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Are All Opioids Addictive?

Opioid pills spilling out of a prescription bottle onto a blue counter  

Any opioid use can lead to dependence or addiction.

Opioids derived from the poppy plant have been used for centuries for treating pain and other ailments. Even to this day, both natural and chemically synthesized opioids are used for the treatment of severe pain. However, the addictive potential and the risk of a fatal overdose from opioid use are also well recognized today. The rate of prescription opioid misuse has gradually declined among teenagers over the past 15 years. However, misuse of prescription opioids remains a problem in young adults between the ages of 19 and 25 years old.

What are Opioids?

Opioids include natural and synthetic compounds that bind to the opioid receptors present in the nervous system and the gastrointestinal system. Some opioids, such as morphine and codeine, occur naturally and are derived from the resin of the opium poppy plant. Other opioids are synthesized in a laboratory by modifying naturally occurring opioids (like semi-synthetic opioids such as hydrocodone, oxycodone, and heroin), or synthesized anew using other molecules (like synthetic opioids such as fentanyl and methadone).

The ability of opioids to relieve pain has been known for many centuries and opioids are considered one of the most effective methods of relieving acute pain. This effect is due to their ability to bind opioid receptors in the brain and prevent the transmission of pain messages from the body to the brain. Opioids are also used for the treatment of cough and diarrhea.

Many opioids also cause euphoria and result in decreased anxiety, making opioids a commonly abused class of drugs. Some opioids, like methadone, have a more gradual mode of action and do not have euphoric effects. However, the use of all opioids can lead to the development of physical dependence. Such dependence is observed even when medications like hydrocodone, oxycodone, codeine, and morphine are used as prescribed.

Dependence or reliance on opioids does not necessarily imply an addiction to the drug that involves negative social consequences. However, the use of illicit opioids like heroin or the use of prescription medications in a manner other than prescribed (misuse) can lead to the development of addiction.

Abuse of opioids among teenagers generally involves prescription opioids, whereas the abuse of heroin within the age group is relatively uncommon. This rate is likely due to the fact that prescription opioids are more easily accessible to teens. The rate of prescription opioid misuse among high school students was 3.4% in 2018. The rate of heroin abuse in the same age group was 0.4%.

Why Are Opioids So Addictive?

Opioids like heroin and morphine bind to opioid receptors in the brain and the body. These opioid receptors are particularly concentrated in brain regions that are involved in responding to rewarding stimuli, such as the brain reward pathway. This brain reward system that involves the neurotransmitter dopamine responds to pleasurable stimuli and is involved in reinforcing or repeating activities that are essential for survival. In other words, opioids activate this brain reward pathway, resulting in an increased release of dopamine associated with a pleasurable experience.

Repeated intake of opioids, however, leads to lasting changes in the reward pathway, including decreased dopamine levels. Such a decrease in dopamine levels requires sustained intake of the drug to stimulate the release of the neurotransmitter and function normally. These adaptations in the brain also result in decreased pleasure experienced with other rewarding activities, increased sensitivity to cues that lead to drug use and increased impulsivity. Such changes thus lead to compulsive intake of opioids, resulting in addiction. In such cases, discontinuation of drug use leads to withdrawal symptoms, involving a negative emotional and physical state. These withdrawal symptoms can be difficult to cope with and contribute to the continual intake of the drug.

Besides the dopamine neurons in the reward pathway, prolonged use of opioids also cause a change in the brainstem nucleus, locus coeruleus, that releases the neurotransmitter norepinephrine. An increase in the levels of norepinephrine in the locus coeruleus mediates many of the unpleasant symptoms of opiate withdrawal, such as increased heart rate and blood pressure, anxiety, nausea, and vomiting.

Are Opioids Safe for Teen Use?

Prescription opioids are effective in the treatment of severe pain associated with surgical procedures, sports injuries, and cancer. Such use of prescription opioids in teens can be safe when done in a manner prescribed by the physician and for a short duration of time. Adolescence is a vulnerable period involving social and emotional challenges that may lead to the misuse of these drugs and teen addiction.

Unfortunately, there are no guidelines from the Centers for Disease Control and Prevention for the prescription of opioids for adolescents. The increased accessibility of these drugs further increases the risk of misuse. Even the legitimate use of prescription opioids in teens (before 12th grade) is associated with the abuse of opioids in early adulthood (19 to 23 years old). Besides causing addiction, the misuse of prescription opioids by teens can also lead to a fatal overdose. Thus, although the use of prescription opioids can be safe and effective in teens when used under careful supervision, these medications should be used sparingly.

Alternatives to Opioids for Pain

There are many alternatives to opioids for the treatment of pain, with some common examples being acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), localized nerve block injections. For example, NSAIDs, such as aspirin or ibuprofen, can be effective in alleviating pain caused by swelling or inflammation. Acetaminophen is effective in the treatment of mild to severe pain and can be as effective as opioids when used in combination with NSAIDs.  Localized injections of anesthetics are useful in the treatment of nerve pain or muscle spasms, whereas physical therapy and massage are non-pharmacological alternatives for the treatment of chronic pain and improving mobility. Some of the more novel methods for the treatment of pain include the use of radio waves or electrical waves and the non-psychoactive compound present in marijuana, cannabidiol.

Teen prescription drug abuse can be treated and Next Generation Village can help. Contact Next Generation Village to learn more about the treatment options available for your teen.

Medical Disclaimer: Next Generation Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

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