Tag Archives: Opioid

Suboxone and Tramadol


What is Suboxone?

Suboxone is a combination of two drugs: buprenorphine and naloxone and one typically ingests sublingually (placing a dissolving strip under the tongue).  

Why the combination? Well, buprenorphine is a low strength opioid which is intended to provide the user with mild pain killing relief and can also induce a euphoric high. However, it’s effects will level off with higher dosages- meaning that taking more of it will not necessarily increase the level of high you may experience. 

Naloxone (sold individually as Narcan) on the other hand is an opioid antagonist which can block the effects of buprenorphine. If the suboxone is taken as directed (i.e. not altering the medication to be crushed, snorted or injected), the naloxone will remain dormant and will not prevent the opioid from working. However, if the drug is altered, the naloxone will be released and prevent the buprenorphine from activating. This mechanism helps prevent abuse of the drug. 

What is it Suboxone for?

Suboxone helps treat people who may be dealing with an opioid dependency. The opioid present in this drug is considerably weaker than some others such as heroin, and allows users to lower their dependence without having to experience painful withdrawals.

Suboxone abuse

Given that suboxone contains naloxone which will render the opioid useless if altered in any way, snorting, injecting or inhaling this drug would be pointless. Also, attempting to do so can produce strong withdrawal symptoms for someone who is using it to taper off a stronger opioid (as they will not experience anything). Further, taking any medication in a manner inconsistent with it’s directions can lead to permanent damage to the body and should be avoided.

What is Tramadol?

Tramadol is a mild opioid when compared to other narcotics such as morphine or heroin and treats mild to moderate pain in patients. It is sold under several brand names such as Ultram, Ultram ER and ConZip. Tramadol still possesses the same qualities as other opioids and can cause users to experience a euphoric high and elevated mood, as it promotes the release of dopamine. It is also a serotonin reuptake inhibitor (SRI) which causes a buildup of the chemical, similar to that of some antidepressants which could explain why some abuse the drug.

Tramadol can pose serious health risks when altered or abused. Chewing, crushing and snorting, or injecting the drug will cause a faster release of the drug into the bloodstream, rather than the controlled release one would experience if taken as directed. While this may provide a more instant effect and high, the sudden absorption of the drug into the body can cause an overdose and death in some severe cases. Tramadol is a central nervous system depressant which slows your heart rate and breathing, leading to an opioid induced respiratory depression and potentially death. Further, tramadol may cause serotonin syndrome due to it being a fairly powerful SRI.

What is the difference between Ultram, Ultram ER and Ultracet?

While all three drugs contain tramadol, their functions vary somewhat:

Ultram – This is your basic brand name tramadol.

Ultram ER – Ultram ER or ‘extended release’ is an altered form of tramadol which provides a slow ongoing release of the opioid into the body. This is commonly for patients experiencing chronic pain and those who need long term relief. 

Ultracet – Ultracet is a combination of tramadol and acetaminophen and typically treats patients after dental surgery or for individuals with moderate to severe pain. As expected, the tramadol will bind to the opioid receptors and prohibit the release of serotonin and norepinephrine while the acetaminophen actually increases the pain threshold of a patient. Combined, the drugs work to reduce the overall pain experienced. Ultracet can be very harmful if abused. Along with the addictive effects of the opioid, acetaminophen can cause severe liver damage if abused.

Can you take Tramadol with Suboxone?

Mixing suboxone and tramadol could have deadly effects. As we know, taking suboxone in its directed form will cause the naloxone to remain dormant and will only release the buprenorphine. The intake of two opioids at once can cause an overdose. If altered, suboxone does have the potential to completely negate the effects of both tramadol and buprenorphine making the mixture useless. Further, mixing naloxone and tramadol can lead to an increased risk of seizures.

Mixing any opioid with alcohol is incredibly dangerous as one drug will enhance the effects of the other substance. As mentioned earlier, opioids are a central nervous system depressant and alcohol is no different. Combining the two will further increase the depressive effects and can lead to respiratory depression and death. The intake of three or more drugs is categorized as polysubstance abuse and is even more dangerous. With more substances, treatment is more difficult. It’s not impossible, but it’s important to find help from a recovery center that is adequately prepared to treat each issue.


How long does Tramadol stay in your system?

Tramadol has a half-life of around 6 hours. This means it takes roughly 6 hours for the chemical to reduce to half its initial strength. Generally, it takes around a day or two for the drug to completely leave the body. However, this is also heavily dependent on the users body composition. The ability to detect Tramadol depends on length of use and dosage. Different tests will detect it at different times.

