In the United States, over 500,000 lives were claimed by opioid overdose between 1999 to 2018. To this day, the opioid crisis continues to cause grief for many communities across North America. Although there is a growing awareness about the epidemic, the damage of the opioid crisis is prolonged by the stigmas, myths, and unfamiliarity with opioid addiction. Considering the magnitude of people affected by this issue, it is necessary to become more informed about opioid addiction. 

Common Myths 

1. Opioid painkillers are just stronger versions of other pain relief medications (e.g Tylenol). 

This is not true. Different types of pain relief medications function in various ways. There are pain relief medications that focus on decreasing inflammation, such as NSAIDs (non-steroidal anti-inflammatory drugs), and corticosteroids (injections with strong anti-inflammatory effects). One common type of NSAID is ibuprofen, a key active ingredient in Advil. Another common pain relief medication is acetaminophen, commonly known by the brand name Tylenol, which reduces pain by acting on the brain. 

Opioid painkillers are different. They are narcotics, meaning that they reduce pain messages to the brain. By activating opioid receptors, G protein-coupled receptors (GPCRs), on nerve cells, they reduce feelings of pain. In short, they modify how the brain receives pain. 

Since there are many different types of pain relief medication, they act on the body differently and have different side effects. Be sure to check with your doctor or pharmacist for specific instructions! 

2. You won’t get addicted to opioids if you are careful. 

Addiction alters brain chemistry. The impact of the opioids is directly on the nerve cells in the brain, so it directly affects the brain. Opioids stimulate the brain’s reward system, triggering withdrawal symptoms that drive dependence and addiction. In other words, one’s mentality or caution cannot entirely prevent them from developing an addiction to these drugs.

There also exists the misconception that medication prescribed by a doctor would not be addictive. The properties of a drug depend on the chemical structure of the drug. Discuss all options and risks with your physician. 

Addiction is also not the be-all, end-all of taking prescription opioids, but they must be taken with caution. 

3. Everyone has an equal risk for addiction.

Different groups are more susceptible to addiction. This depends on a variety of risk factors, including past/current substance abuse, untreated psychiatric disorders, young age, and social environments. It is a combination of biological, psychiatric, and social factors. As seen with the opioid crisis that is a product of socio-structural factors outside of an individual’s control, certain circumstances can increase the risk of addiction. Thus, clinicians must use assessment tools for addiction risk when prescribing opioids. 

Key Terms 

What are OxyContin and oxycodone? 

Such as the relationship between acetaminophen and Tylenol, Oxycodone is the drug name for opioid painkillers, and OxyContin is the brand name. Some other common opioids include Vicodin, Percocet, methadone, Opana, Dilaudid, fentanyl, and morphine. 

What is the difference between tolerance, dependence, and addiction? 

As explained by the National Institute on Drug Abuse, tolerance describes the situation in which a person needs a higher dose of the drug to achieve the same effect as when they first took it. This is because their body is not as receptive to the drug at the time of their first dose. 

Dependence is when a person stops using a drug and experiences withdrawal symptoms. People who are dependent on medication are not necessarily addicted. 

Addiction is characterized by an overwhelming and uncontrollable compulsion to take a drug or substance. This is where a person cannot stop taking a drug despite harmful consequences, even when their treatment is complete. 

What is naloxone? 

This is a short-acting drug that successfully blocks opioid receptors. Naloxone has been in use for over 30 years in treating opioid-overdose, especially the induced respiratory problems. Naloxone can be administered in three main ways: intravenous, intramuscular, or intranasal.

Typically, naloxone is administered by emergency medical personnel, but peers and family members are usually the first responders. Naloxone’s efficacy is time-dependent because death typically happens within 1-3 hours after the overdose.  Since it is best to intervene within an hour of the overdose symptoms, there is a growing need to increase access to this drug. 

Since March 2016, Canada increased public access to naloxone by allowing pharmacies to give naloxone to those who might experience or witness an opioid overdose. It is now a non-prescription drug, available in two types of take-home kits: naloxone nasal spray (intranasal), and naloxone injectable (intramuscular). 

As of Sept 2019, naloxone is still prescription-based in the United States. The FDA, however, is pushing for it to become more accessible. Individual states have their own regulations, available here. 

What are supervised consumption sites? 

Supervised consumption sites (SCS) are locations where an individual can take drugs under the watch of trained healthcare professionals, such as registered nurses. They are also called supervised injection sites or supervised injection facilities. These sites do not provide any illegal drugs; they only have medication on hand in case of overdose and for treatment. 

Supervised consumption sites are an example of harm reduction strategies where the focus is to limit the consequences of drug use. By recognizing that abstinence is not possible for addiction, SCS provides a safe place for drug consumption or injection. Supervised consumption sites serve as an early stage in the recovery process; the goal is to help the individual stop using drugs completely. This is a slow process, based on trust between the users and healthcare providers. 

