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Opioid and Opiate Addiction

Opiates are some of the world's oldest known drugs. Derived from the poppy plant, the use of natural opiates dates back to ancient times and there is even archaeological evidence that suggests that the opium poppy may have been used by Neanderthal man over 30,000 years ago.[1]

Any drug derived from the poppy plant, whether naturally or synthetically, is a type of opioid. This includes illegal drugs like heroin and regulated drugs like morphine, codeine and oxycodone, which are often used by healthcare professionals for pain management.  Opiates are drugs in the opioid family that are derived directly from the poppy plant and not processed synthetically.

There are over 50 known types of opioids, which are often known by their brand name rather than their scientific name. For example, oxycodone is the scientific name for one type of opioid, which is sold under several brands that use oxycodone as the main ingredient, including OxyContin and Percocet.

Often prescribed by healthcare professionals to address acute, episodic and chronic pain, opioids can create a powerful psychological addiction that can develop from the use of licit (legal) or illicit (illegal) forms of the drug. Early identification and drug use management is essential.

How do opioids work?

The body has opioid receptors in the brain, spinal cord and some internal organs, which opium and opium-based drugs act on to partially or fully suppress pain and create a feeling of euphoria.

The euphoria from opioid use can create a powerful psychological addiction. Also, people who are prescribed opioids for pain management may fear pain reoccurrence if the drug use is stopped.

Opioid misuse and addiction in Canada

The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain[2], a national guideline for healthcare professional, highlights a number of concerns about opioid misuse and addiction in Canada:

  • Canada has some of the highest uses per of medicinal opioids per capita in the world, ranking second after the US in 2011 as the main consumer of both morphine and oxycodone based on the volume of the drug purchased.[3]
  • In Ontario, OxyContin prescriptions rose 850% from 1991 to 2004.
  • A 2009 study of prescription overdose deaths in Ontario found that 56% of patients had received an opioid prescription within four weeks of death.
  • A study of opioid dependent patients admitted to the Centre for Addiction and Mental Health (CAMH) found that only 21% received their opioid from the street alone. The rest received their opioid from physician prescriptions (37%) or a combination of a prescription and the street (26%.)
  • The Canadian Rx Atlas, Third Edition published in December, 2013 showed an increase in the total market share and spending on drugs in Canada for opioid drugs in 2012/13 compared to 2007/08.[4]

What are the signs of addiction?

Since opioid addiction has a strong psychological component, someone with an opioid addiction will typically show signs that the drug is playing a disproportionate role in the person's life, possibly impacting their work and relationships with friends and family.

The Canadian Society of Addictive Medicine has published this definition of addiction:

"Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one's behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."

There are a range of behaviours that may be indicative of a prescription drug addiction.[5]

Less suggestive behaviours include hoarding drugs at times when the person has reduced symptoms and acquiring the drug from multiple sources. More suggestive behaviours include prescription forgery, recurring loss of prescriptions, many unsanctioned dose increases and stealing or borrowing drugs from others.

Opioid addiction can develop from use of any form of the drug, but the experience of withdrawal symptoms does not mean that a person is addicted. For example, a cancer patient who has been prescribed an opioid for the pain may experience physical withdrawal symptoms, but not the accompanying psychological symptoms that would cause that person to crave and continue to use the drug.

Opioid addiction stigma and challenges

A research study found that just 24.2% of people with prescription opioid use disorders seek treatment.[6]

Women and Addiction: A Comprehensive Handbook noted that people with an opioid addiction from prescription drugs face two main treatment challenges.[7] First, a patient may fear revealing concerns about possible opioid addiction symptoms to the doctor that prescribes their medications, as doing so may impact their future healthcare treatment.

Second, the stigma associated with drug addiction from the use of illegal drugs may cause some patients to avoid seeking treatment. A study in 2007 found that people who "accidentally" became addicted to opioids were unlikely to seek help from an addiction centre.

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[1] Understanding Drugs and Behaviour By Andrew Parrott, Alun Morinan, Mark Moss, Andrew Scholey, 2004, Wiley, ISBN : 978-0-471-98640-9 p104

[2] The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain http://nationalpaincentre.mcmaster.ca/opioid/index.html

[3] Narcotic Drugs: Estimated World Requirements for 2013 / Statistics for 2011 http://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2012/Narcotic_Drugs_Report_2012.pdf

[5] Misuse of and dependence on opioids, Canadian Family Physician, volume 52 http://www.cfp.ca/content/52/9/1081.full.pdf

[6] Women and Addiction: A Comprehensive Handbook, by Kathleen T. Brady MD Ph.D., Sudie E. Back Ph.D., Shelly F. Greenfield MD MPH, Publication Date: April 2, 2009, ISBN-10: 1606231073 p 389

[7] Ibid p 388-389