Opiates are originally derived from the poppy plant which has been around for thousands of years. The earliest reference to the use of the plant dates back to 3400B.C. where they were cultivated in lower Mesopotamia. Even the earlier Sumerian civilization at around 460-357 B.C. used the plant and called it the “Joy plant”. Many other civilizations used it as well such as the Arabs, Greeks and even the Romans as a sedative. The juice of the white poppy from which opiates are derived from was usually prescribed to be taken with the seed of the nettle plant at the time.
How Opioids Work?
Opioids bind to and activate the opioid receptors located in various areas of the brain, spinal cord and other organs in the human body involved with the feelings of pain and pleasure. When they attach to themselves they block out pain signals sent from the brain and release large amounts of dopamine throughout the body and if not closely monitored it may lead to the repetition of use.
The Evolution of Opiates
In 1806, German chemist Fredrich Wilhelm Adam Serturner isolated a substance known today as morphine from opium. It was named Morphine after the god of dreams, Morpheus. After this discovery it became a mainstay for the USA doctors for treating various medical conditions such as anxiety, female ailments and respiratory problems. It was also widely used a painkiller in the world war as well. The use of the opiates in the war was so strong that there was a post-Morphine dependence that was so great it was known as, “soldier’s disease.” In 1853, the hypodermic needle was invented, after which morphine began to be used in minor surgical procedures to treat neuralgia which gave rise to the medicalization of opioids. Heroin was synthesized as a product of morphine in 1898, and the German chemical company Bayer offered it as a cough relief. It was offered as a non-addictive substitute for morphine at the time.
In 1909, USA passed the opium exclusion act barring importation of opium as it had started being smoked. It was considered the first official mark on the war of drugs. The act placed a nominal tax on opiates and required pharmacist registration for its distribution. In Germany, after Bayer stopped mass production of heroin the University of Frankfurt developed oxycodone hoping it would retain the analgesic effects of morphine but with lesser physical dependence like heroin. In the USA at around 1938, Opioid-derived medicines were being sold such as codeine and oxycodone despite their negative consequences. The Controlled Substances Act, passed in 1970, began to consolidate all of the prescription opioid drugs under the then existing federal law into five separate schedules. These schedules were based upon the substance’s medicinal value, it’s harmfulness and potential for abuse or addiction in society. The United States of America medical landscape in the 1980s was characterized by “opiophobia” – a fear of prescribing opiates and other opioids.
In the 2000’s Purdue’s aggressive marketing of its opioid Oxycontin intersected with the trafficking of cheap, pure heroin and it was advertised as non-addictive because the drug was designed to be released constantly in the body during a 12 hour period. Recreational drug users were able to get “high” by crushing or dissolving the time-release pills.
Types of Opiates
There are various types of opiates which are broadly classified into three main categories. There are the natural opiates which are derived from the opium poppy plant and an example is morphine. The second category is known to contain partial synthetic derivatives of morphine and is called opioid drugs and examples are such as hydrocodone, oxycodone, and oxymorphone. The third category is composed of synthetic compounds like alfentanil, levorphanol, codeine and propoxyphene among others. Some of the most commonly used opiates today are such as opium which is used by over 13 million people worldwide. It has the appearance of blackish-Brown tar and is commonly smoked by the user. It is one of the most expensive opiates and is made from the white liquid of the poppy plants and has been found to be very addictive. Heroin, which is also a well known synthetic opiate has also a widespread reach all over the world and is rated the most dangerous. It is a street drug that is processed from morphine and is taken into the body in three main ways namely, injection, smoking, and snorting.
The three mainly used time-release opiates according to research are oxycontin, hydrocodone, and codeine. Codeine has, however, become the most widely and commonly used opiate in the world according to a survey done by the world health organization. A large number of cough syrups in the United States of America that require the use of a prescription contain codeine. They attribute its popularity to the fact that codeine is the safest of all the opioid analgesics. It is used to suppress chronic coughing and is taken orally.
Benefits of using Opiate medication
Chronic pain is a public health problem and frustrating to everyone affected especially the elderly who wish to remain in their homes and live independently. Opioid analgesics are prescribed for various ailments namely acute trauma, perioperative care, cancer pain with family physicians being at the forefront prescribing more opioids than any other physicians. The use of opioids as a treatment for acute pain and cancer pain syndromes has found to be effective in recent years. Physicians specializing in pain have found that the prescription of long-term opioids has been found to be increasingly common and effective in battling with malignant chronic pains. In recent years several controlled trials have been conducted and documented on the efficiency of opioids in the treatment of chronic non-malignant pain such as low back pain, post-herpetic neuralgia, and painful peripheral neuropathy. The research supports that it should be used to provide direct analgesic actions and not just act as a counteractive pain reliever. In a randomized, double-blind, placebo-controlled trial, the controlled-release oral opioids were found to be more effective than tricyclic antidepressants in decreasing the pain of post-herpetic neuralgia. Other reports have uncovered the presence of opioid receptors in the peripheral tissues which are activated by inflammation. The findings suggest that opioids may have a role to play in the treatment of chronic inflammatory diseases such as connective tissue disorder and rheumatoid arthritis.
