Misuse of prescription opioid painkillers and heroin affects more than two million Americans every year.1 More than 130 of those Americans die every day from overdosing on opioids,2 which resulted in 47,600 overdose deaths in 2017 alone.3 Unfortunately, many people are not utilizing available resources for opioid detox and addiction treatment programs. The American opioid crisis is now one of the foremost public health concerns of this century as it surges to unprecedented heights. Yet another alarming indicator that the opioid crisis is taking its toll came in November of 2018: the CDC largely attributes the decline of the U.S. life expectancy to increasing rates of drug overdose and suicide.4 It has become painfully clear that anyone who uses opioid painkillers, even if they strictly follow their doctor’s instructions, is at risk of developing addiction.5
Since we all likely know someone who has or will be affected by opioids, this article teaches how to immediately respond to an opioid overdose and sheds light on the two primary detox and treatment processes for addiction to opioid painkillers.
What are Opioids?
Opioids are a large class of drugs that include heroin (illegal in the U.S.), fentanyl, and prescription pain relievers such as oxycodone, morphine, and many others. These opioids work by binding to opioid receptors in the brain to reduce feelings of moderate to severe pain.6 In addition to relieving pain, opioids deliver a feeling of euphoria which makes them easy to misuse.7 That’s why the National Institute on Drug Abuse estimates that between 8 and 12% of patients in the U.S. that are prescribed opioids develop an opioid use disorder (OUD).8 Opioid detox and addiction treatment is extremely difficult to do alone because of their highly addictive nature.
What is the Best Immediate Response to Opioid Overdose?
The signs of opiate abuse are different than the signs of overdose. A few of the signs of opioid painkiller abuse are:9
- Needle marks on arms and legs from injected use
- Constricted, “pinpoint” pupils
- Trouble staying awake/falling asleep at inappropriate times
- Flushed, itchy skin
- Withdrawing from once-enjoyed social activities
- Sudden, out-of-character, dramatic mood swings
- Impulsive actions and decisions
- Risky behavior (such as driving under the influence)
- Visiting multiple doctors to obtain more prescriptions
If you observe these signs in yourself, please seek professional help for opioid detox and addiction treatment before it is too late. Many people have died from opioid overdose because they thought they were in control and ignored the signs that they needed help. If you know someone who displays these signs of abuse, be on high alert for the following signs of opioid overdose.
In the event of an opioid overdose, the most common physical signs to look for are:10
- Dangerously slowed, shallow, or stopped breathing
- Small, constricted “pinpoint” pupils
- Falling asleep or loss of consciousness
- Choking or gurgling sounds
- Limp body
- Pale, blue, or cold skin
If you think someone is overdosing, call 911 immediately and administer naloxone, if possible. Try to help the person to keep breathing and stay awake. Lay them on their side to prevent choking and stay with them until emergency help arrives.
Naloxone: The Second Line of Defense Against Opioid Overdose
The first line of defense against overdosing on opioid painkillers is seeking professional help when you observe the signs of abuse. For someone who is past that point and shows the signs of overdose, call 911 and administer naloxone, if possible. Naloxone is a medication that is designed to rapidly reverse opioid overdose. It’s an opioid antagonist, which means that it binds to the opioid receptors in the brain and prevents other opioids in your system from having an effect.11 Out of more than 12,000 dosages administered in Massachusetts between July of 2013 and December of 2015, 93.5% of those naloxone dosages saved someone’s life from an overdose.12
There is no reason to be reluctant to administer naloxone to someone who might be in need. On the contrary, reluctance or delaying the administration of naloxone could cost someone their life. It won’t harm someone that doesn’t need it. Naloxone will only reduce the effect of an opioid overdose, it will never make it worse.13 If you are unsure if naloxone is needed in the event of an overdose, it is recommended to err on the side of caution and administer it!14
Naloxone (brand name: Narcan) is available in most Walgreens and CVS stores, no prescription needed. If you know someone who uses or abuses any form of opioid, you might save their life by keeping it close by. While naloxone is an effective, immediate response to opioid overdose, it doesn’t solve the underlying problem of addiction.
There are two very different methods of opioid detox and addiction treatment.
Since there is controversy regarding the best way to treat opioid addiction,
it’s important to learn about both methods.
Replacement Therapy: Life-Long Maintenance
Replacement therapy is a long-term treatment process that involves prescribing medications, such as methadone or buprenorphine, to taper down the patient’s dependency over a period of months or years. Depending on the complexity and depth of the addiction, doses can be targeted toward opioid detox or maintenance to avoid the patients from suffering extreme withdrawal symptoms or relapsing.
Patients can reach a stabilized physical condition and be regularly monitored by their doctor while receiving regulated doses of methadone or buprenorphine that control the chemical reactions in the brain. This method helps patients avoid uncontrollable urges, the risk of overdose, and criminal activity that is associated with opioid use disorder. However, roughly 75% of replacement therapy patients must use some degree of methadone or buprenorphine for the rest of their lives in order to keep control. The unfortunate fallback with replacement therapy is that patients never become fully abstinent for the long term.15
Opioid tolerance, dependence, or addiction are manifestations of brain changes from chronic use. The withdrawal symptoms and struggle for recovery are the results of these changes in the brain.16 The methadone or buprenorphine enable a patient to maintain relatively normal function without having to undergo withdrawal. They are considered as “maintenance treatment” because they stabilize a patient, but they have a gradual onset and don’t produce the euphoria of more potent opioids. They are not as addictive and reduce the patient’s desire for opioids.17
Aversion Therapy: Mitigated Withdrawal and Long-Term Sobriety
Aversion therapy is a type of behavioral therapy that repeatedly pairs unwanted behavior with discomfort.18 This has proven to be an effective method for retraining the brain after it has become dependent on an addictive substance. Aversion therapy patients are likely to recover from their addiction for the long term and enjoy a sober life.19 Schick Shadel Hospital is a well-known addiction recovery hospital in Seattle, WA that has perfected the aversion therapy treatment for a wide range of addicted substances, including opioids.
