Opioids, a class of drugs derived from the opium poppy (including synthetic variations), are pain relievers with a high potential for misuse.
Opioids are used to relieve pain, but they also cause an exaggerated sense of well-being and, if used too much, dependence and addiction.
Taking too much of an opioid can be fatal, usually because breathing stops.
Urine tests can be done to check for opioids.
Treatment strategies include detoxification (stopping the drug), substitution (substituting another drug and gradually reducing its dose), and maintenance (substituting another drug that is taken indefinitely).
Ongoing counseling and support are essential in all treatment strategies.
"Opioid" is a term for a number of substances derived from the opium poppy and their synthetic and semisynthetic variations. Opioids have a legitimate medical use as powerful pain relievers
Abuse of opioids is relatively common, because these drugs are widely available and cause an exaggerated sense of well-being. People can become dependent on any opioid. (See also Drug Use and Abuse.)
Serious dependence and addiction rarely occur when people use opioids to treat a brief episode of severe pain (for example, from a burn or broken bone). Although many people who use opioids to relieve pain for more than several days feel some mild symptoms of opioid withdrawal when they stop, people who take opioids for a long time to treat chronic pain are at increased risk of developing a substance use disorder.
Tolerance can develop after a few days of continued opioid use. That is, people need more and more of a drug to feel the effects originally produced by a smaller amount. People may become more tolerant to some effects than to others. Although people with a substance use disorder often have tolerance to a drug, having tolerance by itself does not mean that a person has a substance use disorder.
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Symptoms and Signs of Opioid Toxicity or Withdrawal
Opioids cause immediate and sometimes long-term symptoms.
Immediate effects
Opioids dull pain and are strong sedating drugs, causing people to become drowsy and quiet. Opioids may also cause euphoria.
Other, less desirable effects include
Constipation
Nausea and vomiting
Facial flushing
Itching
Confusion (especially in older people)
When taken with certain other drugs, some opioids can cause a serious disorder called serotonin syndrome. This syndrome is characterized by confusion, tremors, involuntary muscle spasms or twitching, agitation, excessive sweating, and a high body temperature.
A rare condition called spongiform leukoencephalopathy has been reported in heroin users who inhale the drug. Symptoms vary and may include motor restlessness, apathy, impaired coordination (ataxia), or paralysis. The symptoms may resolve, or they can progress to problems with the autonomic nervous system and death.
Overdose
Taking too much of an opioid at once (overdose) is life threatening. In the United States in 2020, there were about 91,800 deaths from opioid overdose. Breathing becomes dangerously slow and shallow and may stop. The lungs may fill with fluid. Blood pressure, heart rate, and body temperature may decrease, and pupils constrict (becoming like pinpoints). Eventually, people become unconscious or die, usually because breathing stops. Combining opioids with alcohol or other sedatives is even more lethal.
Long-term effects
Opioids themselves do not cause many long-term complications other than dependence. Some people have minor side effects such as chronic constipation, excessive sweating, sleepiness, or decreased libido. However, many complications can result from sharing needles with another person and from unknowingly injecting other substances with the opioid.
Withdrawal symptoms
Opioid withdrawal is uncomfortable but rarely life threatening. Symptoms can appear as early as 4 hours after opioid use stops and generally peak within 48 to 72 hours. They usually subside after about a week, although the time frame can vary considerably depending on which opioid is used.
Each opioid is eliminated from the body at a different rate, which alters how quickly withdrawal progresses and stops. Withdrawal symptoms are worse in people who have used large doses for a long time:
At first, people feel anxious and crave the drug.
Breathing becomes rapid, usually accompanied by yawning, perspiration, watery eyes, a runny nose, dilated pupils, and stomach cramps.
Later, people may become hyperactive and agitated and have a heightened sense of alertness.
Heart rate and blood pressure increase.
Other withdrawal symptoms include
Gooseflesh
Tremors
Muscle twitching
Fever and chills
Aching muscles
Loss of appetite
Nausea and vomiting
Diarrhea
Opioid use during pregnancyHow Drugs Cross the Placenta). Because babies born to women who use opioids have been exposed to the drugs their mothers have taken, they may quickly develop withdrawal symptoms, including
Tremors
High-pitched crying
Jitters
Seizures
Rapid breathing
If mothers take opioids immediately before labor and delivery, the baby’s breathing may be weak.
Diagnosis of Opioid Toxicity or Withdrawal
A doctor's evaluation
Sometimes urine tests
Acute opioid intoxication is usually apparent based on what people or their friends tell the doctor and on results of the physical examination. If it is not clear why a person is acting abnormally, doctors may do tests to rule out other possible causes of symptoms, such as a low blood sugar level or a head injury. Doctors can also do urine tests to check for the drug. Other tests may be done to check for complications.
Treatment of Opioid Toxicity or Withdrawal
An opioid overdose requires emergency treatment, but the ultimate and difficult goal of treatment is to help people control their use of opioids. Treatment can include
Emergency treatment
Detoxification
Possible maintenance treatment (for people who are unable to quit)
Rehabilitation
Emergency treatment
An opioid overdose is a medical emergency that must be treated quickly to prevent death. Breathing may require support, sometimes with a ventilator, if the overdose has suppressed breathing.
Detoxification
There are several approaches to detoxification:
Stopping the opioid and allowing withdrawal to run its course (cold turkey detoxification)
Substituting a similar but less potent drug, then gradually decreasing the dose and stopping the drug
Substitution
abnormal heart rhythms. Therefore, people on this drug are monitored closely when it is started or if the dose is changed.
is a mixed opioid agonist and antagonist. That means it has
Detoxification must be followed by rehabilitation
Maintenance treatment
Maintaining opioid users with regular doses of one of these medications enables them to be socially productive because they do not have to spend time getting the illicit opioid and because the medications used do not interfere with functioning the way that illicit drug use does. For some opioid users, the treatment works. For many, lifelong maintenance is necessary.
is being used more and more because it can be prescribed by doctors in their office. Thus, opioid users do not have to go to a special clinic.
Rehabilitation
Regardless of which approach is used, ongoing counseling and support is essential. Support may include specially trained doctors, nurses, counselors, opioid maintenance programs, family members, friends, and other people with the same substance use disorder (support groups).
The therapeutic community concept emerged nearly 25 years ago in response to the problems of heroin use. Samaritan Daytop Village and Phoenix House pioneered this nondrug approach. Opioid users live in a communal, residential center for an extended period of time. These programs help people build new lives through training, education, and redirection. The programs have helped many people, but initial dropout rates are high.
Questions about precisely how well these programs have worked and how widely they should be applied remain unanswered. Because these programs require a lot of resources to run, many people may be unable to afford them.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
National Institute on Drug Abuse (NIDA): Opioid-specific information from the federal agency that supports scientific research into drug use and its consequences and supplies information about commonly used drugs, research priorities and progress, clinical resources, and grant and funding opportunities.
Phoenix House: Residential substance use disorder treatment in states and Washington, DC.
Samaritan Daytop Village: A New York-based agency that helps various populations struggling with addictions, including military veterans, mothers and babies, and homeless people.
Substance Abuse and Mental Health Services Administration (SAMHSA): US Department of Health agency that leads public health efforts to improve behavioral health and provides resources, including treatment locators, toll-free helplines, practitioner training tools, statistics, and publications on a variety of substance-related topics.
