The body is a chemistry lab where normal reactions happen daily, but the expected results from these reactions differ when opioids are introduced.
“People might get drowsy, might feel tired,” said Karilynn Dowling-McClay, associate professor at Bill Gatton College of Pharmacy at East Tennessee State University. “It [an opioid] can affect the stomach and the whole GI [gastrointestinal] system, so some people, especially when they first start, they might have nausea, stomach upset.”
Understanding what an opioid is and how it affects the body is necessary to combat opioid misuse.
Originally, the naturally occurring substances found in poppies, such as morphine and codeine, were referred to as opiates; while laboratory made products, like oxycodone and heroin, were called opioids according to the Drug Enforcement Administration Museum. However, opioid has become a collective term to describe addictive drugs.
These drugs affect the central nervous system by travelling to the brain and binding to opioid receptors.
“When someone takes that drug, it makes its way to the brain, and the drug molecule attaches to the receptor in the brain tissue,” said Dowling-McClay.
Opioids are addictive because they interact with chemical signaling in the brain, and they can temporarily lessen physical and emotional pain.
“They can make people feel good, or they can make people forget what’s going on in their [people] life that’s causing them stress or trauma,” said Dowling-McClay. “It’s very appealing to continue using them.”
Taking opioids for any length of time can have side effects. In the short term, these drugs provide pain relief, however, drowsiness and stomach problems can occur.
While science is determining whether or not opioids physically change the brain over time, the known long term side effects of opioids include constipation, repressed breathing, tolerance, dependence and substance abuse disorder, previously known as addiction.
“They [people taking opioids] might feel really sick if they don’t have access to their drug when they need it,” said Dowling-McClay. “Lots of, you know, stomach issues, flu-like symptoms or they might become really agitated, really anxious, things like that. Basically, the body is saying, ‘I only know how to function right if I have the drug present.’”
Tolerance is the amount of a substance needed to produce a desired effect. Gradually, the body becomes used to a substance and needs a higher dose to have a response. While tolerance is natural and not a sign of addiction, it can potentially lead to substance abuse problems. Dependence occurs after the drug has been in the body a while. Physical and/or psychological signs manifest when the drug is either unavailable or out of the body.
According to the Drug Enforcement Administration, the Controlled Substances Act classifies drugs into five categories based on how dangerous a drug is and the drug’s medical uses. Schedule I drugs have “no currently accepted medical use” and are the most dangerous while Schedule V are the least dangerous. Opioids can be found in each schedule.
“The big players in the opioid epidemic have been things like oxycodone and hydrocodone and those are what we call Schedule II or Level II controlled drugs,” said Dowling-McClay.
Schedule II drugs have a high probability for misuse since they are the most regulated drugs that can be prescribed. In spite of federal laws designed to curb the amount of opioids a patient has access to, substance abuse continues to plague the nation.
To some extent, substance abuse is random in that anyone has the potential to become addicted; however, research indicates genetics and childhood trauma play a role in an individual’s susceptibility.
The cycle of opioid misuse can be broken through prevention, treatment, and overdose reversal. Prevention involves teaching children and teenagers healthy coping mechanisms; it also involves medical professionals appropriately prescribing opioids.
“It’s about building healthy life coping skills that don’t involve using a substance cause that’s where the risk comes in they might get addicted to the substance,” said Dowling-McClay.
One medication available to treat substance abuse disorders is methadone. Although it is another opioid, it can be an effective treatment for substance abuse disorders when combined with counseling. Methadone works well because it stays in the body for long periods of time and helps reduce cravings according to Johns Hopkins Medicine. However, methadone does have side effects.
“The methadone still can have stomach side effects like any other opioid, can still make people drowsy,” said Dowling-McClay.
Suboxone, also known as buprenorphine, is another treatment option. It is like methadone in that it helps to manage the side effects of withdrawal, but it is also different because it has a partial response on the opioid receptors in the brain.
The final step in breaking the addiction cycle is overdose reversal. This is where naloxone, better known by the brand name Narcan, comes in. Unlike methadone and suboxone, naloxone blocks the “euphoric/sedative effects of opioids” according to Johns Hopkins Medicine making it possible to reverse an overdose.
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