OPIOIDS
Opioids are a class of substances commonly used in medicine for pain relief. “Opiate” is a term sometimes used synonymously and refers to drugs derived from the opium poppy (e.g., morphine). By contrast, “opioids” are synthetic or semi-synthetic, which means they are in some way manufactured. “Narcotics” is another term often used; this refers to drugs that cause sleepiness or numbness, which opioids do, and is often used in reference to legally controlled substances.
With the growth of pain research in recent decades, opioids have become common in medical practice and among people who use drugs. Opioids are known by dozens of medical names (e.g., hydromorphone, hydrocodone, oxycodone, tramadol, buprenorphine) and street names (e.g., Oxy 80s). Another common group of opioids has been developed to help reduce the lethal effects of physical dependence that can develop; opioid agonists (i.e., methadone; buprenorphine/naloxone, also known as Suboxone®) and slow-release oral morphine have been used for several decades around the world to reduce the harm of opioid dependence.
OPIOID MISUSE & DEPENDENCE
As a highly addictive substance, anyone who uses an opioid may become dependent. This means that people having never used illicit drugs or who have no experience with addiction may develop a dependence, even if their initial exposure was through a prescription for pain relief. Exposure to violence, toxic stress, and trauma, including intergenerational trauma, has been shown to increase the risk for a wide variety of poor health outcomes, including substance misuse disorders (Blanch, Shern, & Steverman, 2016). Research suggests that the emotional numbness triggered by opioids may increase the risk of opioid use disorder (OUD) for people who have been exposed to significant trauma (Fareed et al., 2013).
In the body, a first exposure often involves good feelings, as opioids increase the release of endorphins in the brain, a hormone that can produce pleasure while reducing the perception of pain1. Over time and repeated use of opioids, the body’s production of endorphins slows down, meaning that good feelings associated with opioids eventually stop. As the body becomes more tolerant to opioids, a person might increase the amount they take in order to keep having the same good feelings. Misuse happens when someone consumes opioids against prescription guidelines (e.g., increasing one’s dose, accessing the drug from unregulated sources) and is a common risk factor for addiction, which is experienced as a powerful, even out-of-control or compulsive craving. The terms substance use disorder (SUD) or opioid use disorder (OUD) are often used in place of terms like addiction, to be specific and avoid potentially stigmatizing language.
OPIOID AGONIST THERAPY (OAT)
Opioid agonist therapy (OAT) is a treatment for addiction to opioids that involves taking opioid agonists (i.e., methadone; buprenorphine/naloxone, also known as Suboxone®) and/or slow-release oral morphine. OAT prevents withdrawal and helps eliminate cravings without causing a person to feel high. For people who are addicted to opioid drugs, taking OAT can help to reduce harms related to drug use. A person who is stabilized on OAT should be able to focus on their health and well-being beyond this medication.
THE OVERDOSE CRISIS
Some people who develop opioid addiction struggle hard to reduce their use of opioids on their own, which can increase their willingness to consume forms of the drug obtained illicitly (i.e., on the street, via non-medical sources) and in more risky ways (e.g., injecting its liquid directly into the bloodstream instead of swallowing it in pill form, which can slow absorption through digestion). When opioids are secured illicitly, their potency and purity are not guaranteed, often leading to overdoses when unpredictable concentrations of powerful opioids are mixed into non-opioid drugs. Additionally, when illicit opioids are injected, usually to experience a quicker effect, the use of unsterilized needles may increase the spread of blood-borne illnesses like Hepatitis C and HIV (Secretariat of the Safe Injection Global Network, 2000). This further undermines one’s own health and others’ health who come into contact with supplies that are not safely disposed of. Other harms that can come from uncontrolled opioid use come by way of the risks that a person may be willing to take in order to satisfy an out-of-control craving. In the past decade, growing numbers of overdoses and deaths caused by opioids have created a public health emergency, sometimes referred to as the overdose crisis in Alberta. These overdoses and deaths are partly linked to prescription opioids, but also to an increasingly toxic supply of illicit drugs (e.g., fentanyl) that are as much as 50-100 times more potent than morphine.