3. Opioids: From bathroom cabinet to epidemic. How everyday drugs affect our health.

What is prescription opioid misuse?

Also known as: Oxy, Percs, Happy Pills, Hillbilly Heroin, OC, or Vikes

Prescription opioids are medications that are chemically similar to endorphins – opioids that our body makes naturally to relieve pain – and also similar to the illegal drug heroin.  In nature, opioids are found in the seed pod of the opium poppy plant. Opioid medications can be natural (made from the plant), semi-synthetic (modified in a lab from the plant), and fully synthetic (completely made by people).

Prescription opioids usually come in pill form and are given to treat severe pain—for example, pain from dental surgery, serious sports injuries, or cancer. Opioids are also commonly prescribed to treat other kinds of pain that lasts a long time (chronic pain), but it is unclear if they are effective for long term pain.

For most people, when opioids are taken as prescribed by a medical professional for a short time, they are relatively safe and can reduce pain effectively. However, dependence and addiction are still potential risks when taking prescription opioids. Dependence means you feel withdrawal symptoms when not taking the drug. Continued use can can lead to addiction, where you continue to use despite negative consequences. These risks increase when these medications are misused. Prescription medications are some of the most commonly misused drugs by teens, after tobacco, alcohol, and marijuana.

Common opioids and their medical uses are listed below.

Opioid Types	Conditions They Treat
oxycodone (OxyContin, Percodan, Percocet) hydrocodone (Vicodin, Lortab, Lorcet) diphenoxylate (Lomotil) morphine (Kadian, Avinza, MS Contin) codeine fentanyl (Duragesic) propoxyphene (Darvon) hydromorphone (Dilaudid) meperidine (Demerol) methadone	severe pain, often after surgery acute (severe) pain some forms of chronic pain (severe) cough and diarrhea

Fentanyl has been in the news recently.  It is a powerful opioid prescribed for extreme pain that is 50 to 100 times more potent than morphine. It is extremely dangerous if misused, and is sometimes added to illicit drugs sold by drug dealers. Find out more about Fentanyl.

Types of opioids:

Type of Opioid	How Are They Derived	Examples
Natural opioids (sometimes called opiates)	nitrogen-containing base chemical compounds,  called alkaloids, that occur in plants such as the  opium poppy	morphine, codeine, thebaine
Semi-synthetic/man-made opioids	created in labs from natural opioids	hydromorphone, hydrocodone, and oxycodone (the  prescription drug OxyContin), heroin (which is made  from morphine)
Fully synthetic/man-made opioids	completely man-made	fentanyl, pethidine, levorphanol,  methadone, tramadol,  dextropropoxyphene

How Prescription Opioids Are Misused
People misuse prescription opioid medications by taking them in a way that is not intended, such as:

• Taking someone else’s prescription, even if it is for a legitimate medical purpose like relieving pain.
• Taking an opioid medication in a way other than prescribed—for instance, taking more than your prescribed dose or taking it more often, or crushing pills into powder to snort or inject the drug.
• Taking the opioid prescription to get high.
• Mixing them with alcohol or certain other drugs. Your pharmacist can tell you what other drugs are safe to use with prescription pain relievers.

Prescription opioids are chemically closely related to heroin, and their effects, especially when misused, can be very similar. Because heroin may be cheaper to get, people who have become addicted to prescription pain medications sometimes switch to using heroin. Nearly 80 percent of people addicted to heroin started first with prescription opioids. However, the transition to heroin use from prescription opioids is still rare; only about 4 percent of people who misuse prescription opioids use heroin. Even so, because millions of people are using prescription opioids, this adds up to hundreds of thousands of heroin users.

Source: The National Institute on Drug Abuse Blog Team. (). Prescription Pain Medications (Opioids). Retrieved from https://teens.drugabuse.gov/drug-facts/prescription-pain-medications-opioids on June 14, 2017.

