Methadone and Suboxone are the recommended first choice for the treatment of opiate and opioid substance use disorder (addiction) according to the CRISM guidelines. (Canadian Research Initiative in Substance Misuse)

Opiates are drugs that are derived from the opium poppy. These include opium, codeine, morphine and heroin.

Opioid means “opiate like” and takes into consideration that many of our modern analgesics (pain killers) are synthetically derived compounds with a chemical structure and drug effects similar to opiates. The synthetic drugs include methadone, buprenorphine (Suboxone), oxycodone (Percodan/Percocet and Oxycontin), hydromorphone (Dilaudid), hydrocodone (Hycodan, Vicodin), fentanyl (Sublimaze or Duragesic) and meperidine (Demerol). There are many others as well.

Note that these drugs can be used in many ways – opium was often smoked, many like oxycodone are taken orally, many are injected and some are snorted. Fentanyl has a transdermal (across the skin) preparation but is abused by smoking and injecting.

Opiate and opioid drugs are primarily used for their analgesic qualities although some modified compounds are used more for their antitussive (cough suppressant) qualities (dextromethorphan or DM) or to decrease diarrhea (Imodium or loperamide). Interestingly, neither dextromethorphan nor loperimide cross the “blood-brain barrier” and therefore do not cause euphoria.

In addition to decreasing pain they also will slow down your bowels and decrease respiratory effort and cough. Of all the effects these drugs possess it is the euphoria or a pleasurable comforting feeling that result in the recreational use and the abuse of the drug.

Our body produces natural opioids known as endorphins. The word endorphin literally means “the morphine within.” Indeed, these chemicals are functionally identical to morphine or heroin. Joggers often state they feel a “runner’s high” when jogging and in fact they are experiencing an opioid high from endorphins. We don’t yet understand everything that these natural opioids do in the body, but evidence suggests that they are involved with pain control, mood and anxiety control, learning, regulating body temperature, and many other functions. Endorphins are secreted at much lower quantities that the opiates that people take to get high. Abusing opiates changes the endorphin system in the brain.

In fact opioids are very safe drugs in general. Unlike other drugs of abuse they do not have long term permanent negative effects themselves. They do have several side effects but these are not a result of organ damage and will resolve when the drug is stopped. Adverse health effects that addicts experience are usually due to high risk activities like needles, prostitution, trauma (fights etc) or the use other drugs like speed and cocaine. Methadone and Suboxone do not cause long term organ damage.

One significant danger that has become more of a problem in Lambton and Kent since 2011 is blacking out while smoking fentanyl. Many users tend to minimize the significance of this event. It is a pre-death experience. See FAQ.

Opiates have been used for thousands of years and even thousands of years ago it was recognized that people could become dependant on these drugs and have a difficult time trying to stop using them.

The following criteria are used to diagnosis a dependency or addiction in the DSM IV (the 1994 list of criteria psychiatrists use to classify psychiatric disrders):

A maladaptive (bad adaptation) pattern of substance use, leading to clinically significant impairment or distress, as manifested by three or more of the following:

  • Tolerance, as defined by either the need for markedly increased amounts of the substance to achieve the desired effects of markedly diminished effects when the same amount of the substance is used.
  • Withdrawal, as manifested by either the characteristic withdrawal syndrome for the substance or the substance is used to avoid withdrawal symptoms
  • The substance is taken in larger amounts or over longer periods than was intended
  • There is a persistent desire or unsuccessful efforts to cut down or control the substance use
  • A great deal of time is spent in activities to obtain the substance
  • Important social, occupational or recreational activities are given up or reduced because of the substance use
  • The substance use is continued despite knowledge of having persistent or recurrent physical problem that is likely to have been caused or exacerbated by the substance

Please note that DSM V has been released as of June 2013. Changes include removing the term dependence – this meant addiction in DSM IV but dependence was often used by healthcare providers to mean physical dependence (tolerance and withdrawal without addictive behaviors). In DSM V the term is Substance Use Disorder and depending on how many criteria a patient has the disorder is characterized as mild, moderate or severe.

In the end the labels have changed but the opiate problem remains the same. 

Symptoms of opiate withdrawal:

  1.  dysphoric (feeling of unease) mood, irritability, anxiety
  2.  nausea or vomiting
  3.  muscle aches, joint aches
  4.  runny nose
  5.  goose bumps, sweating
  6.  diarrhea or loose stool, abdominal cramps
  7.  yawning
  8.  fever
  9.  insomnia
  10. restlessness
  11. headache (some patients only)