Opioid Crisis Infographic

1. A Brief History of the Opioid Epidemic

The opioid crisis is reaching frightening heights, and we need to act. At Paracelsus Recovery, we recognise that, as mental health, and addiction professionals, one way in which we can help is to create educational content to help increase the public’s awareness. To that end, we created a four-part educational series focused on opioid abuse.

In 2020, an unprecedented 100,000 people died due to an opioid overdose in the US. Drug overdose rates have been ever-increasing in the US, but they are now skyrocketing due to pandemic-related stressors. Unfortunately, the epidemic is also now spreading across the globe – with opioid abuse increasing in countries like Australia, the United Kingdom and Ireland.

But how did the opioid crisis reach such epidemic proportions in the US? And more importantly, how can we start to tackle the crisis?

 The opioid crisis in the US can be understood as occurring in three waves. These ‘waves’ are calculated based on which drug is most prevalent in overdose deaths. The first wave was oxycodone, the second was heroin, and now we are in the third wave of fentanyl. To understand why the epidemic exists, we need to start with Wave I:

Wave I: Oxycodone in the 90s

In the late 90s, various pharmaceutical companies began aggressively marketing extended-release oxycodone as a safe and non-addictive medication for pain (esp. chronic pain). 

One of the core tenants of this strategy was that all pain is bad, and opioids can help us to ‘end suffering worldwide.’ This was a dangerous idea because it essentially encouraged a medical culture of escapism. It should go without saying that not all pain is bad, and one of the main tasks of life is learning how to deal with our pain.  

In addition, false academic articles were used to claim that oxycodone had a 0.5-1% addiction rate. A 0.5% addiction rate would only hold if the medication was used for a very short period, such as during surgery or for 72 hours afterwards. 

Instead, the emphasis was on how oxycodone can treat chronic pain, which it is not effective at doing. If you take opioids long term, you are very likely to become dependent.

Wave II & III: Heroin and Fentanyl

In the 2000s, the CDC tried to tighten restrictions and make prescription opioids harder to obtain. As a result, the focus turned to heroin, a cheap and widely available illegal opioid. We then entered ‘wave II’ of the crisis in 2010. We entered wave III (fentanyl) in 2013, as it is even cheaper and easier to make than heroin.

Fentanyl is also 80- 100 times stronger than heroin, morphine, or oxycodone. As a result, most overdose deaths that we see today occur when people consume their usual quantities, but the drugs are laced with fentanyl (or the person does not realise just how potent fentanyl can be).  

Unfortunately, even if a young person today isn’t prescribed oxycodone by their doctor, opioid abuse has become normalised throughout the US. Studies show that nearly 1 in 3 people know someone struggling with opioid addiction, whether it’s a friend, a parent, a parent’s friend, a sibling and so on. That means that opioid abuse is not only normalised but very easily accessible.  

How Can We Start Tackling the Problem? 

Harm-reduction practices have the best track-record when it comes to tackling an opioid crisis. For example, Portugal decriminalised the public and private use of all drugs in 2001 in an attempt to tackle their own heroin epidemic. Instead of going to jail, users who were caught would stand before a three-person panel typically consisting of a lawyer, a physician and a psychologist or social worker. The commission would assess whether the individual is addicted and would create a treatment plan.

 The results were astounding – by decriminalising substance abuse and responding in a non-judgemental manner that emphasised healthcare, Portugal effectively ended its opioid crisis. In our opinion, combining harm reduction with education and resources are the best tools at our disposal for ending opioid-related deaths.

2. What are the Different Types of Opioids?

The opioid crisis is reaching frightening heights, and we need to act. At Paracelsus Recovery, we believe that a combination of harm-reduction, education and resources are vital.

 We recognise that, as mental health, and addiction professionals, one way in which we can help is to create educational content to help increase the public’s awareness. To that end, we created a four-part educational series focused on opioid abuse. In this part, we outline key facts about the five most commonly abused opioids.

