Opioid Addiction Disorder

It is possible that opioid use goes back into Roman times, and it is probable that it has been
around much longer than that. It is also generally agreed that the ancient people in what is now known
as Iraq cultivated poppies to refine opium from the seeds. From ancient Iraq, opium began to spread all
over the old world. It is speculated that opium was initially used in religious rites, taken orally or
inhaled. In the 1500's a manuscript was found that suggests a method of curing childhood tantrums
through making an extract out of ground poppy stems. Most researches also agree that Arab traders
convoyed the opioids from India to China, which then came back around to Europe. Following hot on
the heals of the drug, came addiction. Manuscripts dating back to the sixteenth century have recorded
instances of opioid tolerance and addiction (Brownstein, 1993). China became overwhelmed with an
opioid addiction problem, but efforts to restrict its use was curtailed by British and French trade
agreements (Brownstein, 1993).
In the early 1800's the poppy was refined down even further into morphine and codeine.
However, in the mid eighteen hundreds the hypodermic needle was invited, which revolutionized the
administration process. The medical industry found that opioids became very successful in small
surgeries due to the new found increased anesthetic properties. Unfortunately, people began to become
addicted to the morphine just as they did with opium before. People began to research ways to separate
the anesthetic properties of opioids, which lead to the invention of heroin. In 1946 methadone was
developed out of an unrelated chemical compound, but has been found to help wean opioid addicts off
of addiction (Brownstein, 1993).
Currently opioid addiction is having a serious global impact upon society. It is estimated that 30
million people have an opioid addiction in the world today (Volkow, 2014). Around 2 million people in
America alone are suffering from a prescription opioid addiction. This unfortunate circumstance has
developed into more than a tripled increase of prescription related deaths. Furthermore, research is
showing that non-medical use of opioid is on the rise in the United States (Volkow, 2014). The dilemma

that society faces, is the contrast between the health benefits that opioids provide and the dangerous
repercussions that are created through the use of them. Sciences greatest challenge is to find the perfect
balance between providing the highest health benefits, while lowing the negative consequences of
opioids.
Impacts of Opioid Abuse
Opioids are one of the three top categories that are being abused in current society, also
including central nervous system depressants, and stimulants. The current social impact that society
finds itself in is largely due to to the massive increase of prescribed opioids from heavy advertising
programs initiated by the pharmaceutical companies (Volkow, 2014). Due to this flooding of prescribed
opioids, there has been a heavy increase of medical and non-medical opioid use, due to the illegal sale
of prescription drugs perpetuated by prescribed patients to non-medical users (Volkow, 2014). Over the
past 25 years the number of prescribed opioids have skyrocketed from about 76 million in the 90's, to
over 200 million. Of that statistic 100 percent of the Vicodin represented is from the United States,
along with 81 percent of the worlds Percocet prescribed (Volkow, 2014).
Along with the massive increase in prescribed opioids all of the negative consequences that are
related to the abuse of them also dramatically increased. In just four years, from 2004 to 2008,
emergency room visits of the non-medical use of opioids increased from 144,600 all the way up to
305,900 (Volkow, 2014). In one decade (1997 to 2007) emergency admission for opioid abuse
increased four percent. Over the past 20 years death related to opioid abuse more than tripled, with
2010 hailing in with 16,651 death in the United States (Volkow, 2014). When researchers look at drug
abuse and mortality rate, opioids rank in as the highest instance. By 2002 death certificates showed that
opioids surpassed every other drug in terms of cause of death from poisoning (Volkow, 2014). Opioids
have been found to become even more dangerous when they are refined by the user to get them more
high, such as crushing into powder to snort or inject. Using opioids in conjunction with other
substances also increases the risk of addiction and death. However, even those who use the medication

as prescribed my their physician are in danger of some of the same risks involved as those who use it
non-medically. Even so, out of the 100 million people who need pain relief, almost half are on opioids
for pain management (Volkow, 2014). The current argument is that opioids improve the patients quality
of life, but there has no been much research into the area to support the claim.
Behaviors that Contribute to Escalating Addiction
An escalated addiction ranking to moderate or severe in the DSM-V has been shown to have
man adverse effects on the addict and society. To be diagnosed as moderately addicted the addict has
to show 4 to 5 indicators on the symptom list, and to be diagnosed with severe opioid dependance they
must have 6 or more indicators present within a 12 month period (APA, 2013). Indicators include
increasing amount of opioid use, unsuccessful attempts of decreasing amount of consumption,
increased time investment in obtaining or recovering from the drug, increased craving to use, decreased
ability to function in normal daily activities (work responsibilities, and social obligations), engaging in
risky behaviors combined with opioid use, continuing use after the realization that opioids are causing
self-harm, increased tolerance, and withdrawal (APA, 2013).
Opioid addiction is generally marked by the illegal attainment of the drug, or if the are legally
attained the addict over consumes beyond the prescribed dosage. Sometimes even legally attained
opioids are based on false claims of pain, while in other instances addicts will see multiple Doctors to
get more than one opioid prescription. Addicts in the health care field will write themselves
prescriptions, or divert opioids from hospital or pharmacy resources for their own private use (APA,
2013). Looking at an opioid addicts criminal history, many times there will be a coinciding crime
record, which hints towards risky behaviors or illegal means of attaining the drug through stealing or
possession charges. With professionals in the medical field who have addiction problems, criminal
activity can include problems with state licensing, other staff, or administrative agencies (APA, 2013).
Furthermore, addicts can also show problems with their marriages, unemployment, and difficulty
holding down a job.

