Opioids are medications that reduce the intensity of pain-signal perception. They influence the brain as they control emotion, which reduce the effects of painful stimuli. For centuries, opioids are used to treat pain, cough, and diarrhea. However, the most common use of opioids is to treat chronic pain even though there is little evidence for their effectiveness when used long term. Some patients experience worse pain or increased sensitivity to pain as a result of treatment with opioids, this phenomenon is known as hyperalgesia.
Overdose is a significant danger when it comes to using opioids because of these compounds that interact with parts of the brain stem that control breathing. Taking too much of an opioid can conquer breathing enough that the user suffocates.
Prescription opioid medications include:
• Hydrocodone
• Oxycodone
• Oxymorphone
• Morphine
• Codeine
• Fentanyl
• And many others
Dependence occurs due to physiological adaptations to enduring exposure to a drug. Often it is part of addiction. However, addiction involves other changes to brain functionality and it different by compulsive drug usage regardless of the negative consequences. Those who are dependent on a certain medication will experience physical withdrawal when trying to reduce drug dosage or stop using the drug. The symptoms can be mild to severe depending on the nature of the drug, this can be managed medically by slowly reducing the drug dosage.
Receptor desensitization and downregulation are molecular processes that cause tolerance. The brain is constantly exposed to high levels of opioids, which will lead the brain to respond by reducing its response to receptor activation. This will result in a minimized response to the drug therefore, higher dosage of the opioid is needed to get the same results. Opioid tolerance is the reason why people have opioid use disorders and the reason why opioid users are at an increased risk of overdose. Overtime people lose their tolerance to the opioid and no longer know what dose of the drug they can safely tolerate.
Tolerance often understood as the need to take higher doses of a medication to get the same result, which can be seem similar to dependence. When tolerance occurs, it is often hard for doctors to evaluate whether a patient is developing a drug addiction or needs a higher dose to control the symptoms. Doctors ought to be vigilant to their patients’ symptoms and level of functioning when tolerance or dependence is present.
Opioids act by attaching to and activating opioid receptor proteins, which can be found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When drugs attach to their receptors, they stop the pain signals. Using opioids may result in drowsiness, mental confusion, nausea, constipation, and respiratory depression.
Patients often use opioids to manage pain. When taking opioids, it is possible to develop a substance use disorder. A single large dose of an opioid can lead to respiratory depression, which can be fatal. Proper and short-term medical use of opioid pain relievers rarely leads to an opioid use disorder or addiction. On the other hand, regular use of opioids may lead to dependence, tolerance, and addiction. Withdrawal symptoms maybe occur if dosage is suddenly reduced or stopped. These symptoms can include, but not limited to restlessness, muscle pain, insomnia, diarrhea, vomiting, cold flashes, and involuntary leg movements.
Aging comes with painful and chronic conditions in bones, joints, and muscles. Opioids and pain medications have a stronger impact on older adults because the body process slower as people age. Older Adults often use multiple medications, which can interact with opioids and cause serious side effects. Some symptoms that older adults face with opioid substance disorder include, but not limited to depression, delirium, and dementia.
The opioid side effects that older adults and others may face include, but limited to nausea, urine retention, mild cognitive impairment, respiratory depression, increased sensitivity to pain, and cardiovascular system effects. Some risks related to older adults consuming large dosages of opioids could include injury and sometimes death. Older adults with opioid use disorder have a higher risk of death compared to younger adults with the same disorder.
In 2018, a report by Agency for Healthcare Research and Quality (AHRQ) pointed out that eight in ten older adults struggle with chronic pain such as heart disease, diabetes, arthritis, and depression. To cope with the pain, older adults take opioids, which raises the risk of negative side effects.
Frequent opioid use was found to be more common with older adults who were poor or low-income, insured through a form of public insurance, and/or rural areas residents.
To reduce the risk of overdose in older adults, doctors ought to educate the patient and the caregiver about the signs and risks involved in opioid overdose.
The U.S. Pharmacist recommends that older adults manage their pain by using nonpharmacologic therapies when possible. Some options include:
• Relaxation techniques – such as relaxing the muscles and meditation.
• Self-hypnosis – by causing a distraction, altering perception, or numbing the area of the body where the pain is occurring.
• Psychiatric therapy.
• Heat applications – heat helps with pain by improving blood flow to the affected area.
• Cold massage – by slowing the inflammation and swelling, numbing sore tissues, and interrupting the pain-spasm reaction.
• Electrical nerve stimulation.
• Physical therapy.
There are effective strategies in place to prevent opioid misuse but are highly underutilized. The Health and Human Services (HHS) announced five priorities for addressing the opioid crisis:
• Improving access to treatment and recovery services.
• Promoting the use of overdose-reversing drugs.
• Strengthening the public’s understanding of the opioid epidemic through better public health surveillance.
• Providing support for research on pain and addiction.
• Advancing better practices for pain management.
If a person develops an opioid use disorder, it can be treated, and recovery is possible. Treatment requires a wide-ranging, interdisciplinary set of solutions, which could include pain control, behavioural therapy, and medication-assisted treatment for opioid use disorder. Overcoming the misunderstandings and other obstacles that prevent the adoption of these treatments is essential for tackling the opioid epidemic.
References:
Ronan MV, Herzig SJ. Hospitalizations Related to Opioid Abuse/Dependence And Associated Serious Infections Increased Sharply, 2002-12. Health Aff Proj Hope. 2016;35(5):832-837.
Jones CM, Paulozzi LJ, Mack KA. Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse–Related Emergency Department Visits and Drug-Related Deaths—United States, 2010.
Molton, I., & Terrill, A., 2014. Overview of Persistent Pain in Older Adults. American Psychologist, 69(2), pp. 197-207.
Knudsen HK, Abraham AJ, Roman PM. Adoption and implementation of medications in addiction treatment programs. J Addict Med. 2011;5(1):21-27.
Allouche S, Noble F, Marie N. Opioid receptor desensitization: mechanisms and its link to tolerance. Front Pharmacol. 2014;5:280.
Walsh SL, June HL, Schuh KJ, Preston KL, Bigelow GE, Stitzer ML. Effects of buprenorphine and methadone in methadone-maintained subjects. Psychopharmacology (Berl). 1995;119(3):268-276.
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