Many substances can be addictive, but opioid painkiller addiction is one of the most talked about in the media today. In the USA it has been deemed an epidemic, and there have been fresh warnings this week that the UK is dangerously close to suffering a similar epidemic.
Opioid Painkiller Addiction Awareness Day (OPAAD) aims to raise awareness of addiction, reduce stigma and help sign post people to where they can get help. Misconceptions and myths still surround addiction, which can prevent sufferers from seeking treatment or even recognising symptoms of addiction in themselves or loved ones.
Opioids are a family of medicines usually prescribed to treat chronic or long term pain for which over-the-counter painkillers are too weak, as well as for short term use to treat pain following surgery and other medical procedures. Opioids are synthetic substances which act on the body’s opioid receptors to produce the ‘morphine’ effect found in opiates, which are natural substances found in the poppy plant.
Addiction is defined as being physically and mentally dependent on a particular substance or activity. Common addictions include medication or prescription drugs, illicit drugs, alcohol, caffeine, gambling, and exercise.
Addiction is often misunderstood as being about ‘chasing a high’, be that the high of intoxication caused by alcohol and drugs, or the high caused by a flood of endorphins such as dopamine, released by the brain following exercise or winning when gambling.
However, while chasing highs is undoubtedly a large part of addiction, the brain also begins to associate times, places, people and experiences with an addictive substance or activity, therefore the substance or activity becomes a part of your routine, a habit.
For example, if you routinely come home from work stressed and have an alcoholic drink to relax and chill out, your brain begins to rely on alcohol as a way to deal with other stressful situations as well. Your brain also begins to associate the time and place with drinking – at home after finishing work – develops the habit of having a drink when you come in from work, stressed or not.
Opioid medication is typically prescribed for severe or long term pain that weaker, over the counter painkillers such as paracetamol and ibuprofen are not strong enough to treat. They are also often prescribed short term following surgery or medical procedures which cause severe pain. Opioids are classed as narcotics and come in various forms including pills, soluble tablets, liquid medicine and injections.
Opioids and narcotics work by attaching themselves to opioid receptors in the brain and spinal cord, reducing, or blocking completely, the pain signals being sent around the body and boosting feelings of pleasure. However, the very thing that makes these drugs an effective treatment for severe pain is also what makes them dangerous and addictive. When taken as prescribed, one of the most common side effects of opioid painkillers is drowsiness, as they slow down your breathing and heart rate, and lower your blood pressure. However, when taken more often than prescribed or in larger doses, opioid painkillers can slow down your heart rate too much eventually leading to death.
In reducing pain signals in the body, opioids also create what is often described as a feeling of
euphoric high, offering temporary relief from anxiety or depression or just a feeling of well-being and happiness. While this is a welcome relief for chronic pain sufferers, it can lead to dependency on and high tolerance to the opioid, with patients needing stronger doses to achieve the same level of pain relief, or explore other methods of pain management.
In worst cases it is this euphoric high that can lead to addiction, and some patients are more at risk than others.
There are many risk factors associated with substance addiction and abuse, one of which is pre-existing mental health problems. Chronic pain often has no obvious cause or diagnosis and therefore is frequently accompanied by feelings of anxiety or depression due to the impact it has on the patient’s life and lack of answers about their condition. Patients who suffer mental health problems are more at risk of developing an addiction to opioids, exceeding dosage, or turning to stronger illicit drugs than patients who do not have mental health problems. The highs and heightened pleasure associated with opioids also help lift patients temporarily out of depression or anxiety.
This is not to say that everyone prescribed opioid painkillers who also has mental health problems will go on to become an addict or abuse stronger illegal opioids – far from it – but it is something doctors should be taking more seriously according to those working with recovering addicts. Advocates claim it is a multi-faceted issue and that socioeconomic issues also contributing to the risk of addiction, with prescription rates highest in more deprived areas with high unemployment, and that doctors need to do more to check on vulnerable patients at risk of developing an addiction.
The risk of dependency, addiction, and other negative side effects associated with opioid painkillers have led many to seek alternative ways to manage their pain.
An increasing number of patients are turning to CBD to help them deal with severe and long term pain. While opioids work on the opioid receptors to block pain signals in the nervous system, CBD works on receptors in the Endocannabinoid System to maintain homeostasis and promote a sense of balance within the body.
The Endocannabinoid System is the body’s internal balancing mechanism, responsible for maintaining a long list of bodily functions including pain sensitivity, inflammation, stress responses, immunity, sleep and mood. Cannabinoids are produced by the human body which trigger receptors in the Endocannabinoid System to maintain balance in the body. CBD does not trigger these receptors but rather manipulates them to help absorb more of the body’s natural cannabinoids. In turn this helps the body to better manage your responses to pain and inflammation, as well as maintaining positive mental health.
Its use as an alternative to opioid painkillers for managing pain is not the only thing CBD has the potential to offer when it comes to addictive painkillers.
Studies are now being conducted into how CBD could help to treat addiction, offering an alternative to the likes of methadone – access to which is usually much tighter regulated than access to opioid painkillers. There is still a lot of stigma attached to methadone treatment, with many associating it with heroin addiction, but CBD does not have the same stigma and is much easier to access than prescription only methadone.
A small double blind study conducted in the USA found that CBD reduced cravings and anxiety in former heroin users when presented with triggers for heroin use, compared to the placebo group. The study consisted of just 42 participants, all former heroin users, and the research team are now working towards a larger study to develop CBD based treatments for opioid addiction.
Many believe that they have to hit rock bottom before seeking help for opioid dependency or addiction, but that is not the case. If you, or someone you know, are struggling with opioid use, or are worried about your current pain management plan, contact your doctor to discuss other options.
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