Even though it is important to focus on behavior, to understand behavior it can be helpful to

investigate the chemical changes which occur in the brain of the addict. Brain abnormalities caused
from using opioids is largely responsible for addiction. Fortunately, the abnormalities which affect the
addicts brain are generally resolved after the client is detoxified within a few weeks of discontinued
use. However, the brain abnormalities which create addictive behaviors last much longer, and have a
much broader scope on the clients life. These wide reaching factors can include situations such as
stress, social expectation, psychological addiction, and genetic predispositions that predict an addictive
personality (Kosten & George, 2002). These factors can make the recovered addict crave opioids years
after rehabilitation. Addicts who continue abusing opioids generally due so because of the euphoric
feelings associated to the high.
Issues that Impact the Consequences of Opioid Addiction
Many of the social and cultural issues that impact an individuals abuse of opioids have been
found to revolve around anomie. Native American elders believe that substance abuse problems stem
from a loss of culture (Abbot & Chase, 2008). It has been discovered that when people migrate to the
United States from another country, and lose their cultural identity, they have a high rate of succumbing
to addiction. This phenomena is shown to be due to the level of acculturation. When people lose their
traditional support system, they looks for acceptance through peers (Abbot & Chase, 2008).
Unfortunately, in todays society in the United States many social activities can revolve around
substance use of one kind or another. In Hispanic immigrants specifically it has been found that
individuals who maintained strong family ties were less likely to become addicted to a controlled
substance (Abbot & Chase, 2008).
For many, opioid addiction can be a life-long issue. Research suggests that there are high
overall rates of smoking, alcohol, marijuana, and other drug related use (Hser, Hoffman, Grella &
Anglin, 2001). Furthermore, disability, hepatitis, and a criminal lifestyle has been shown to stay fairly
consistent even in those who have recovered from opioid use. This has even been shown to be true in

individuals who are older in age than the younger opioid addicts (Hser, Hoffman, Grella & Anglin,
2001).
Impact of Opioids Across the Lifespan
There are numerous problems which effect the opioid addict over the span of their lifetime.
Health problems and incarceration seem to rank as the highest ongoing problems. Physical conditions
that arise from opioid addiction include constipation, sleep-disordered breathing, fractures,
hypothalami-pituitary-adrenal dysregulation, and overdose (Baldini, Von Korff & Linn, 2012). Opioid
use in of itself has been shown to cause large declines in health, while also increasing the cost of
healthcare for the individual. Current studies are also showing that there is an increasing death rate
even among patients who are legally prescribed opioid medication.
Constipation is one of the must prevalent health problems that opioid users have to deal with.
Multiple reports show that almost half of the people using opioids experience constipation problems,
and 25% experience nausea. In the most severe case of constipation, patients can end up in the hospital,
or die from a bowel obstruction (Baldini, Von Korff & Linn, 2012). Along with constipation and
nausea, opioid users may also experience vomiting, stomach cramping, and bloating. There is also a
potential of an increased risk for gastrointestinal bleeding. The impact of constipation alone creates
significant concerns about the physiological distress and depression that comes along with the serious
cases (Baldini, Von Korff & Linn, 2012).
Gastrointestinal issues are not the only aspect affecting the lifelong health of the opioid addict.
There has been an association between sleep-disordered breathing and chronic opioid use, as well as
other breathing oriented problems. Around-the-clock clients who were given opioids for at least 6
months showed that 75% ended up having some type of sleep apnea (Baldini, Von Korff & Linn, 2012).
Respiratory depression, bradycardia, and hypotension have also been found to occur with opioid
overdoes, especially in patience who are prescribed high doses of opioids (Baldini, Von Korff & Linn,
2012).

Opioid use also impacts the family and the users personal relationships. When opioid users
become enmeshed with their addiction, the primary relationship becomes the drug instead of with
people (text). Sometimes families will get together to form an intervention, but many times addicts
become isolated, and have little support from sober people. This support factor is even more true for
individuals who have immigrated into a new country, who have little cultural family support (Abbot &
Chase, 2008).
Conclusion
Even though opioids have along history of use, and do provide medical benefit, more research
needs to be done about the overall effects that the drug has upon its user. The health risk related to long
term opioid use is undeniable, yet people are still prescribed opioids on a long term basis. Fortunately,
modern science is on the researchers side, and more light will shine on opioid use in the future.

References:
text
Abbot, P. & Chase D.M., (2008) Culture and substance abuse: impact of culture affects approach to
treatment. Psychiatric Times.
Retrieved from: http://www.psychiatrictimes.com/articles/culture-and-substance-abuse-impactculture-affects-approach-treatment
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders. DSM-5
Washington D.C. American Psychiatric Association.
Baldini, A., Von Korff, M., & Lin, E. H. B. (2012). A Review of Potential Adverse Effects of LongTerm Opioid Therapy: A Practitioners Guide. The Primary Care Companion to CNS
Disorders, 14(3), PCC.11m01326. http://doi.org/10.4088/PCC.11m01326
Brownstein, M.J. (1993) A brief history of opiates, opioid peptides, and opioid receptors. Proceedings
of the National Academy of Sciences.Vol 90. pp 5391-5393
Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC46725/pdf/pnas01469-0022.pdf
Kosten, T.R., & George, T. P. (2002) The neurobiology of opioid dependence: implications for
treatment. Science & Practice Perspectives, 1(1), 13-20
Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/
Hser Y, Hoffman V, Grella CE, Anglin M. (2001) A 33-year follow-up of narcotics addicts. Archive of
General Psychiatry. 58(5):503-508
doi:10.1001/archpsyc.58.5.503.
Volkow, N. (2014) Americas addiction to opioids heroin: prescription drug abuse. National Institute on
Drug Abuse.
Retrieved from: https://www.drugabuse.gov/about-nida/legislative-activities/testimony-tocongress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse