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The United States is currently in the midst of an opioid epidemic. This class of drugs, which includes substances such as heroin and prescription painkillers, have contributed to over 67,000 overdose deaths in 2018 alone — and approximately 128 Americans die from opioid overdoses each day 1.
Opioids are highly addictive, have intense and often painful withdrawal symptoms, and place users at a high risk of death or relapse. In addition, opioid use disorder commonly co-occurs with other mental health conditions, including depression and suicidal ideation.
Here’s what you need to know about mental health and opiate addiction.
Opioids, also known as opiates, are a class of drugs derived from opium poppy seeds. These seeds contain substances such as morphine and codeine, which provide sedating, pain-relieving, and euphoric effects.
These drugs typically come in two forms: illegal derivatives and prescription painkillers. Opioids, regardless of their type, are highly addictive and dangerous in large doses. Misuse of opioids often leads to addiction, unpleasant withdrawal, and overdose death.
Heroin is a semi-synthetic opioid that can be injected, smoked, or snorted. This drug is a Schedule I controlled substance in the United States, since heroin has no medical benefits, can be highly dangerous, and carries a high risk for opioid use disorder.
Heroin-involved overdose deaths have increased significantly across the United States, with 14,996 deaths in 2018 alone 2.
In addition to overdose risk, heroin can lead to:
Prescription opioids are substances used to treat moderate to severe pain after a medical procedure, such as a major surgery or serious injury. Like all opioids, these drugs can be very addictive; in 2016, 11.5 million Americans reported misusing prescription opiates 3.
Patients can use a higher dose of the drug than prescribed, or take the drug solely to experience its euphoric effects. When the addiction progresses, they may use other people’s prescriptions once the medical reason for their own prescription is no longer valid.
Many doctors prescribe these painkillers to their patients, despite their highly addictive nature. In 2017 alone, doctors wrote over 191 million prescriptions for opiate painkillers to American patients 3.
Common prescription opioids include:
Side effects of prescription opioid abuse include tolerance, physical dependence, depression, increased sensitivity to pain, and slowed breathing.
Fentanyl is a synthetic prescription opioid that is highly dangerous in small quantities, contributing to over 31,000 overdose deaths in 2018 alone. Fentanyl was involved in 59% of opioid-related deaths in 2017, compared to 14.3% in 2010 4.
Fentanyl is particularly dangerous due to its potency. Often used to treat severe pain, fentanyl is 50 to 100 times more potent than morphine, and a fatal dose can be as little as 250 milligrams 4.
Many fentanyl-related overdose deaths involve fentanyl-laced drugs, such as heroin and cocaine, that the victim was unaware of when they purchased these substances. Other users take fentanyl willingly, since it is highly addictive.
Withdrawal symptoms can develop within hours of a last dose, and because they are so severe, many people continue to misuse opioids in order to treat or avoid them.
OUD then begins a vicious cycle where you need more opioids to achieve the desired effect, experience worsening withdrawal symptoms over shorter periods of time, and continue to misuse these drugs on a regular basis.
If you believe you have OUD, seek professional treatment immediately. You will receive care designed to manage withdrawal symptoms and help you gain the tools necessary to recover from your condition.
People who have opioid use disorder often also have a co-existing mental health condition, such as depression or anxiety. In fact, out of the 19.3 million adults who suffered from substance use disorder in 2018, 9.2 million also suffered from a co-occurring mental illness 6.
In some cases, patients develop mental health issues due to their opioid use disorder. In other cases, patients develop an opioid use disorder to cope with symptoms of their mental illness.
Regardless of which came first, it is important to understand the symptoms of these mental health conditions and seek treatment as soon as possible.
This condition can increase your risk of developing opioid use disorder — people with depression who begin taking prescription opioids are two times more likely to develop OUD 7.
In addition, people who develop depression after using opioids for a long period of time may experience more severe depression symptoms than others. In fact, some patients develop depression symptoms after using prescription opioids in as little as one month 8.
This risk may occur for a number of reasons. Opiate use can induce symptoms of depression, such as social withdrawal and sleep disturbances. These substances also influence your brain chemistry, causing depression to develop over time.
In addition, you may reach for opioids to cope with symptoms of depression, using their euphoric effects to improve your mood. Over time, however, this abuse will only lead to worsening depression.