    I.       Morphine 

Morphine is a naturally occurring opioid, derived from the poppy plant. Morphine has been used for medical practices for over 200 years and is generally considered the prototype opiate. Heroin, codeine, and Vicodin are all made from morphine. Morphine is also an endogenous drug which means it can be found naturally occurring within the human body.

 Morphine is often prescribed to treat severe pain following a surgery or injury. Side effects include euphoria, pain-relief, sedation, internal hallucinations, respiratory depression, low blood pressure, addiction, and fatal overdoses. Because the euphoria that morphine produces is a lot greater than what you would find with other opioids, it is similar, if not identical, to heroin.

Like any opioid mentioned here, once a person becomes addicted to morphine, they will experience intense withdrawal symptoms whenever they have been without the drug. These symptoms are highly painful and can be highly dangerous. If someone has a morphine addiction, it is vital to undergo the detoxification period under medical supervision.  

      II.     Heroin

Similar to morphine, heroin is made by combining chemicals with the resin of the poppy plant. It was first manufactured by a German pharmaceutical company in 1898. It was marketed as a treatment for morphine addiction.

 Until recently, heroin was the most abused opioid. For example, in 2018, 9.2 million of the 13.5 million opioid users in the world were on heroin. Heroin can be smoked, snorted, and injected; the latter often being the preferred option amongst people who are addicted to the drug as the effects take hold faster and you receive a greater high.

Heroin side effects include a rush of euphoria, dry mouth, pain-relief, heavy legs or arms, warm flushing of the skin, increased body temperature, nausea, vomiting, slow or irregular heart rate, addiction, and fatal overdoses. With long term use, heroin can lead to infections in your heart lining and valves, hepatitis C, pulmonary complications, skin infections and abscesses, oral health problems and permanent organ damage to the liver, kidneys, and brain due to the lack of oxygen that occurs during an overdose.

Heroin is both physically and psychologically addictive. This means that a person will experience physical withdrawal symptoms when they stop using which can also be highly traumatic. Studies show that treatment programmes which combine medication-assisted treatment with intensive psychotherapy are the most successful at helping users effectively treat a heroin addiction.

     III.        Fentanyl

Fentanyl is one of the most potent synthetic opioids available today. A synthetic opioid is a substance that was synthesised in a laboratory but targets the same parts of the brain as a natural opioid (e.g., morphine and heroin).

 However, much like natural opioids, fentanyl works by inhibiting pain signals in the brain and increasing the amount of dopamine in circulation. Side effects include dizziness, confusion, drowsiness, respiratory depression, and addiction.

 Fentanyl is 100 times stronger than morphine or heroin, and a lethal dose is often only around two milligrams (about two grains of salt). Fentanyl is also a lot cheaper to produce and it is at the heart of the opioid crisis. If you or a loved one suffers from fentanyl addiction, it is vital to always keep naloxone (Narcan) on you.

      IV      Oxycodone

Oxycodone is a semi-synthetic opioid that is the active ingredient in prescription painkillers such as oxycontin. Oxycodone was once intended to be a safer alternative to heroin or morphine, but by 2004 it was considered the leading drug of abuse, especially in the USA. Despite first being marketed as non-addictive, oxycodone is highly addictive (like all opioids) when high doses are taken for a prolonged period.

     V.       Vicodin

Vicodin is a combination medication that is used to relieve moderate to severe pain. It contains an opioid pain reliever (hydrocodone) and a non-opioid reliever (acetaminophen). The hydrocodone changes how your body responds to pain, which is why it is so addictive. 

Much like oxycodone, Vicodin is a prescription medication used to treat severe pain, such as that you would find after a surgery, accident or during prolonged treatments such as chemotherapy. Side effects are similar to the opioids mentioned above and withdrawal symptoms include restlessness, mood changes (e.g., increased anxiety, insomnia, suicidal ideation), muscle aches, diarrhea, nausea, and sweating.

