Opioids are highly effective painkillers that can be prescribed for home use and are used to treat patients in the hospital. They are derived from the opium poppy plant. Depending on their formulation, they are called opioids, opiates, or narcotics. For our purposes, all of the drugs mentioned here will be described as opioids. They are among the most addictive substances used in medicine today.
If you have a problem with narcotics or another substance, The National Rehab Hotline is always available. Twenty-four hours per day, seven days a week, 365 days a year, you can call confidentially to get information and advice, find emotional support, and begin your journey to a sober, happier life. The number is 866-210-1303, and you can call right now.
According to the 2019 National Survey on Drug Use and Health (NSDUH), over 10 million Americans over the age of 12 misused opioids. Of those who did, 9.7 million misused medications that were prescribed. You no longer have to be part of that statistic.
What Opioids Do
The effects of opioids can be divided into their effects on the mind and those on the body. Their main purpose, however, is to reduce moderate to severe pain associated with surgery or conditions like bone breaks and chronic pain disorders. They are also used in medically supervised drug detoxification.
Opioids bind with opioid receptors in the spinal cord to block pain. They also work in a part of the brain called the limbic system, creating a sense of well-being or even euphoria. Some amount of opioids also make their way to the brainstem, which slows breathing, reduces coughing, and lowers your heart rate. As it makes its way to the bowel, the opioid slows down function, often resulting in constipation.
What Types of Opioids Are There?
With the exception of heroin and tramadol (schedule IV), all opioids fall under Schedule II as controlled substances. Drugs in Schedule II have a medical use but should be prescribed and used with extreme caution. This is because they have a very high potential for physical dependence, psychological dependence, and misuse. Heroin is listed in Schedule I, which is for compounds that have no accepted medical use and carry the highest potential for misuse.
The list of opioids below is ranked from weakest (1) to strongest (14). The data is drawn from the U.S. Centers for Disease Control (CDC).
1. Codeine – A short-acting drug, it is prescribed primarily to treat coughs during the flu, bronchitis, and, occasionally, mild pain. It can come in a liquid or pill form. It is often combined with aspirin or acetaminophen.
2. Meperidine (Demerol) – This drug is indicated for pain that ranges from moderate to severe. Like codeine, it can be prescribed and used at home. It is roughly 10 times less potent than morphine. With the advent of newer drugs, it is not used so often anymore. Demerol worked particularly well for pain from sickle cell disease, however, the medication leaves a metabolite or byproduct called normeperidine, that can cause seizures.
3. Tramadol (Ultram) – This medication is usually prescribed separately from aspirin or acetaminophen. Around the same potency as Demerol, it is used to control moderate pain from things like oral surgery. Unlike the other opioids, it is listed in Schedule IV, meaning it has a low potential for misuse.
4. Morphine (Duramorph) – This medication is usually prescribed in a hospital environment because of its potency; it is 10 times stronger than Demerol or tramadol. It is used for severe pain caused by broken bones, wounds, cancer, or surgery. It is often administered intravenously, but can also be given as tablets or rectal suppositories.
5. Hydrocodone (Norco, Vicodin) – It is usually in a pill form that also contains either acetaminophen or ibuprofen. It is used for surgical pain, severe injury, and chronic pain from conditions like rheumatoid arthritis.
6. Percocet – This is a combination of acetaminophen and oxycodone. It is used to treat acute and severe pain in the same instances as hydrocodone.
7. Oxycodone (Roxicodone, OxyContin) – This opioid is one of the most prescribed and one of the most misused. It is used to treat moderate to severe long-term pain. In the sustained-release form, its composition allows it to provide pain relief for 24 hours, making it one of the longest-acting opioids.
8. Methadone – This drug is used primarily to treat opioid withdrawal symptoms and as medication assisted treatment for opioid use disorder. Since it is most often used to wean patients off of other opioids, it can only be administered under a doctor’s supervision in a clinical setting. It is familiar to most people as a drug given long term as a substitute for heroin, when the user cannot quit that drug entirely. It is dispensed through clinics, where clients may go every day or less often to get their doses. It also can be used for a few days as a taper to relieve withdrawal symptoms as people are detoxed from heroin, or pain pills. Finally, it is occasionally given to people legitimately as a pain medication.