Misusing opiates can both lead to the development of an anxiety disorder or an increase in the severity of your anxiety symptoms. Many anxiety patients with OUD use opioids to cope with their symptoms, which in turn can worsen the condition and restart the cycle of dependence.
People who suffer from long-term opioid use disorder are more likely to develop any anxiety disorder than people who do not use opioids 9. These drugs are capable of producing anxiety symptoms, which can occur during or after use.
Opioids can exacerbate current anxiety symptoms, leading to paranoia, agitation, and difficulty sleeping. Anxiety symptoms often appear during the withdrawal process as well, making it difficult to quit without professional treatment.
Since PTSD is triggered by a traumatic event, opioid use does not directly cause this condition. However, 42% of people with PTSD are dependent on opioids, which suggests that many patients use these substances to cope with PTSD symptoms and avoid memories of the event 10.
In addition, dependence on opioids tends to place people in situations where traumatic events are likely to occur. For example, you may go to a dangerous part of your city to purchase drugs and increase your risk of falling victim to a violent crime. If you do not seek swift professional treatment after a traumatic event, you have a higher chance of developing PTSD.
Since opioid misuse often exacerbates or leads to the onset of mental health conditions, these drugs can increase the frequency of suicidal ideation as well. You may feel hopeless, unable to control your situation, and unsure how to break free from the cycle of opiate addiction.
Suicide is never the answer, even if it may seem like the only option. You can take steps to seek help, restore your quality of life, and begin enjoying the activities you once loved again.
If you believe you may attempt suicide, seek help immediately. Call 911 for emergency medical attention, or call the National Suicide Prevention Lifeline at 1-800-273-TALK.
Listen to former congressman Patrick J. Kennedy passionately talk about the connection between suicide rates and opiate overdose rates.
He states that suicide numbers are “way under reported in this country,” and that “We’re in denial.”
These medications help diminish cravings, blocks receptors from producing feelings of pleasure when using opioids, and detoxifies your body from opioids, helping you stay on the path to recovery.
If you have a co-occurring mental health condition, your doctor will prescribe compatible drugs that can help safely manage your symptoms. Some of these medications may also be used to treat OUD.
Cognitive behavioral therapy (CBT) is a common treatment option that involves walking through harmful beliefs and unhealthy coping mechanisms, and developing the skills you need to overcome your condition.
CBT is one of the most effective therapy options for people with anxiety and mood disorders, as well as people who struggle with substance abuse. During a CBT session, you will engage in a structured conversation with a trained counselor, who will in turn help you understand your negative thinking patterns and actively work to help you combat them.
CBT may help manage many mental health disorders, including:
Exposure therapy is a treatment option for people with certain anxiety and trauma-related disorders, such as phobias and PTSD. During this option, a trained counselor will expose you to a situation, event, object, or memory that may trigger your symptoms.
The purpose of exposure therapy is to desensitize your response to these triggers, helping you gain control over your responses and re-engage in the activities you once loved. As a result, you may see reduced or eliminated symptoms and an array of skills to combat triggers once you finish treatment.
Seeking Safety is a treatment program designed to target trauma-related disorders and substance use disorders at the same time. During this program, patients will develop coping skills to manage their trauma symptoms and stay on the path to sobriety.
Unlike exposure therapy, Seeking Safety is focused on the present and the future, rather than the past trauma itself. During this treatment program, you will be asked what safety would look like in your life. After identifying this vision, the program will teach you the coping skills necessary to achieve safety in your daily life.
Dialectical behavioral therapy (DBT) is a treatment option for people who suffer from self-harm behaviors, which may include drug use, suicidal ideation, or cutting. The purpose of DBT is to help you develop healthy responses to stress, improve relationships, and regulate your emotions.
A DBT session is very similar to CBT. You may participate in DBT in a group, where you will learn behavioral skills in a classroom setting, or individually, where a counselor will walk you through a structured conversation. At the end of your program, you will have challenged and changed negative thinking patterns, and can apply the strategies you learned to daily situations.
While these prevention tips are helpful, opiate addiction is difficult to stop once it has begun. Seeking professional treatment from a rehabilitation facility or clinic that specializes in OUD can help you safely detox from these substances.
If you are struggling with opiate addiction, don’t wait to seek help. Visit a treatment facility to receive the counseling and medication you need to develop healthy coping skills, manage your symptoms, and stay on the path to full recovery.