To conclude, in 2018, the New York Times noted that fatal drug overdoses had now surpassed deaths due to car HIV/AIDs, car accidents and gun violence. Unfortunately, pandemic-related stressors like financial pressure and loneliness have drastically increased these numbers. If you or a loved one is struggling with opioid addiction, it is vital to seek help as soon as possible. Opioid addiction is one of the most challenging experiences a human can go through. However much the addiction may make you think otherwise, you are not alone, and help is available.

3. The Biology Behind Opioid Addiction

 The opioid crisis is reaching frightening heights, and we need to act. At Paracelsus Recovery, we recognise that, as mental health, and addiction professionals, one way in which we can help is to create educational content to help increase the public’s awareness. To that end, we created a four-part educational series focused on opioid abuse.

 Opioids are one of the most addictive substances in the world. Opioids like morphine, heroin and oxycodone also release an unfathomable number of feel-good emotions like dopamine, which creates the sense of euphoria and relaxation. However, most opioid addictions occur due to the physical dependency that can happen.

 Chronic and prolonged use of all addictive substances will lead to a physical dependence, but none are quite as potent as opioid dependency. As a result, most users will find themselves trapped in a cycle of opioid addiction because they are trying to avoid feeling sick, not so that they can get high. To help users and loved ones understand, we asked our experts to break down the biology behind opioid addiction.


How Does Our Body Become Dependent on Opioids?

All opioids act on the body’s opioid system by binding to opioid receptors in our brain. Our endorphins temper pain signals by binding to these receptors. Opioid drugs essentially bind much more strongly and for much longer. When a drug binds to opioid receptors, it triggers the release of dopamine, which leads to euphoria.

But it also suppresses the release of noradrenaline impacting wakefulness, breathing, digestion and blood pressure. A therapeutic dose will suppress noradrenaline enough to cause side effects like constipation. At higher doses, it will decrease heart and breathing rates to dangerous levels, which leads to loss of consciousness and overdoses. With continued use, the body needs to adapt to this change in its system. To do so, it will decrease the number of opioid receptors. So now, if you want to experience the same mood effects (release of dopamine) as before, you need to take a larger dose (this is how tolerance forms).

But, as people take more to compensate for tolerance, noradrenaline levels continue to decrease. To compensate, the body increases its number of noradrenaline receptors. This increased sensitivity to noradrenaline allows the body to continue functioning normally, but opioids are now essential to maintain the new balance.

This is because when someone stops taking opioids, noradrenaline levels will start to rapidly increase. But the body needs time to remove all those additional noradrenaline receptors. This imbalance causes withdrawal symptoms. 

Psychology Behind Opioid Addiction

Simply put, opioids are painkillers. They reduce your pain and replace it with a sense of bliss or euphoria. However, the drugs do not discriminate when it comes to whatever type of pain you are struggling with. For example, say you take opioids for a knee injury, but you have also recently experienced a loss. The opioids will reduce the pain of both these stressors. This is what makes them so addictive.  

In addition, studies show that while young adults are more likely to use opioids recreationally, opioid addiction is highest in middle-aged people who suffer from underlying mental health issues. But, in our experience, the only deciding factor truly is whether or not you are in pain. 

For example, what tends to happen is that a doctor prescribes an opioid-based painkiller for chronic pain (e.g., cluster headaches caused by an undiagnosed anxiety condition). Those opioids release dopamine. Mental health issues deplete our brain of this neurochemical, so pre-medication, that patient would have been functioning in a deficiency state. But suddenly, they feel happy and normal.

But that feeling only lasts so long and it leads to tolerance, which sets people up for physical dependency which reinforces the psychological aspects of the substance. While the person may have found relief to begin with, now they cannot even function without the substance.

Opioids have the highest relapse rates of any substance, and it is a direct result of how the physical and psychological aspects of addiction reinforce each other.