A randomized placebo-controlled clinical trial in patients with chronic non-malignant pain discovered that the use of slow-release codeine reduced pain as well as the pain-related disability.
The Negative impact of Opiates
The use of opiates has been strongly associated with dependence over the years as most opioids with long-term use slowly become addictive in nature if not carefully used. The general public misuses opioids in ways such as taking the medication in a non-prescribed way, taking another person’s prescription medicine and the recreational use to just get “high.” When one chooses to misuse the drug there are various ways it is ingested into the system such as crush of the pills, opening of the capsules and dissolving the powder in water and later injected into a vein which is the worst of the various forms.
Some common effects of using opioids are drowsiness, nausea, constipation, euphoria and slowed breathing. Slow breathing is a serious concern as it can lead to hypoxia where not enough oxygen reaches the brain and that may lead to short and long-term psychological and neurological effects. Expectant mothers who use the opiates put their unborn at risk. The baby may be born with a certain level of dependence and have withdrawal symptoms after birth. The condition is mainly referred to as neonatal abstinence syndrome. The constant use by expectant mothers may also lead to miscarriages or low birth weight of the baby.
Long-term use of opioids even as prescribed by a physician may lead to the patient developing a high tolerance meaning that they would require an even higher or more frequent dose to get the desired effect. This may lead to dependence or addiction. Drug addiction is a chronic disease which is characterized by compulsive or uncontrollable use despite the long-lasting changes in the brain as well as other harmful consequences involved with its use.
There are withdrawal symptoms that are usually associated with the drug when one stops using it such as muscle and bone pain, sleep problems, diarrhea and vomiting, severe cravings among other symptoms.
Social effects of Opiate-related medication
Excessive consumption of prescription drugs by an individual affects them as an individual but also the society around him/her. The workplace is greatly affected when a worker is a heavy user as they may cause work-related accidents when they are working under the influence of the prescription medication. Excessive use of opioids also reduces the amount of productivity of an individual in the workplace as they may suffer from low concentration as well as lack of sufficient cognitive skills caused by the brain-altering effect of the opioids.
The family unit is also greatly affected by the use especially when one of the guardians is greatly affected. The burden is mostly transferred to the children who are emotionally scarred as they are more likely to face abuse. Children that come from a household where the opioid abuse is rampant are more likely to have poor academic performance as they do not get sufficient guidance and help from their parental figures. Addiction to the medication may lead to depression of the children who lack emotional support as well as the partner who may have constant arguments and have to play both roles in the family unit. In rare cases where both guardians are found to be hooked to the prescription medication, child protective service may view them as unfit to parent and the children sent to an orphanage or foster care where they are further disadvantaged as they may be moved from one household to another greatly affecting them mentally at their tender ages. This may lead to the children inheriting the drug abusive ways of their alcoholic parents.
Poor work ethics may lead to a decrease in wages as they are in constant trouble with the management of the premises and may end up losing their jobs. As one continually abuses the medication their mental, as well as physical health, deteriorates and one may find themselves using their money to cater for recurring medical expenses instead of investing their money in more profitable endeavors elsewhere. An increase in the amount of crime can also be connected to the increase in the use of prescription drugs in the general populous of an area. This is mainly caused by the reduction in inhibitions where people do not think about the consequences of their actions during the time they are committing the offense. People may also resort to crime to get sufficient money to maintain their habits when other channels of attaining funds are closed.
Violence is also a major social problem associated with the abuse of the prescription drugs where disagreements lead to the break out of fights which may lead to serious injuries as well as loss of life when they get out of control.
The spread of diseases is also made possible by sharing of needles when users inject themselves with the opioid medication. Heavy use among the youth in learning institutions also affects their grades and if not put in check leads to dropping out of school. This would eventually lead to a decrease in manpower that would in the future help the economy and society in a more positive and constructive way.