9. Heroin – This illicit drug is among the most dangerous in the world. It is usually snorted or injected. Because manufacturing it is illegal and not controlled, it varies in strength between two and five times stronger than morphine. It is often combined with cocaine or other opioids. It is illegal to make, possess, use, or distribute heroin in the United States.
10. Hydromorphone (Dilaudid) – Hydromorphone is used for severe pain, usually after major surgery. It is up to eight times stronger than morphine. It is usually given intravenously, but it can be given in pill form. It is strong enough that it is primarily used in a hospital setting. Sometimes it is available on the streets for illicit use.
11. Oxymorphone (Opana) – Up to 10 times stronger than morphine, this medication is used almost exclusively to manage severe, chronic pain. It is prescribed when other opioid painkillers prove ineffective. It is up to 10 times stronger than morphine.
12. Buprenorphine (Butrans, Suboxone, Subutex, Buprenex) – This drug, which is up to 25-100 times stronger than morphine, is used almost solely in opioid detox or as medication assisted treatment (“maintenance”) for those unable to quit opiates entirely. Unlike the other opioids, it does not produce a “high,” which is why it is often used in opioid detoxification. This unique drug is a combination of an opioid agonist, which would produce a “high” and pain relief, combined with an opioid antagonist, which is supposed to block the high. It is used for as a substitute drug for opioid addiction. In place of their pain pill or street drug of choice, the client takes buprenorphine to relieve cravings and withdrawal symptoms. It is said to be 25 to 100 times stronger than morphine, but its action is unique. Besides being used for medication-assisted treatment, forms of buprenorphine are used for opioid detoxification. The patient receives it for about 5 days on a gradually decreasing dose, to decrease the withdrawal symptoms as he or she stops using heroin or other opioids. The most common form is suboxone, which contains Narcan (naloxone) to block respiratory depression, should the patient intentionally or accidentally take an overdose. It is also available as Subutex, which does not have the naloxone, and is given in treatment centers or by doctors to trusted patients for home use. Buprenorphine is also available as a patch or an injection. Although many treatment professionals support medication-assisted treatment, such as received from buprenorphine, others prefer a goal of complete abstinence. At any rate, buprenorphine, such as Suboxone, sometimes makes its way onto the street and is used among other opiates by people with addiction problems.
13. Fentanyl (Actiq, Duragesic patch) – At 50-100 times more powerful than morphine, this incredibly strong opioid is used in severe post-surgical pain and sometimes for chronic pain conditions. It is administered either intravenously, as a patch, called Duragesic, or as a lozenge or lollipop. It accounts for the majority of opioid-related deaths in the United States. It is especially dangerous as a street drug, where it is often mixed with cocaine, heroin, or methamphetamine. Drug dealers place in on the other drugs to increase their potency while lowering the cost to the dealer to produce the street drugs.
14. Carfentanil – This opioid is so strong that it is not used on humans. It is 10,000 times more potent than morphine. It is used primarily as a tranquilizer for elephants and other large animals. When sold on the street, it is often mixed with other opioids. Even a single use of carfentanil can be deadly.
What Are the Risks of Opioid Misuse?
Since opioids depress the respiratory system and heart, they are very dangerous when misused. While severe constipation may not seem like that bad of a symptom, it can lead to extreme discomfort and even a perforated bowel, which can cause sepsis. Because of the “rebound effect,” long-term opioid use can result in increased tolerance to the drug, causing a condition called hyperalgesia, which is marked by chronic pain and hypersensitivity to touch.
In addition to hyperalgesia, dysphoria (chronic uneasiness), depression, and chronic diarrhea can result as people “rebound” during long-term use. In essence, long-term misuse of an opioid will create effects that are the opposite of what the drug is supposed to do. The chronic pain of hyperalgesia is extremely hard to treat if one has already built up a tolerance to opioids.
