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Opioid dependence is more common than many people think. Every year, thousands of people become dependent on prescription pain medication after their diagnosed need for pain relief has passed.
No one is immune to opioid dependence. It affects men and women of all ages, races, ethnic groups, and educational levels. According to the 2005 National Survey on Drug Use and Health (NSDUH):
Opioids are drugs that have the same effect on the body as opium. Some opioids are made directly from opium (for example, morphine, codeine, and heroin). Other opioids are manufactured to be chemically similar to opium (for example, the pain medications oxycodone, hydrocodone, and fentanyl, with brand names such as OxyContin®, Vicodin®, Percocet®, and Actiq®).
For people in pain, opioids can be effective medicines for pain relief. For some, however, opioid dependence can be an unintended side effect of prescribed pain treatment.
When opioids enter the bloodstream, they attach to opioid receptors (called mu receptors) in the brain, stimulate the release of dopamine, and produce pleasurable feelings. After repeated use, some people can experience withdrawal symptoms and cravings—and can have a strong physiological desire to repeat the experience.
Frequent and persistent use of opioids can cause brain cells to change the way they work. The brain can be "re-set" to think the drug is necessary for survival. In other words, the brain of a person dependent on opioids can cause them to feel as though they cannot live without this drug—and eventually they may adopt compulsive drug-seeking behavior.
Researchers have discovered that opioids cause long-term changes in the brain, and thus opioid dependence is considered a long-term medical condition. The good news is, opioid dependence can be treated effectively with drug therapy combined with counseling.
The need to satisfy cravings or avoid withdrawal can be so intense that even people who want to stop taking opioids find this difficult. Consequently, they may find themselves doing things they wouldn't ordinarily do in order to obtain more of the drug they crave. For this reason, even though opioid dependence is a medical condition and not a moral failing, it can drive behavior.
Nerve synapse in the brain where opioid receptors are located.
The pleasurable feelings—as well as the unpleasant withdrawal symptoms—increase the likelihood that opioid use will be repeated. Most people who take these powerfully reinforcing drugs don't become dependent on them. Although the specific causes vary from person to person, certain factors, such as the opioid of choice, a family history of drug or alcohol dependence, genetic predisposition, underlying emotional issues, peer pressure, and the individual's environment, can increase the chances of becoming dependent.
When a person uses opioids, the brain gradually gets used to the drug and becomes less sensitive to it. As a result, the person needs more of the drug to achieve pleasurable feelings. This is how tolerance develops. With longer use or higher doses, the brain adjusts to the increased levels of opioids, and then requires those increased levels to feel satisfied or "normal" to avoid withdrawal. This is how tolerance often leads to dependence.
Physical dependence is typically associated with tolerance and withdrawal. Psychological dependence involves continued drug use despite any negative effects.
Psychological dependence can reach the point where people have uncontrollable cravings for the drug—and are willing to take significant risks to obtain it, regardless of the harmful consequences to themselves, their families, their jobs, or their community.
