Is opiate addiction different from other addictions?

The answer is yes and no. No, in the sense that all drug addictions have in common an effect at the reward center of the brain – if you are interested in this read about the nucleus accumbens and ventral tegmental areas of the brain.

Opiate addiction however is very different in a practical sense for a number of reasons:

  • Quitting has a very low success rate even if 12 step programs like AA or NA are used, if the person has good family support and even if they try withdrawal management (detox) and inpatient rehab programs. The success rate of staying clean for a year is as low as 5% – far lower than with other substances.
     
  • The relapse rate is much higher than other drugs. Even people that have been clean for 3 years have up to a 50% lifetime relapse rate. This is as much as 3 ½ times the lifetime rate for relapsing to alcohol.
     
  • Aside from the addiction itself there are no long term physiological effects to regular oral opiate use that are not reversible when the opiate is stopped. There are obvious medical problems associated with smoking, snorting and injecting any drug but alcohol, cocaine and crystal methamphetamine are all inherently harmful physiologically even when taken orally.
     
  • Tolerance is significant and develops very rapidly. The dose that used to provide a mood altering effect no longer works within a week or two. At first people increase the dose and then they experiment with other routes of administration that provide a more rapid increase in blood levels – snorting, smoking and injecting. These routes are not only more addictive but they also have health risks including increased chance of overdose. Tolerance does develop with other substances but nothing like opiates. An alcoholic might drink 2 or even 3 times what a normal drinker does before he starts to appear intoxicated but many opiate dependent people take the equivalent of 50 Percocets per day or more, just to function. Most people that are not opiate tolerant feel altered with a single Percocet.
     
  • Profound physical and psychological withdrawal – much more so than other substances. Although the withdrawal from alcohol and benzodiazepine drugs can be more dangerous (for example withdrawal from both can cause seizures) opiate withdrawal is considered the most uncomfortable. The physical withdrawal from opiates can last 10 days to 2 weeks. The time of onset to full withdrawal depends on how long the particular opiate you are using lasts in your system (the half-life). For example full withdrawal develops 24 hours after last use of short acting opiates like morphine compared to 5 days after stopping methadone. Although many people can soldier through the nausea, diarrhea, vomiting, cramping, muscle and joint aches, malaise, restlessness, sweating, flushing, chills etc what they aren’t prepared for is the weeks to months of the more psychological symptoms including insomnia, irritability, depression and lethargy. In some people these symptoms don’t ever completely resolve.
     
  • There are different paths to opiate addiction. All substance abuse and consequently addictions are more common in the children of addicts and in those with certain traumas like sexual abuse. People that use most substances are looking to get high although they may express many reasons they feel they need to get high. Unlike other substances some of the people that become addicted to opiates may not have been trying to get high. Consider these examples:
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    • High overtime hour workers or shift workers are sometimes exposed to opiates at work. Co-workers offer them a small dose of opiates for energy. This helps the shift pass faster so they buy some for the next shift. Tolerance develops rapidly and at some point thy feel the amount spent on the higher doses is no longer worth the money. When they try to quit they discover they get withdrawal. They are hooked but were only looking to get through their shifts.
       
    • 50% of people with treated depression may have only partial or limited relief of their symptoms with their medication. Those that have undiagnosed depression of course are not treated. Similarly, many people have untreated anxiety. When people with depression or anxiety are exposed to opiates, either recreationally or through a limited prescription, they often have an astounding experience. They describe feeling “normal”. This makes sense when we remember that one of the effects of opiates is euphoria (a feeling of intense happiness or well being) which is the opposite of depression or anxiety. Many feel they have discovered the answer to their problem. However tolerance develops very rapidly requiring increased doses to continue to provide the desired mood elevating effect. As the price becomes too much they attempt to quit and discover they go into withdrawal and experience a return of their depression or anxiety as well. They are hooked but were only trying to live without depression or anxiety.
       
    • Many people are initially exposed to opiates through a prescription from a dentist or doctor. Especially in the case of prescriptions from physicians for long term opiate therapy for chronic pain. If the patient moves or the doctor’s practice closes or the patient and the doctor have a disagreement the patient often finds themselves without a prescriber to continue their opiate prescription. They go into opiate withdrawal and although they may not have manifested addictive behaviors before they will now rapidly start to develop these in the quest to get the opiates they need for pain control and to function. They are hooked but were only following their doctor’s recommendations.
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