How long does Suboxone stay in your system?

The half-life of the chemical buprenorphine, a component of suboxone, is around 37 hours. This means it takes roughly 37 hours for the chemical to reduce to half its initial strength. The length of time Suboxone stays in one’s system varies by length of use and dosage.

What is generic Suboxone?

Generic Suboxone refers to any non brand name suboxone products. Generally users will purchase this to save money as it can be around 74% cheaper than brand name Suboxone.

What are some Suboxone withdrawal symptoms?

  • Nausea
  • Vomiting
  • Headaches
  • Insomnia
  • Anxiety
  • Depression


What are some Tramadol withdrawal symptoms?

  • Sweating
  • Irritability
  • Anxiety
  • Diarrhea
  • Nausea
  • Cramps


Suboxone and tramadol both carry a high risk for addiction. Improper use can cause severe detriments to an individual’s health. If you or a loved one needs help, please reach out today.

The Risks of Gabapentin During Addiction Recovery May Compromise Sobriety

Gabapentin Risk during Recovery - Fight Addiction Now

Gabapentin* is a widely-prescribed anticonvulsant medication that carries a risk of causing dependency. Any potentially addictive substance is dangerous for people recovering from substance abuse, so it is essential to acknowledge the real dangers of this often-overlooked prescription drug. Some people may receive prescriptions for gabapentin for various legitimate medical issues, but prescribing doctors need to take patients’ past struggles with substance abuse into account before prescribing gabapentin medication.

What Is Gabapentin?

What is gabapentin used for with a typical prescription? The medication exists in several forms. Fast-acting versions can help treat seizure disorders and manage the symptoms of post-herpetic neuralgia, a condition commonly resulting from shingles infections that causes skin and nerve pain. Long-acting gabapentin can help treat restless leg syndrome. Despite the fact that gabapentin does not have a controlled substance scheduling, there is still a significant risk of a legitimate prescription leading to gabapentin abuse.

Risk For Dependency

How is gabapentin addictive if it is just an anticonvulsant? Doctors who prescribe gabapentin typically recommend increasing dosages over time, which can lead to tolerance and in turn, dependency. When combined with opioids like hydrocodone, gabapentin can produce an intense feeling of euphoria. Research shows that 15 to 22% of opioid users also abuse gabapentin**. Is gabapentin an opioid? Not exactly, but many doctors prescribe it as an opioid alternative. It can produce powerful effects when taken with opioids.

How Can Gabapentin Interfere With Substance Abuse Treatment?

It can be relatively easy for a person to abuse a gabapentin prescription by taking the medication with an illegal drug, like heroin. It’s also possible for a person who finished rehab to receive a gabapentin prescription for restless leg syndrome or a seizure disorder and start experiencing withdrawal symptoms, potentially triggering relapse. Anyone who completes rehab must be extremely careful with any medications he or she takes in the future; any medications that have habit-forming qualities require careful scrutiny. There are almost always alternatives that won’t encourage habitual use or won’t interfere with past substance abuse treatments.

Unique Problems With Gabapentin

Gabapentin Risk during Recovery

Gabapentin side effects range in severity. Taking gabapentin with other substances like opioids or alcohol can intensify these effects. Some of the most commonly reported side effects of gabapentin use include:

  • Depression
  • Angry outbursts or fits of rage
  • Irritability
  • Fatigue and lethargy
  • Reclusiveness and lack of interest in social activity
  • Anxiety
  • Suicidal thoughts
  • Memory problems
  • Sleep problems
  • Manic episodes
  • Eye twitching
  • Dizziness

These are just a few of the commonly reported gabapentin effects that can be uncomfortable or upsetting. It is important to remember that gabapentin may not produce habit-forming effects when taken by itself, but the risk of addictive effects increases dramatically when people take gabapentin with alcohol or other drugs. Combining gabapentin and alcohol can not only amplify the side effects of gabapentin, but also increase the risk of respiratory complications.

Another unique aspect of gabapentin that may complicate substance abuse recovery is the fact that gabapentin will not appear on a drug screening. A person who finishes rehab for another substance abuse issue may start abusing gabapentin and it would be impossible to confirm the problem with a screening. Additionally, gabapentin is relatively cheap compared to most other addictive drugs.

Off-Label Uses

Aside from gabapentin’s typical uses, the manufacturer also extolls several off-label uses for the drug. Some people use gabapentin for bipolar disorder, diabetic neuropathy, migraines, and other psychological and neuropathic conditions. In 2017, gabapentin was the fifth-most prescribed medication in the United States, but more than 80% of prescriptions were for off-label uses***. Some substance abuse treatment centers actually use gabapentin to help stop the seizures that often result from alcohol cessation.