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Praise for Healing the Brain

"A book that can help medical professionals as well as the general public, Mr. Balog has tackled a subject that is complex and he makes it quite approachable. It has added and enriched my own practice of medicine by making me more aware of issues not often discussed in medical circles."--Peter Paganussi, MD, Virginia

"Author David Balog has done an excellent job of creating a book for educators (or anyone working with youth) that explains the complicated workings of the brain in an easy to understand manner. Balog goes on to discuss various types of trauma and how the adolescent brain responds to trauma such as depression, stress, addiction, risk taking, PTSD, etc. LGBT/Q youth may experience trauma in ways majority youth often do not. The author shares important coping strategies....I highly recommend this book!"--Carol Dopp, M.Ed. 

"David Balog understands the strain of alienation, so he tackles this subject with compassion and concern. Mr. Balog draws on his knowledge of brain science to give readers insight into what happens to young people under tremendous stress, and he offers practical advice on how to help and cope."--Gary Cottle, author

"Provides comfort and learning to the reader. Flows easily from one topic to the next and knits tidbits of information together in a unifying mosaic. Easy to read. Difficult to put down." --Michael J. Colucciello, Jr., New York State Dept. of Mental Health researcher, retired.

"Well researched, fleshed out with relevant case histories, this book packs a lot of solid information into its 152 pages. Written in an engaging style for the layman, it covers a wide range of topics. One learns a great deal about the biology of stress, particularly the vulnerability of the brain in the pre-adult years. This book also provides a glossary of key brain science terms and a listing of organizations serving the LGBT /Q community and resources on the brain."--Gary Bordzuk, librarian

How heroin destroys lives

A friend once said that he was warned not to even try heroin. "You will," he was told, "feel like you need to shower constantly."  In this excerpt from Healing the Brain, we look at essentials of heroin.

The Heroin Epidemic

Heroin is an illegal, highly addictive drug processed from morphine, a naturally occurring substance extracted from the seed pod of certain varieties of poppy plants. It is typically sold as a white or brownish powder that is “cut” with sugars, starch, powdered milk, or quinine. Pure heroin is a white powder with a bitter taste that predominantly originates in South America and, to a lesser extent, from Southeast Asia, and dominates U.S. markets east of the Mississippi River.

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Increased use of heroin has ravaged families, schools, communities, and a generation of youth.

Highly pure heroin can be snorted or smoked and may be more appealing to new users because it eliminates the stigma associated with injection drug use. “Black tar” heroin is sticky like roofing tar or hard like coal and is predominantly produced in Mexico and sold in U.S. areas west of the Mississippi River.

The dark color associated with black tar heroin results from crude processing methods that leave behind impurities. Impure heroin is usually dissolved, diluted, and injected into veins, muscles, or under the skin.

What are the immediate (short-term) effects of

heroin use?

Once heroin enters the brain, it is converted to morphine and binds rapidly to opioid receptors. Abusers typically report feeling a surge of pleasurable sensation—a “rush.” The intensity of the rush is a function of how much drug is taken and how rapidly the drug enters the brain and binds to the opioid receptors. With heroin, the rush is usually accompanied by a warm flushing of the skin, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching. After the initial effects, users usually will be drowsy for several hours; mental function is clouded; heart function slows; and breathing is also severely slowed, sometimes enough to be life-threatening. Slowed breathing can also lead to coma and permanent brain damage.

What are the long-term effects of heroin use?

Repeated heroin use changes the physical structure and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed.

Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations. Heroin also produces profound degrees of tolerance and physical dependence. Tolerance occurs when more and more of the drug is required to achieve the same effects. With physical dependence, the body adapts to the presence of the drug and withdrawal symptoms occur if use is reduced abruptly. Withdrawal may occur within a few hours after the last time the drug is taken. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), and leg movements. Major withdrawal symptoms peak between 24–48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months.

Finally, repeated heroin use often results in addiction—a chronic relapsing disease that goes beyond physical dependence and is characterized by uncontrollable drug-seeking no matter the consequences. Heroin is extremely addictive no matter how it is administered, although routes of administration that allow it to reach the brain the fastest (i.e., injection and smoking) increase the risk of addiction. Once a person becomes addicted to heroin, seeking and using the drug becomes their primary purpose in life.

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