Frequently Asked Questions About Opioid Abuse

Our clinical team at Brookhaven Hospital was asked to take part in a feature story on the opioid epidemic on KJRH Channel 2 in Tulsa, Oklahoma. Click on the video above to watch a brief interview with Ron Broughton, our Chief Clinical Officer.

Q: What is an opioid?

A:  Opioids, also called opiates or narcotics, are derived from opium originating from the poppy plant. Byproducts of opium are morphine and codeine.

Opioids generally fall into two broad categories of street drugs or prescription drugs. Heroin, a street drug, is a highly addictive powdery substance made of morphine that can be snorted, smoked or injected. Prescription drugs are made up of morphine or codeine derivatives.

Q: What are some common opioid names?

A:  Drug names, prescription brand names and street names:

  • Fentanyl (Duragesic, AKA: Apache, China girl, Dance fever)
  • Heroin (AKA: Horse, H, Brown Sugar, Smack)
  • Hydrocodone (Zohydro ER, Hysingla ER) (AKA: 357s, Vics, Lorries, Tabs, Watsons)
  • Hydromorphone (Dilaudid) (AKA: Big D, Super 8, Shake & Bake, Peaches)
  • Methadone (AKA: Fizzies, Maria, Chocolate Chip Cookies, Dollies)
  • Oxycodone with acetaminophen (Percocet) (AKA: Ox, Hillbilly Heroin)
  • Oxycodone with aspirin (Percodan)
  • Meperidine (Demerol) (AKA: Juice, D, Dust, Dillies)

Q: What are the physical signs that someone is abusing an opioid?

A:

  • Slurred speech
  • Itching or flushed skin
  • Constipation
  • Feeling no pain
  • Feeling euphoric or high
  • Shallow or slow breathing
  • Small pupils
  • Nausea and/or vomiting

Q: How can you tell if someone is addicted to opioids?

A:  Individuals taking opioids to control pain for a long period of time may need higher and higher doses for effective pain relief. If use is stopped abruptly, withdrawal symptoms may occur. This would be indicative of physical dependence on the opioid.

Addiction to a substance is typically defined as compulsive abuse of the drug despite the negative and destructive consequences.

Other behavioral signs of addiction may include:

  • Neglecting Other Activities: Spending less time on activities that used to be important (hanging out with family and friends, exercising, pursuing hobbies or other interests) because of the use of alcohol or drugs; drop in attendance and performance at work or school.
  • Risk Taking: More likely to take serious risks in order to obtain one’s drug of choice.
  • Relationship Issues: People struggling with addiction are known to act out against those closest to them, particularly if someone is attempting to address their substance problems; complaints from co-workers, supervisors, teachers or classmates.
  • Secrecy: Going out of one’s way to hide the amount of drugs or alcohol consumed or one’s activities when drinking or drugging; unexplained injuries or accidents.
  • Financial Problems: Increased drinking or drug use often takes a noticeable financial toll.
  • Changing Appearance: Serious changes or deterioration in hygiene or physical appearance – lack of showering, slovenly appearance, unclean clothes.
  • Family History: A family history of addiction can dramatically increase one’s predisposition to substance abuse.

(According to the National Council on Alcohol and Drug Dependence, Inc., NCADD)

Q: What are the withdrawal symptoms of opioids?

A:

  • Craving the drug
  • Irritability
  • Yawning
  • Runny Nose
  • Muscle aches
  • Vomiting
  • Abdominal cramping
  • Diarrhea
  • Sweating
  • Confusion
  • Enlarged pupils
  • Tremors
  • Loss of appetite

Q: How can someone become addicted if the medication is prescribed by their doctor?

A:  Just because it is prescribed by a doctor, does not mean the substance is not potentially addictive. Addiction often begins with a slippery slope of taking a few more pills than prescribed to control an increasing pain level. This can quickly lead to attempts to avoid the body’s expression of withdrawal symptoms by seeking out increased doses of the medication.

Q: If I’m taking an opioid to control my pain, can I become addicted?

A:  Most who take opioids for a long period of time will develop a tolerance, meaning it will take more of the drug to obtain the same effect. This combined with the euphoric psychological effect is what can lead to addiction.

Q: Are there non-addictive alternatives to opioids?

A:  Yes. There are non-opioid alternatives for pain relief such as: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) (Advil, Motrin, Naprosyn, and Voltare). Sometimes prescription anticonvulsants (Neurontin, Tegratol) or antidepressants (Cymbalta) are used successfully to treat chronic pain.

Mindfulness techniques, relaxation exercises and physical therapy are also alternatives to assist in pain management.

Q: Why is the topic of opioids in the news so frequently?

A:  In the last few years, opioid addiction has become a national epidemic.

Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014.

In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.

People who become addicted to prescription opioids may find street drugs, like heroin, to be more readily available and less expensive. Four in five new heroin users started out misusing prescription painkillers. As a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013.

(According to the American Society of Addiction Medicine, ASAM)

Q: What are the statistics about opioids in the state of Oklahoma?

A:  In 2012, Oklahoma was fifth highest in the nation for death by overdose. 460 deaths in 2012 involved opioids. Oklahoma is one of the top states in the nation for the sale of prescription painkillers.

 Q: What are some efforts to prevent overdosing and death from opioids?

A:  One effort many states are making to prevent deaths by overdose on opioids is by making the drug, Naloxone (Narcan), available over the counter. This drug counteracts the effects of opioids in the body and counteracts an overdose. Once someone’s life is saved, they will need treatment and a recovery plan to maintain their sobriety.

There are also prescription drug monitoring programs to better track when individuals engage in “doctor shopping,” which involves multiple prescriptions from several doctors. This database is not a national one, however, but state-based and each state has different laws pertaining to the requirements for physicians to access the information.

The Centers for Disease Control and Prevention (CDC) released new guidelines for physicians when treating a patient’s chronic or acute pain which, in part, involves prescribing very few pills per visit to allow for closer monitoring and reduce the risk of opioid abuse.