While opioids function as painkillers, they also produce strong feelings of euphoria. This experience, known as a “high,” is the primary reason people turn again and again to opioids. It may be obvious, but the fundamental reason most people take opioids is because they like how these drugs make them feel. However, it is important to examine the underlying causes of this feeling to understand why people become so helpless over time when it comes to opioids.
When people consume opioids, the drugs activate opioid receptors in the brain. Opioid receptors are located in the brains of all mammals, and they control feelings of pleasure and pain. When a drug has activated a person’s opioid receptors, the result is that pain signals are blocked. At the same time, these receptors cause the brain to release high quantities of a neurotransmitter known as dopamine.
Dopamine causes people to experience intense pleasure. It is the same chemical that is released when people have sex, make a slam dunk in basketball, or complete a personal goal. It is the brain’s way of rewarding itself. Dopamine plays an essential role in the brain’s motivation and decision making centers, and neurologists recognize dopamine as the neurotransmitter that is responsible for reinforcing behavior.
Opioids cause the brain to release more dopamine than just about any other activity, which means drug-taking behaviors become reinforced and almost impossible to say no to. When people feel a desire for opioids again, they may think they’re doing it because they like the feeling, but the underlying neurological reality is that their brains have been hijacked.
With regular use, people develop a tolerance to opioids. What is opioid tolerance? Opioid tolerance when the brain and body become accustomed to a specific dosage of opioids. Once a person has adapted to a specific dose of opioids, that same dose will no longer produce the same “high” that the individual has previously gotten. In order to get high, they have to either take opioids more frequently, increase their dosage, or switch to a more potent opiate. As a result, the phenomenon of tolerance causes people to consistently increase their dependence on opioids.
Alongside physical dependence comes withdrawal effects. When people become physically dependent on opioids, the result is that when they stop taking them they experience severe opioid withdrawal. The symptoms of opioid withdrawal are known to be excruciatingly painful and debilitating. As symptoms progress, cravings for opioids can become almost impossible to ignore. For this reason, even individuals with a strong desire to stop taking opioids are often unable to quit.
Opioid Withdrawal Symptoms
The initial symptoms of opioid withdrawal generally begin within the first day of quitting opioids. They can also occur when a person has simply cut down their dosage while continuing to use opioids. These mental and physical effects of opioid withdrawal include:
- Muscle aches
- Lacrimation (eyes tearing up)
- Yawning very often
- Inability to sleep
- Excessive sweating
- Runny nose
- Cravings for opioids
After two or three days, symptoms of opioid withdrawal generally reach their peak intensity. The earlier symptoms can become more severe, and many people experience a range of additional acute symptoms. These acute symptoms of opioid withdrawal include:
- Abdominal cramping
- Nausea and vomiting
- Goose bumps on the skin
- High blood pressure
- Rapid heartbeat
- Blurry vision and dilated pupils
- Extreme cravings for opioids
After approximately a week, the vast majority of these symptoms will have decreased in severity and continue to fade over time. However, most people continue to experience cravings for opioids over the coming weeks and months, and some people continue to experience withdrawal symptoms – a condition known as post-acute withdrawal syndrome (PAWS). For these reasons, the risk of opioid relapse remains high even after a person has withdrawn from opioids. It is therefore essential for people to receive addiction treatment during the detox process and during the aftermath of that process.
Is Opioid Dependence the Same as Opioid Addiction?
In short, the answer is no. It is possible for a person to withdraw from opioids completely, at which point they are no longer physically dependent, but they may still suffer from an opioid addiction. Opioid addictions are mental in nature. Even after withdrawing from opioids, people with opioid addiction continue to experience obsessive thoughts and cravings having to do with opioids.
They may recognize the harms that opioids have inflicted, and they may understand how irrational it is to use opioids after having made it through the detox period, but individuals who suffer from addiction are helpless to say no.
It is important to understand that physical dependence on opioids is a major impediment to recovery, and withdrawal is difficult, but opioid addiction is a distinct condition. Opioid addiction is often far more difficult to manage, since it is caused by a wide variety of underlying factors.
The nature of addiction makes it impossible for a person to control without outside help. However, it is possible for a person to manage their addiction and live happily without opioids, as long as they seek outside help.