Medically-Assisted Detox And Addiction Treatment

Gabapentin - Fight Addiction Now

Medically-assisted treatment is essential for substance abuse recovery. The standard of care for addiction in the U.S. typically requires a combination of cognitive behavioral therapy and medication. For example, a person who suffered from opioid addiction may take methadone during the post-acute withdrawal phase to keep withdrawal symptoms manageable. He or she will also undergo psychiatric counseling to address co-occurring disorders and receive medical treatment for preexisting conditions and the other effects of addiction.

Some substance abuse treatment centers may think gabapentin is safe as an anti-seizure countermeasure, but it is essential to review each patient’s risk for dependency on an individual basis before prescribing this medication. Once a person recovering from substance abuse experiences a high from gabapentin it can easily open the door to dependency or relapse.

Finding Support During Addiction And Recovery

It’s important to seek substance abuse treatment as soon as possible once you recognize the problem, and arming yourself with knowledge in advance is a great way to eliminate a lot of the uncertainty that typically surrounds detox and rehab. Recovery is not a single life event; it is an ongoing process with many phases that all require a strong commitment to getting clean.

Share Your Experiences With The Fight Addiction Now Community

The Fight Addiction Now community is a large network of advocates, professionals, researchers, survivors, and friends and family of people who have experienced the worst of addiction firsthand. If you or a loved one are uncertain about the idea of entering detox or rehab or simply want to learn more about gabapentin and other types of substance abuse, we invite you to join our community and take part in our discussions.

Fight Addiction Now aims to connect people struggling with substance abuse to valuable support services and resources for rebuilding life after rehab. Exchange your own stories with other members and find common ground with people all over the country who have experiences similar to your own. Addiction can feel isolating and alienating, and having access to a knowledge and support base like Fight Addiction Now can be tremendously beneficial to your recovery effort.

Real Talk about Suboxone and Using Drugs to Get Off Opioids

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Real Talk About Suboxone and Using Drugs to Get Off Opioids

We have had a lot of talk in our Fight Addiction Now community about getting off of heroin, prescription painkillers like OxyContin, and even opioid maintenance drugs like Suboxone and methadone. There is a lot of enthusiasm for this topic, and it is definitely a hot topic amongst those who have successfully gotten sober, are working towards their sobriety, and even those that are addicted and looking to find their options for heroin addiction treatment.

There has also been a debate on the subject of using drugs to get of drugs – specifically, using opioid drugs to get off opioids. There is so much to bring up about this topic that we wanted to outline what it truly means to use medications to quit heroin and other drugs, and have a real talk about this controversial subject to continue the conversation in the Fight Addiction Now community.

Let’s start with the most common argument against using medications and substances in people that have an addiction to medications and substances.

Isn’t Medication Assisted Treatment (MAT) Just Using Drugs to Get off Drugs?

Medication Assisted Treatment is a common practice in the United States and is quickly being recognized as the preferred method of treatment for addiction treatment. Still, many aren’t convinced that this form of treatment and our community has brought up a lot of very good points on the subject – both for and against this method.

What is Medication Assisted Treatment (MAT)? 

Medication Assisted Treatment is simply a treatment that combines medication therapy and behavioral therapy (addiction counseling, therapy, holistic treatment and therapies, cognitive behavioral therapy, psychodrama therapy, and any combination of therapies to treat the behavioral aspects of an addiction to drugs and alcohol).

The reason it is a preferred method of treatment is because of its harm reduction potential. That just means that a person using this therapy is much less likely to harm themselves than using other therapies. This harm from continual relapses, overdose, death, or the negative health effects that can arise from the continued use of illicit drugs like heroin bought from the street. Essentially, you are less likely to cause yourself any more harm than is already done, by using the medication and dosages given by a medical professional.

What Drugs Are Used For Opioid Medication Assisted Treatment (MAT)? 

The types of medications used in MAT seem to be causing the biggest stir in our community and in the public eye in general. Currently, the only three types of medications allowed by the FDA for opioid medication-assisted treatment are:

  • Methadone
  • Naltrexone
  • Buprenorphine

Are these drugs perfect? No, far from it… but they have been deemed safe to use for both opioid maintenance and for detoxing/tapering from opioid addiction. Methadone and Buprenorphine are both addictive substances – and some would argue that they are more addictive than heroin and prescription painkillers that contain opioids. The combination of the negative side effects of the drugs and their addictive properties is one of the primary reasons people argue against their use in treating addiction.