The good news is that, if you decide to seek treatment for an opioid use disorder, these rebound symptoms will fade with time. Even if opioids are making you feel worse rather than better, there is hope with help. Help can start by calling the Hotline.
Opioid Withdrawal After Short-Term Misuse
According to Medlineplus.gov and the Mayo Clinic, short-term withdrawal symptoms will vary depending on the length of time that the opioid was misused. The most common short-term withdrawal effects are:
• Agitation, mood swings, and irritability
• Anxiety or panic
• A burning, itchiness, or tingling sensation just under the skin
• Increased tearing in the eyes
• Muscle aches
• Restlessness or insomnia
• Runny nose (known medically as “rhinorrhea”)
• Sweating
• Yawning
Opioid Withdrawal After Long-Term Misuse
Luckily, these symptoms are short-lived and can be mitigated with medical care. Long-term withdrawal symptoms include:
• Abdominal cramping
• Changes in blood pressure
• Chills and sweating
• Chronic pain and skin sensitivity
• Dilated pupils
• Nausea and vomiting
• Tachycardia (rapid heart rate)
• Depression or thoughts of suicide
Medical professionals can lessen these symptoms and help you deal with them. That is why it is so important to make that phone call. Though calling the Hotline is only the first step, it will lead to many more that can get you sober while making the journey as comfortable and pain-free as possible.
Taking the First Steps to help with an addiction problem
There is no denying that the first steps to ending a substance use disorder can be difficult. However, if you look back at the list of side effects and withdrawal symptoms above, beginning this journey will be worthwhile. Remember that there are medical professionals trained in helping opioid users through withdrawal symptoms.
There is also a support network built into this journey whether you decide to attend a rehabilitation facility or seek private help. There are many advantages to making your first step a call to The National Rehab Hotline at 866-210-1303.
• The Hotline is available to you 24 hours a day, 365 days a year.
• It is completely confidential, so you do not have to reveal your identity or location.
• You not obligated to make any decisions when you call. You can merely reach out for information or a listening ear.
• Information the Hotline can give you includes types of treatment, the location of treatment centers and mental health specialists, and contact with emergency services.
• If it is not you but a loved one, friend, or neighbor who is struggling, you can call on their behalf.
The Types of Help Available
One of the great things about seeking treatment is that it can be modified to best fit your needs and schedule. Treatment can be inpatient or outpatient, individual or in groups. It can be over a period of one month continuously, in the evening, or on weekends.
After you have decided to seek treatment, you will have many choices that the Hotline can help you make. Some of the major types of treatment include:
• Going to a residential rehabilitation facility (rehab) – Here you will spend 14 to 30 days focusing solely on your recovery. Many of the other treatments listed are employed during your stay in rehab, including private and group counseling and cognitive-behavioral therapy (CBT).
• Intensive outpatient therapy (IOP) – This is for people who cannot afford to miss work. It functions much like rehab, except that it happens in the evenings and weekends. This allows you the time and discretion needed to get treatment while remaining at work. Partial hospitalization (PHP) is also available, where you typically attend group therapy for a few hours each day.
• Medical detoxification (detox) – If your withdrawal symptoms are severe or even dangerous, you will need a doctor’s supervision to get through that period. This usually involves a stay in a hospital or clinic. While your vital signs are monitored, doctors may prescribe medications such as benzodiazepines, methadone, or buprenorphine to alleviate the symptoms of withdrawal.
• Therapy – Sometimes, talking to a single person is preferable. An individual therapist can be a psychologist, counselor, social worker, or addiction specialist. They will help you learn coping skills and teach you how to adjust your life so that you can get clean and avoid relapse.
Getting off drugs starts with a Single Phone Call
The first step in seeking help may seem scary or overwhelming but remember to take it one step at a time. Calling The National Rehab Hotline at 866-210-1303 is a very small first step that can help you test the waters and see what options are available. If opioids are disrupting your life, family, and work while leading you to be unhappy, you can call today, right now.