Although SCS have been proven as effective tools for treating the opioid crisis, they are not yet available everywhere in North America. The first legal SCS opened in 2003 in Vancouver, Canada as a response to the HIV epidemic and rise in drug overdose during the mid-1990s. After its successes, more centers have been opening. Unfortunately, the increase is slow due to prevailing stigmas surrounding addiction. 

What to do if someone has an opioid overdose? 

Telltale symptoms of an opioid overdose include: 

1. Blue lips, fingernails, or toenails 
2. Breathing very slowly or not at all
3. Faint or no pulse 
4. Pale and clammy skin
5. Unresponsive to their name or pain 
6. Snoring or gurgling noises while asleep or nodding out 

How to check for those symptoms: 

1. Look: monitor if their chest is moving
2. Listen: with an ear on their mouth, listen for breathing 
3. Feel: for their breath 
4. Give a chest noogie by rubbing knuckles roughly on the center of their chest. If they don’t respond to the pain, it is likely an overdose
5. Try waking them up 

Action steps: 

1. Check for the symptoms
2. Call emergency services (911) 
3. Administer rescue breathing if they are not breathing 
4. Administer naloxone if it is available 
5. Stay with the individual  until medical first responders arrive 

According to Connecticut’s Poison Control Center, it is imperative to always stay with the affected individual and monitor their condition. 

Since the opioid crisis is a product of socio-structural factors, the movement towards healing is a collective effort. Through understanding the misconceptions, key terms, and ways to identify an opioid overdose, the stigmas about opioid addiction can be lessened, healing scars created by the opioid crisis. 

References 

“America’s Drug Overdose Epidemic: Putting Data to Action.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 Dec. 2020, www.cdc.gov/injury/features/prescription-drug-overdose/index.html.

Canada, Health. “Naloxone.” Canada.ca, / Gouvernement Du Canada, 18 Apr. 2019, www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/naloxone.html#4.

Canada, Health. “Frequently Asked Questions: Access to naloxone in Canada (including NARCAN™ Nasal Spray).” Canada.ca, / Gouvernement Du Canada, 30 June 2017, www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/narcan-nasal-spray-frequently-asked-questions.html.

Canadian Nurses Association. “FACT CHECK: DISPELLING MYTHS ABOUT SUPERVISED CONSUMPTION SITES .” Canadian Nurses Association.

Commissioner, Office of the. “Statement on Continued Efforts to Increase Availability of All Forms of Naloxone to Help Reduce Opioid Overdose Deaths.” U.S. Food and Drug Administration, FDA, www.fda.gov/news-events/press-announcements/statement-continued-efforts-increase-availability-all-forms-naloxone-help-reduce-opioid-overdose.

“How Opioid Drugs Activate Receptors.” National Institutes of Health, U.S. Department of Health and Human Services, 5 June 2018, www.nih.gov/news-events/nih-research-matters/how-opioid-drugs-activate-receptors.

Jim Morelli, MS. “Pain Relief Medications: OTC, Prescription & Side Effects.” RxList, RxList, 27 Apr. 2016, www.rxlist.com/pain_medications/drug-class.htm.

Kerr, T., Mitra, S., Kennedy, M.C. et al. “Supervised injection facilities in Canada: past, present, and future.” Harm Reduction Journal (2017). https://doi.org/10.1186/s12954-017-0154-1

Kim, Daniel et al. “Expanded access to naloxone: options for critical response to the epidemic of opioid overdose mortality.” American journal of public health vol. 99,3 (2009): 402-7. doi:10.2105/AJPH.2008.136937  

Kosten, Thomas R, and Tony P George. “The neurobiology of opioid dependence: implications for treatment.” Science & practice perspectives vol. 1,1 (2002): 13-20. doi:10.1151/spp021113 

Rosen, Sheryl. “Pain Pills/Opioids Frequently Asked Questions.” Connecticut Poison Control Center, 27 Dec. 2016, health.uconn.edu/poison-control/about-poisons/medications/information-for-people-using-pain-pills-or-other-opioids/pain-pillsopioids-frequently-asked-questions/.

“Tolerance, Dependence, Addiction: What’s the Difference?” NIDA Archives, archives.drugabuse.gov/blog/post/tolerance-dependence-addiction-whats-difference#:~:text=If%20a%20person%20keeps%20using,without%20being%20addicted%20to%20it.

Webster, Lynn R. MD “Risk Factors for Opioid-Use Disorder and Overdose.” Anesthesia & Analgesia vol. 125, 5 (2017): 1741 -1748. doi: 10.1213/ANE.0000000000002496 

Zwarenstein, Carlyn. “Data Show the First Supervised Injection Site in the U.S., Although Illegal, Prevented Overdose Deaths.” The Globe and Mail, 29 Apr. 2019, www.theglobeandmail.com/world/article-data-show-the-first-supervised-injection-site-in-the-us-although/.