How Long Should You Take Methadone/Buprenorphine? 

The length of time that a person should be taking methadone or buprenorphine drugs like Suboxone is where a grey area is created in the use of these drugs. There is a huge difference in using Suboxone on a taper schedule for 30 days to get completely off drugs, and taking high dosages of Suboxone for months or years, with no plan to taper down or quit them completely.

Long Term Opioid Use and Opioid Maintenance 

Anyone who has taken drugs recreationally – especially prescription drugs – knows that there is a “right” way to take drugs, and a “wrong” way. All prescription drugs were created to treat the symptoms of various medical maladies, from pain to anxiety to regulating blood pressure. When you don’t medically need the drugs to address symptoms, you are not supposed to take them.

For those suffering from chronic pain, there is a need to take medications to address the symptoms of pain for longer periods of time. The likelihood of dependence and addiction is high, but it is medically decided that treating the symptoms and reducing pain is more of an immediate concern than the risk of addiction is.

Long-term use of prescription painkillers is not recommended for everyone, but in some cases may the best solution for treating pain and symptoms in patients.

Following this same line of thinking, some opioid addiction programs will utilize opioid maintenance therapy in a long-term program. These types of programs give patients monitored dosages of opioid drugs on a daily, weekly or monthly schedule. Also within the programs, the dosages are not tapered down, and the goal is to stay on the medication long-term, not to quit the medication and opioids completely.

This type of program is not for all people who have an addiction to opioids and is usually (or should be) reserved only for those cases where it is medically decided that the long-term use of the drugs is more beneficial to the wellbeing of the patient than getting them off drugs is. People who suffer from chronic relapse and risk death from injecting illicit drugs that could cause overdose and death are good candidates for this type of treatment.

Long-term use of opioid medications like buprenorphine/Suboxone and methadone is not recommended for everyone, but in some cases may the best solution for keeping an individual who is addicted to opioids alive.

The Possible Dangers of Long-Term Opioid Maintenance 

There are many dangers to using any drug long-term, and even the drugs used in opioid maintenance have their dangers. One of the biggest concerns/dangers members of our Fight Addiction Now community have pointed out is that some “addiction treatment programs” (if you can call them that) are all too quick to get individuals that don’t fit the criteria for long-term opioid maintenance on a long-term opioid maintenance plan.

Yes, there are suboxone and methadone clinics all over the country that either don’t assess the needs of individuals properly or take a predatory stance towards addicts and try to get opioid addicts into long-term Suboxone and methadone use. Some of these clinics take it a reckless step further and will start opioid addicts on dangerously high dosages when they are not needed.

These dosages could even be so high that they pass the threshold for safe detox dosages – meaning that the dosages you are on is so high that most detox treatment programs will refuse to detox you due to medical concerns. In these cases, attempting to quit is dangerous and could take months or years to safely taper down, and the clinic has made a customer for life.

The danger of disreputable Suboxone and methadone clinics getting you hooked for life is very real. Some of these programs even call themselves addiction treatment programs or offer a “Cure for Heroin Addiction.”

Those that are addicted to heroin and other opioids should be careful and do plenty of research into a program before starting treatment. In this sense, our community members and the public is right in sharing a word of warning about programs that utilize opioid replacement drugs. However, not all programs that utilize these drugs have this unsavory intent.

Learn More About Detox

Programs That Safely Use Medication Assisted Treatment, Suboxone, and Buprenorphine 

Now that we have addressed the dangers of opioid replacement drugs, let’s focus on the benefits of using medication assisted treatment, and how “using drugs to get off drugs” is not always a bad thing.

The Dangers of Opioid Withdrawal and Quitting Heroin/Painkillers “Cold Turkey” 

There are certain drugs that have such a strong grip on their users that even quitting them abruptly could lead to serious physical harm and death. Alcoholics and those with a strong physical addiction and dependence to alcohol CANNOT quit “cold turkey.” The withdrawal symptoms – specifically the DTs (delirium tremens) – can be so severe that organs will shut down, a patient can experience seizures, and the threat of death is very real.

Opioids like heroin, OxyContin, fentanyl, and other prescription drugs also prevent dangerous withdrawal symptoms. While not as dangerous and immediately life-threatening as with alcohol, the symptoms of opioid withdrawal are strong enough and painful enough to convince a user that being addicted isn’t as painful as the withdrawals.