If you or a loved one is struggling with opioid addiction, it is vital to seek help as soon as possible. Opioid addiction is one of the most challenging experiences a human can go through. However much the addiction may make you think otherwise, you are not alone, and help is available.

4. Signs and Symptoms of an Opioid Addiction

 The opioid crisis is reaching frightening heights, and we need to act. At Paracelsus Recovery, we recognise that, as mental health, and addiction professionals, one way in which we can help is to create educational content to help increase the public’s awareness. To that end, we created a four-part educational series focused on opioid abuse.

What are Opioids?

 Opioids are an extensive group of pain-relieving drugs that work by interacting with our cell's opioid receptors. Also known as narcotics, opioids are a highly potent sedative used for pain relief or anaesthesia. They are also highly addictive if use is prolonged and excessive.

There are two main types of opioids: natural and synthetic. Natural opiates are derived from the opium poppy plant such as morphine or heroin. Synthetic opioids are made in a laboratory and are designed to mirror the effects of natural opioids. Examples include oxycodone and fentanyl.  

Commonly used opioids include:

• Fentanyl.
• Heroin.
• Oxycodone (OxyContin).
• Hydrocodone (Vicodin).
• Codeine.
• Morphine.

What Do Opioids Do?

Opioids work by blocking the pain signals transmission to our brain. Once ingested, they trigger the release of large amounts of endorphins which block out sensations of pain, increase feelings of pleasure and create a short-lived but powerful sense of happiness and wellbeing. Because of these effects, opioids are taken more and more frequently for recreational use. However, once these effects wear off, people can find themselves wanting to experience these sensations again as soon as possible and this is the first step towards dependency.

Over time, our brain and body can become dependent on opioids to function. When this happens, our body thinks that the opiate is necessary for our survival, and we will go into withdrawal when we do not consume it. When this happens, we have developed a physical dependency that needs to be carefully monitored. Trying to go ‘cold turkey’ can lead to long-term health effects and life-threatening conditions such as opioid withdrawal syndrome.

For example, when someone stops taking opioids, their body’s noradrenaline levels will start to rapidly increase. These increased levels make people most likely to overdose when they have been off opioids for a while (or in withdrawal) because what would have been a standard dose while your tolerance was high is now lethal.

Symptoms of opioid addiction include:

• Spending more time alone or avoiding places or people with whom you cannot consume opioids.
• A lack of concern for interests you once loved, your personal hygiene and your responsibilities.
• Increased sense of fatigue, anxiety, sadness, or mood swings.
• Needing to ever-increase the amount of the opioid consumed obtain the feeling of relief.
• Experiencing withdrawal symptoms such as physical illness when not using the opioid.
• Changes in personality and interests as opioid use begins to take centre stage.
• Lying to loved ones and minimising the extent of your opioid abuse.
• Overexaggerating the pain you are in to your doctor to try and obtain more opioids.
• An increasing sense of panic and fear at the idea you will run out of opioids.
• Your loved ones are commenting on your substance abuse.

How is Opioid Abuse Treated at Paracelsus Recovery?

At Paracelsus Recovery, we adopt a medically-assisted harm-reductionist approach to opiate addiction. We are non-judgemental and pragmatic and can provide fully individualised non-12 step treatment programmes.

Our first step will be to provide a safe and medically supervised withdrawal from the opioid. While withdrawal is always challenging, we will make the process as comfortable as possible with supporting infusions (IVs) and various therapies. This withdrawal protocol will be carried out and supervised by a clinical nurse and our psychiatrist.

After the withdrawal procedure, our priority is to understand what pain opioids relieve for you. Or, in other words, what underlying issues caused you to become dependent on the opioid.   

During the treatment process, which takes place in the convenience and privacy of your chosen residence, we identify the underlying causes of the dependency through a 360-degree assessment. With this information, we will then implement a comprehensive programme that will help you c heal from these issues and create new coping strategies to deal with life’s stressors. At Paracelsus Recovery, we do everything we can to ensure we can provide the best opioid addiction treatment possible.