools in modern healthcare, helping countless individuals who suffer from chronic pain, postoperative paint, or other acute pain when they need it most.

Opioid Use Disorder Treatment

Opioid use disorder is best treated with the help of a qualified addiction treatment center.

Personalized substance abuse treatment programs may be conducted in either an inpatient or outpatient setting, and may include:

• medical detox
• medication-assisted treatment (MAT) using methadone or buprenorphine
• counseling
• individual or group therapy
• cognitive behavioral therapy
• aftercare and long-term support

For more information on our treatment programs, please connect with us today.