Without medication to help ease these symptoms, the addict might never be able to quit drugs completely and risks the chance of dying as an addict.

When faced with the 2 choices of: 1.) detoxing from opioids painfully and excruciatingly without medication, or 2.) making the detox process a little easier by using drugs to step down the intensity slowly and safely – medication-assisted detox utilizing (MAT) and medication-assisted treatment drugs offers a safer and common sense approach.

Getting Help for Opioid and Heroin Addiction is the Best Way to Recover

We have laid out the controversies and concerns about treating an addiction to drugs with drugs, though we have only scratched the surface. We expect that this outline will give us much more to talk about (we haven’t even brought up the possibility of using kratom and non-FDA approved drugs into the mix). However, this gives some common ground to further the conversation.

As one of the members of our community brought up, “it doesn’t matter what method you used to get off heroin, so long as you got off and stayed off.” To an extent this is true, the ultimate goal of anyone who has struggled with addiction and substance abuse is to find a way to get through life without feeling beaten down and broken. To find that life can be worth living again… to find a way to cope with the mistakes we’ve made and to simply get more out of the time we have on this earth.

As long has you have a clear picture of your goals, have a commitment to your sobriety, and are prepared to work for what you want, you can recover from the addiction that has held you down for too long.

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Inpatient vs. Outpatient Drug Rehabs: Which Works Best for Heroin Addiction?

Inpatient vs. Outpatient Addiction Treatment Programs For Heroin - Fight Addiction Now

Inpatient vs. outpatient therapy for treatment of heroin addiction depends on the individual. There is no one clear formula for best treatment options. Determining the best method for recovery depends on the patient, his or her history, recovery attempts, and severity of addiction.

Some individuals respond better to inpatient programs, while others respond better to outpatient. Certain circumstances can indicate the patient needs to be in one type of treatment facility instead of the other. Before finding a heroin addiction treatment facility for you or a loved one, do research to understand available options.

Choosing a Treatment Option

Determining whether you or a loved one suffering from heroin addiction should choose an inpatient or outpatient facility requires research. If the patient is currently seeing a doctor or counselor, ask for his or her professional opinion. Both options have been used to successfully treat heroin addiction.

Many people believe that outpatient programs are only occasional treatments, but outpatient programs can also provide 24-hour care. Each treatment type has its own merits, and it is up to individual patients to decide how they would like to proceed with treatment.

Inpatient Treatment Options

Inpatient rehabilitation centers are intensive, residential programs that are designed to treat serious and longstanding heroin addictions. The initial admission into an inpatient facility typically includes a medically supervised detoxification process.

During treatment, patients will reside in the facility and receive 24-hour care. The length of residency can last from 28 days to six months. The long-term stay helps ensure that patients are constantly supported, monitored and not able to access drugs that result in relapsing.

Rehabilitation in an inpatient facility removes a patient from their day-to-day life. This allows him or her to focus entirely on treatment with few to no distractions and stressors. During residency, patients are on a heavily structured schedule that includes individual and group therapies, classes, personal development and other activities.

Secondary Medical Issues

Research studies have shown that inpatient treatment is best suited for those with other health concerns, either physical or mental. For patients with physical health problems, constant medical care will help ensure they are properly monitored. Rehabilitation is a stressful time and many physical conditions can worsen during this time.

Patients with mental health issues can also greatly benefit from inpatient programs. Many people suffering from heroin addiction have underlying mental health issues which have never been addressed. The intensive therapy provided in inpatient programs can help treat underlying causes of addiction.

Learn More About Inpatient Programs

Outpatient Treatment Options

Outpatient rehabilitation programs are less intensive and may or may not include overnight stays. For outpatient treatment, patients live their lives as normal, but attend treatment or therapy sessions during off-hours. This format will allow a patient to continue his or her normal professional and personal lifestyle without a complete interruption.

Some outpatient facilities have residential options, where a patient can spend all day and all night but come and go as they please. Patients who choose this option will need to make sure their outpatient living environment is safe, effective and free from drugs and alcohol.

Individuals in outpatient programs enjoy a great deal of flexibility and can carry on their life almost to the same extent as before treatment. Outpatient treatments include psychotherapy, as well as group, individual, marital and vocational therapies. These can be scheduled around the patient’s work and family obligations.

Those receiving outpatient care require an abundance of support from friends and family. He or she must also be responsible for distancing themselves from other addicts, including dealers. Many who suffer from heroin addiction have trouble distancing themselves from these individuals, so inpatient care may be a better option if it is an issue.