Treatment for Opioid Addiction
There is a range of treatments including medicines and behavioral therapies that have been proven to be effective in helping users with their opioid addiction. The United States food and drug association have approved the sale of a device know as the NSS-2 bridge that helps people cope with the withdrawal symptoms. The device is a small electrical nerve stimulator placed behind a person’s year and can be used for the first five days which is the acute withdrawal phase. There is also a drug called lofexidine which is a non-opioid medicine designed to reduce the opioid withdrawal symptoms. Buprenorphine and methadone are medicines that work by binding themselves to the opioid receptors in the brain as well as reducing the cravings and withdrawal symptoms in the process. Naltrexone is also a medicine that blocks opioid receptors and prevents them from having any effect on the body.
Behavioral therapies for addiction to prescription opioids help the users to be able to change their general attitudes and behaviors related to drug use. Cognitive behavioral therapy helps to modify the patient’s drug use, expectations, and behavior, as well as help, manage triggers and stress. Multidimensional family therapy which is developed for adolescents with drug use problems addresses a range of personal as well as family influences on a patient’s drug use patterns.
The main causes of Opioid Use
There are various factors that may lead to one developing a prescription problem. Researchers have established that there are certain factors that may play a major role in influencing misuse as well as dependence. Long-term use has been identified to contribute to the chances of one engaging in misuse where one develops impulses and feelings of pleasure encouraging the repeat of the behavior. This, in turn, may lead to the development of an addiction problem as repetitive use is boosted by the strong impulse to not stop.
Research has found that the proximity and availability of prescription medication plays a major role in determining the chances of a person indulging in their use especially among the youth. Research has found that those people who have easier access to the prescription drugs are more likely to engage in their abuse compared to those who are unable to afford them or are far from their point of purchase. Researchers also found that people within the higher income bracket are more likely to engage in the activity and have a higher chance to become hooked compared to those with a lower income in the society due to the increase in prices of some of the prescription drugs such as the codeine cough syrup. The media has also been identified as a major influence as it decriminalizes the vice and encourages its use as a pastime activity.
There are various social factors such as family, religion, and work that may influence the chances of an individual getting hooked. The family unit, as well as the environment one, is raised greatly influences the chances of one getting into the vice where if someone is exposed to it at an early age they are more likely to find themselves develop the want to engage in the activity. Research has found that in the much younger demographic when getting into new institutions a learner may find themselves among peers who may force one to engage in the habit in order to fit in with a certain group of individuals. People not rooted in religious beliefs also have a higher chance of getting involved in the use compared to those who are strongly religious in some situations although it may not always be a strong determinant.
Psychological factors as well play a major role in the development of the habit. This is seen when a person experiences grief, stress, anxiety depression or just a bad day and turns to the comfort of the opioid medication. This may lead to the creation of a pattern where when the user feels down they quickly resort to the prescription medication to help them cope with the tough time. The use can become habitual with time causing the body to become more tolerant and rely on the effects of the drug. The company of friends of an individual also play a major role in the chances of developing the disorder. A person who is constantly around peers who use the pills or syrup is more likely to fall into the habit as it is normalized and they do not see the harm in participating and may slowly find themselves addicted.
Steps taken to combat the Prescription Opioid use
There are various ways that have come up to fight the opiate menace. The setting up of counseling offices in learning institutions has greatly helped the younger demographic cope with peer pressure as well as deal with emotional strain if they are found to have guardians who use the medication. The counseling centers also help increase awareness about the dangers that misuse of the prescription poses to them and society as a whole. Community centers have also been set up where people in need of help can turn to and get help. These centers have been found to help foster a good environment where people form groups where they can share their encounters within the safety of the groups and keep each other in check.
Group therapy has also been found to be very effective in solving the problem efficiently as it provides emotional support. In group sessions counselors advice on alternative ways to relieve one’s self from life pressure and engage in other activities that help unwind and handle stress.
Awareness is the first step in combating any major problem in society. Awareness camps have become a major way to spread awareness of the impending danger that the misuse of the prescription opioids poses and its effects on society. These camps help shed light on the various physical, biological and environmental factors that may cause one to get dragged into their use and once awareness has been provided people can be able to better know how to address the issue. In some of these camps, people are trained on how to deal with people fighting with the dependence as well as how to counsel people on the dangers of engaging in the activity. They are also taught on how best to approach families where a member may be a strong user and help get them the necessary aid they need.
Some governments have introduced the use of a nasal spray and auto-injection of naloxone to be used by the general public on opiate users who may have overdosed. It has greatly helped save lives and help detour people from engaging in the use. In some places, it has helped reduce the frequency with which people use the opioids. This has been found to mainly help control the amount of use by the youth.
