In this entry, we will continue with the question and answer format previously used regarding alcohol withdrawal. Opiate addiction is admittedly a broad topic, and there are various aspects that need to be carefully considered when seeking treatment. If you or a loved one have any specific questions regarding opiates, please feel free to submit your questions using the submission form on the FAQ page of our website, and we will endeavor to address those questions in future blog entries.
Q: What are opiates?
A: Opiates are a class of drugs originally derived from the opium poppy. These natural opiates include morphine and codeine. Classically, these medications are used for pain
relief, cough suppression, and the management of diarrhea. Later, these compounds were modified or manufactured in a laboratory setting, creating semi-synthetic opiates like heroin and hydromorphone. Some of these agents are entirely manufactured in a laboratory setting, referred to as synthetic opioids, with Fentanyl being a classic example, and by now the most common opiate that has gripped the state of South Dakota and the entire US in an epidemic referred to as the opiate crisis. Opiates act on specific areas in the brain called opiate receptors, thus producing differing effects.
Q: What is the effect of opiates on the brain?
A: Opiates have a powerful effect on the brain and commonly cause euphoria (feeling well or elated, especially in the presence of physical or psychological pain). Due to the potent effect of these drugs and the alleviation of negative feelings (i.e., sadness, emotional or physical pain, and discomfort), the reinforcing effect of these drugs is quickly established. Other effects include heart rate, respiration, temperature regulation, and consciousness.
Q: Why are opiates and Fentanyl dangerous and leading to deaths?
A: Fentanyl is 50-100 times stronger than morphine. Thus, the "high" from it is much more pronounced, and people who use it will soon seek those positive effects again. However, Fentanyl does not only produce effects on mood; it also has dangerous effects on many other organs including the heart, blood vessels, and respiratory system. Therein lies the danger of Fentanyl: it can stop breathing, leading to death.
Q: What is tolerance?
A: As any opiate is used repeatedly, a higher dose is needed to produce the same effect, especially the euphoria. This happens as the receptors in the brain adapt to the presence of the medication, and they become less sensitive to the drug. Thus, a higher and higher dose is needed to produce the same effect. However, tolerance to the effect on mood can often happen before tolerance to respiratory depression occurs. Thus, even in long-term users of these drugs, respiratory depression can develop despite the fact that the "high" of these drugs has worn off.
Q: How does withdrawal from opiates work?
A: When opiates are discontinued, a syndrome develops, referred to as opiate withdrawal.
There are two ensuing stages: the acute (early) stage and chronic (late) stage.
During acute withdrawal, the following symptoms occur: nausea, vomiting, diarrhea, joint and muscle pain, runny nose, sneezing, goosebumps, sleeplessness, significant anxiety, and dysphoria (restless, unwell, feeling uneasy, and depressed). Although the effects in the acute stage are not as dangerous as with alcohol withdrawal that can lead to death, the symptoms of opiate and Fentanyl withdrawal are severe, leading to relapse if appropriate support is not given. Our staff is familiar and experienced in helping and treating all these effects. Generally, it is much safer to go through opiate withdrawal in a controlled and managed setting, referred to as medically supervised withdrawal.
Q: What is chronic withdrawal?
A: After the acute withdrawal, which generally lasts a week or less, prolonged (chronic) withdrawal from opiates starts. It is generally believed to last for months and even up to a year or more in some cases. During this stage, the bodily effects (i.e., nausea, diarrhea, goosebumps, and runny nose) wear off, but the mental or psychological effects remain. This can be intense and prolonged and can be a high risk time for relapse. Some people who are highly motivated can successfully remain off opiates during this time, especially if they are in an environment where continuous support can be given. It is also crucial to address triggers to use, behavioural patterns, thought patterns, and last but not least, spirituality.
Q: Is there any medication that can help with withdrawal?
A: At iRecover, we believe that every person is unique, and there is no "one size fits all" approach. We tailor treatment and help according to every participant's needs. An essential aspect of this is considering medication management, or what is referred to in the medical community as MAT (Medication-Assisted Treatment). This will be offered and discussed with every participant in our program.
Q: What are the main elements of MAT?
A: There are three medications that can be used in the management of opiate withdrawal: Buprenorphine, Methadone, and Naltrexone. We believe that these medications should be offered to anyone who struggles with opiate addiction. The scientific evidence that these medications are effective is indisputable. In short, people on MAT have a lower risk of relapse, overdose, death, HIV, or Hepatitis. They are less likely to end up incarcerated. People on MAT have been shown to gain and retain employment, stay in relationships or marriages longer, and have better interaction with family (spouse, parents, and children).
Q: How do these medications work?
A: Buprenorphine is our preferred agent to use. In simplified terms, it works on the opiate
receptors in the brain by blocking the negative effects and not providing the positive (high or euphoria) effects. What makes Buprenorphine preferred is that it has minimal risk for overdose, and it can also be administered in a long-acting injectable formula, which generally increases compliance and long-term success.
Q: Are there other options if I prefer not to take medications that still work on the opiate receptors?
A: Yes, there are. At iRecover, we carefully consider every patient's wishes, goals, and specific situation. One such option is Clonidine, a medication that can be used "off-label" for the management of opiate withdrawal. Clonidine is a traditional blood pressure medication that has been studied and shown to alleviate many of the symptoms associated with opiate withdrawal. This is something that can be discussed with our medical team.
At iRecover US, we are ready to offer help and guidance to ose struggling with opiate addiction. Our trained and skilled staff will discuss, among other elements, MAT options with all patients and help those obtain their goal of sustained abstinence.
By Dr. Hilgard Goosen, CEO of iRecover US, Howard South Dakota
iRecover US is considered by many to be the top alcohol rehab and drug rehab in South Dakota. iRecover US employs evidence based treatment programs to provide the best alcohol addiction treatment and drug addiction treatment to all residents of South Dakota and the Mid-West. We accept insurance and self-pay options are available.
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