Learn More About Outpatient Programs

What to Consider When Choosing Inpatient vs. Outpatient Addiction Treatment

Choosing between an inpatient and outpatient treatment program depends on a few different factors for the patient’s lifestyle and specific situation. Relapse risk, medical diagnoses, living situations and motivation levels are all prime considerations when choosing a treatment facility. Before you or a loved one enters a rehabilitation program, consider the different factors.

Relapse Risk

Some people only need one rehabilitation program to change their lives. Others have tried treatment plans before but have relapsed. If the patient has a history of receiving prior care and has a high risk of relapse, inpatient care may be a more successful option.

Medical Diagnoses

Those suffering from addiction who also have physical or mental illnesses should choose an inpatient rehabilitation program. Medical conditions should be closely monitored in those recovering from addiction to ensure they do not worsen.

Those with mental illness should be closely monitored during the rehabilitation process and receive consistent counseling services throughout recovery. An inpatient program can provide closer monitoring for health conditions beyond substance abuse.

Living Situation

If a patient has a stable living situation with others who are not suffering from heroin addiction, an outpatient treatment plan may work well. The balance between a healthy home life and a strong medical support team can help a patient recover successfully.

On the other hand, if a patient is surrounded by others with addictions or lives in a non-supportive environment, an inpatient program may be the best option. Here, they would receive 24-hour observation and care they otherwise would not receive in an unhealthy home environment.

Levels of Motivation

Patients who have initiated the treatment plan on their own and have high motivation levels for recovery can thrive in outpatient programs. Sometimes detox, therapy and group support are all one needs to recover fully. If a patient has a low level of motivation or has been forced into a rehabilitation program, the structure and intensity of an inpatient program will be more effective.

Making the Decision

Inpatient and outpatient treatment facilities have shown to successfully treat heroin addiction. If you or a loved one is seeking treatment for the addiction, consider all available options and the patient’s situation.

In years past, many doctors would automatically recommend inpatient facility treatment for heroin addiction. Recent studies have shown that both inpatient and outpatient programs can successfully treat the addiction, but success rates depend on the individual’s needs.

The decision for inpatient or outpatient treatment should be made by the patient, his or her family and medical professionals. Psychologists and counselors can determine if a patient is suffering from mental illness to help lead to informed decision about which treatment option might be best.

If you are a family member trying to help someone suffering from addiction, we recommend visiting a counselor with or without the patient for help. Their professional opinion may give you the confidence you need to choose a treatment plan.

See Our Heroin Addiction Fact Sheet

Agonist vs. Antagonist Opioids: How Painkillers, Heroin and Opiate Medications Work in the Brain

Agonist vs. Antagonist Opioids Painkillers Heroin Opiate Medications Work in Brain - FAN

Even if you live under a rock, you have probably heard that we have a nationwide opioid crisis in America. The death toll from opioid misuse, abuse and overdose are staggering.

Use of prescription opioids – such as Vicodin, OxyContin and morphine – as well as the street opioid heroin is skyrocketing. In fact, the epidemic is so bad that a half a million people are expected to die from opioid use within the next decade.

What Are Opioids?

Originating from the poppy plant, current opioids are natural, partially synthetic or synthetic drugs. From Victorian opium lounges to the Wild West surgeon’s table, variations of these drugs have been around for a long time.

Opioids are very good at controlling pain. They are also very good at addicting people.

Opioids are addictive because of the way the drug attaches to receptors in the brain. Our brains have opioid-specific receptors, and when those are activated, we feel pleasure as well as relief from pain. This feeling is desirable and motivates our brains to seek it out again once experienced.

Agonist vs. Antagonist Opioids

An agonist in biochemistry is a substance that mimics another substance and activates a physiological response when combined with a receptor (cells that receive stimuli).

A full agonist activates a full-action response, resulting in a full effect of the substance being mimicked. A partial agonist activates the receptors to action, but to a much lesser degree.

An antagonist is a substance that inhibits and blocks or dampens a physiological action. An antagonist, also termed a blocker or a blocking agent, binds to and blocks a receptor, preventing a substance of similar structure from attaching to the receptor.

How Opioid Addiction Starts

So, as it pertains to how opioids affect the brain, an agonist is a drug that activates the opioid receptors in the brain, causing that euphoric feeling people get when taking drugs like hydrocodone, oxycodone or heroin. A full agonist response elicits a rush of dopamine to the brain’s reward system. For most people, this creates a high level of pleasure or excitement.

The brain is made to repeat rewarding activities, so once you take opioids, your brain wants to repeat that pleasure – and that’s how addiction begins.