Utilizing aversion therapy is the natural choice for people who want to be sober for the long term and avoid a life of dependence on maintenance opioids. Schick Shadel Hospital offers an inpatient opioid detox program where people can safely detox over a period of 3-7 days, depending on their needs. They benefit from all the advantages of medically-assisted detox such as constant monitoring, nutritional repair, and medications that mitigate the withdrawal symptoms.
After patients have fully detoxed, they begin the 10-day addiction treatment program which helps retrain their brain to eliminate opioid dependence and be sober for the long term. By the end of the aversion therapy program, many former patients have reported that the sight or smell of their substance of choice turned from enticing to repulsive! Aversion therapy effectively removes the desire and dependence on addictive substances.
Every day, more than 1,000 Americans are rushed to the emergency room to get treatment after misusing prescription opioids.20 Yet the real gravity of this crisis is still widely unknown or misunderstood.
Please help us raise awareness about the opioid crisis and how to react in an emergency. You might help save a life by sharing this article on Facebook to help raise awareness! You never know who might someday benefit from this information about opioid detox and addiction treatment.
1 Reference, G. (2019). Opioid addiction. Genetics Home Reference. Retrieved 6 March 2019, from https://ghr.nlm.nih.gov/condition/opioid-addiction#statistics
2 Opioid Overdose Crisis. (2019). Drugabuse.gov. Retrieved 6 March 2019, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
3 Overdose Death Rates. (2019). Drugabuse.gov. Retrieved 6 March 2019, from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
4 CDC Data: Life Expectancy Decreases as Deaths From Suicide, Drug Overdose Increase. (2019). Ajmc.com. Retrieved 6 March 2019, from https://www.ajmc.com/focus-of-the-week/cdc-data-life-expectancy-decreases-as-deaths-from-suicide-drug-overdose-increase
5 Am I vulnerable to opioid addiction?. (2019). Mayo Clinic. Retrieved 6 March 2019, from https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372
6 How do opioid (narcotic) pain medications work?. (2019). WebMD. Retrieved 6 March 2019, from https://www.webmd.com/pain-management/qa/how-do-opioid-narcotic-pain-medications-work
7 Opioids. (2019). Drugabuse.gov. Retrieved 6 March 2019, from https://www.drugabuse.gov/drugs-abuse/opioids
8 How to Spot the Signs of Pain Killer Addiction. (2019). Verywell Mind. Retrieved 6 March 2019, from https://www.verywellmind.com/ten-most-addictive-pain-killers-22506
9 Opiate Symptoms and Warning Signs – AddictionCenter. (2019). Addictioncenter.com. Retrieved 6 March 2019, from https://www.addictioncenter.com/opiates/symptoms-signs/
10 (2019). Cdc.gov. Retrieved 6 March 2019, from https://www.cdc.gov/drugoverdose/pdf/patients/Preventing-an-Opioid-Overdose-Tip-Card-a.pdf
11 Opioid Overdose Reversal with Naloxone (Narcan, Evzio). (2018). Drugabuse.gov. Retrieved 6 March 2019, from https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio
12 Nadia Kounang, C. (2019). Naloxone reverses 93% of overdoses. CNN. Retrieved 6 March 2019, from https://www.cnn.com/2017/10/30/health/naloxone-reversal-success-study/index.html
13 5 things to know about naloxone, the opioid overdose reversal drug – The DO. (2018). The DO. Retrieved 6 March 2019, from https://thedo.osteopathic.org/2018/12/5-things-to-know-about-naloxone-the-opioid-overdose-reversal-drug/
14 How to Use Naloxone to Reverse Opioid Overdose and Save Lives. (2019). Where Families Find Answers on Substance Use | Partnership for Drug-Free Kids. Retrieved 6 March 2019, from https://drugfree.org/article/overdose-response-treatment/#administer
15 Everything You Need to Know About Methadone Maintenance Treatment – DrugAbuse.com. (2016). DrugAbuse.com. Retrieved 6 March 2019, from https://drugabuse.com/methadone-treatment/
16 Thomas R. Kosten, T. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science & Practice Perspectives, 1(1), 13. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/
17 Is the use of medications like methadone and buprenorphine simply replacing one addiction with another?. (2019). Drugabuse.gov. Retrieved 7 March 2019, from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/use-medications-methadone-buprenorphine
18 How Does Aversion Therapy Work to Fix Unwanted Behaviors?. (2019). Verywell Mind. Retrieved 7 March 2019, from https://www.verywellmind.com/what-is-aversion-therapy-2796001
19 Elkins, R., Richards, T., Nielsen, R., Repass, R., Stahlbrandt, H., & Hoffman, H. (2017). The Neurobiological Mechanism of Chemical Aversion (Emetic) Therapy for Alcohol Use Disorder: An fMRI Study. Frontiers In Behavioral Neuroscience, 11. doi:10.3389/fnbeh.2017.00182. https://www.frontiersin.org/articles/10.3389/fnbeh.2017.00182/full?utm_source=F-NTF&utm_medium=EMLX&utm_campaign=PRD_FEOPS_20170000_ARTICLE
20 7 Staggering Statistics About America’s Opioid Epidemic. (2016). American Physical Therapy Association. Retrieved 7 March 2019, from https://www.moveforwardpt.com/resources/detail/7-staggering-statistics-about-america-s-opioid-epi
*Article about opioid detox and addiction treatment