Treatment with Opioid Antagonists

An opioid antagonist binds to the opioid receptor and forms something like a seal to cover the entry point where the drug hits the brain. By preventing opioids from crossing the blood-brain barrier, even if people use opioids at the same time, an antagonist will reverse the effects (like euphoria and slow breathing).

Naloxone and naltrexone are opioid antagonists that block the effects of opioid binding. The nasal spray version of naloxone, Narcan, is a fast-acting emergency treatment for someone who has stopped breathing because of opioid overdose. It has saved numerous lives.

Naloxone reverses respiratory depression as a result of too much heroin, OxyContin or other opioid drugs. Both naloxone and naltrexone are also used to treat other conditions, such as drug and alcohol addiction and chronic pain.

What Is Buprenorphine?

Buprenorphine is a mild or partial agonist in that it is an opioid, but it acts as both an agonist and an antagonist. Buprenorphine activates the opioid receptors in the brain, but to a much lesser degree than full agonists like Vicodin or fentanyl. At the same time, buprenorphine blocks other opioids from attaching to the brain’s opioid receptors.

This makes buprenorphine unique and a good choice for addiction treatment. It gives the person addicted to drugs or alcohol a little bit of the pleasure of opioid feelings, which quiets the cravings and suppresses withdrawal symptoms. Buprenorphine is also prescribed for chronic pain. It has much less potential for addiction than full agonist opioids do.

How Heroin Affects the Brain

Everyone has opioids in their brains. They are a naturally occurring substance meant to calm the body and manage the reward and pleasure circuitry in the brain.

Studies have shown that even after taking prescription painkillers for only a few weeks, the changes in the brain’s structure are evident in MRIs. Patients taking pain meds have a reduction in the gray matter responsible for the regulation of pain, cravings and emotions.

What are the implications of a reduction of gray matter that regulate emotions? People taking painkillers over a long time can have a harder time controlling their emotions. Additionally, painkillers reduce your body’s ability to control pain, making you more sensitive to it.

Other effects of the binding of synthetic opioids to the brain’s opioid receptors:

  • Slows down the central nervous system
  • Depresses respiration and slows breathing

A depressed respiratory function is what puts opioid users at serious risk of death. It is easy to overdose on opioids and stop breathing. Heroin, one of the strongest opioids, which is partially why it is illegal, affects the brain deeply and can take years to reverse.

What Happens to the Brain After Someone Stops Using Opioids?

Even after someone has stopped using opioids, their brain still shows effects of the drug. It can take a long time for the brain to restabilize – many months or years. The longer a person uses prescription drugs, the more ingrained brain changes are, resulting in a longer recovery period. Use of stronger drugs, such as heroin or fentanyl, also result in a longer amount of time for the brain to adjust back.

The physical dependence on the opioid can be reduced by gradually tapering off. During this time, the patient can make behavioral changes that will rewire the brain. Cognitive therapy also helps to deal with cravings and negative behaviors.

Post-acute opioid withdrawal symptoms include:

  • Anxiety and irritability
  • Mood swings
  • Increased pain
  • Cravings
  • Low energy and enthusiasm, fatigue

The long-term effects of opioids on the brain are substantial. For a long time after opioid use ceases, the individual may experience learning issues, memory problems and other cognitive impairments. The recovery process will be a lengthy one, and it is common to experience many challenges during the process.

Is There a Difference Between Addiction and Dependence?

Yes. People with chronic pain that take painkillers over time develop a dependence on their medication. If they suddenly stop taking their medication, they will go through physical withdrawal symptoms due to the changes the body undergoes when on painkillers.

Physical acute withdrawal symptoms include:

  • Vomiting
  • Diarrhea
  • Tremors
  • Cramps
  • Weakness
  • Possible suicidal thoughts

Addiction is an abnormal condition, which is classified as a disease. Furthermore, it may or may not come with a physical dependency. Addiction is characterized by compulsive behavior, uncontrollable cravings and participation in drug use (or the addictive behavior of choice) despite harmful life consequences to oneself or others.

Your Turn

Nearly everyone in America knows someone who has been affected by the opioid crisis.

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Is Pain Management and Care Being Forgotten in the Fight Against Opioids?

Pain Management and Care Being Forgotten in Fight Against Opioids - Fight Addiction Now

Opioids – A Blessing Turned into a Curse?

The opioid epidemic in America has received so much attention that it makes some wonder whether all of the recent media and government involvement is helping or hurting our citizens in the long run.

The White House has declared the opioid crisis a public health emergency. Tens of thousands of Americans die each year from opioid-related deaths.

And yet, pain management is a real issue. We should have the right to pain-controlling medications when needed. And right now, opioids are the most effective option to combat severe or chronic pain.

Pain Management and Care in Relation to the Opioid Epidemic

Ending the Addiction Stigma Fight Addiction NowA new study published in the journal JAMA Surgery found that post-surgical patients are at increased risk of addiction because of the pain medication necessary during recovery. The researchers concluded that patients should be administered smaller doses of pain meds post-surgery and counseled on the risks and proper uses of opioids.

For a year now, Michigan’s University Hospital has been implementing these new guidelines of dispensing fewer post-op pills. The results have been favorable, as evidenced by:

  • Patients’ reported pain not increasing
  • Requests for refills remaining the same
  • Patients actually using fewer pills

Opioid Laws

Opioids have long been a controlled substance, but new laws in half of the U.S. now limit the number of pills a doctor can prescribe at one time. More hospitals are implementing the practices adopted at Michigan’s University Hospital.

The current regulatory climate is focused on reducing the number of pills dispensed and discouraging patients from using opioids unless as a last resort. Many states expect doctors to present certain talking points to their patients. In many cases, state law requires patients to sign a document affirming they understand the risks and rules of opioids.

Problems in Fighting the Opioid Epidemic

The vast number of overdose deaths related to opioids seems to have frightened America into single-mindedly setting a mission to reduce those sheer numbers. There are many who are caught up in the struggle of opioid addiction. But what about those who are caught up in the struggle against chronic pain?

Are people who suffer with daily pain now S.O.L. and without help?

A nationwide survey finds that 34 percent of doctors feel that moving away from prescribing painkillers for patients with chronic pain issues may be hurting people. More than one-third of the physicians polled reported that pulling back on pain medications prolongs patients’ misery.

Quality of Life Questions

To deny someone suffering in pain the medication we have available through science is a travesty. If we have the medical knowledge available to help people, we should use it.

At the same time, we don’t want to harm others’ quality of life by allowing addictive and potentially lethal medications to go unchecked and rampantly used for nonmedical purposes.

Insurance Issues

One aspect people forget to consider in this fight against opioids is what people can afford based on what their insurance covers. Insurance companies often do not cover Schedule III drugs. Drugs in this class are far less addictive and often equally effective at managing pain. Many insurance plans do cover drugs like oxycodone and fentanyl, Schedule II drugs, which are more addictive opioids.

Oftentimes, insurance companies require burdensome prior authorizations for drugs like buprenorphine, an effective Schedule III opioid drug. Prior authorizations require time and research from the doctor’s office and are only approved under certain conditions. This is annoying for doctors and pharmacies alike, and can mean a potential waiting period for patients to receive their medication — if it ever gets approved.

Buprenorphine works well for chronic pain while avoiding the typical tolerance and severe respiratory depression that comes with most Schedule II opioids, which do not require a prior authorization.

Why? Money. Pharmaceutical companies and insurance companies are big business. And insurance companies pay for the cheapest effective drugs first. So, because certain opioids are cheaper, doctors and insurers push these medications to patients first.

Ethical Implications

Insurers restricting more expensive but less addictive painkillers just doesn’t seem right. A doctor’s oath includes the promise to “do no harm.” But insurance companies take no such oaths and make no such promises. They focus on their bottom line. But is this ethical? Is this in the best interest of patients?

Perhaps it keeps premiums lower. But it begs the question, “Should insurance companies be for-profit to begin with?”

Doctors have received a lot of criticism for prescribing opioids, but maybe insurers should shoulder some of that blame. It sure seems like insurers are trying to remove the responsibility from themselves and not factor in the best care and quality of life of the insured.

Now, because of the harrowing opioid problem, insurance companies are starting to limit the opioid medication they will cover.

Many insurance companies cover very little in the way of addiction treatment. That raises another debate that if the insurers are contributing to the problem but unwilling to fix it, where does that leave patients?

Weigh In

What do we do to balance the opioid addiction crisis in the scales of chronic pain sufferers? We want to hear you weigh in on the debate!

Have we lost sight of the real problems of the opioid epidemic? Are people in pain suffering needlessly? Or are we just continuing to shuffle blame and not coming up with real solutions to help those affected by opioid addiction and chronic pain?

Chime in with your opinions and experiences! Be part of the debate, the search for answers and finding a solution. We invite your comments below, or feel free to discuss this topic in our forum.