Opioid drugs are a class of analgesic medications that bind to opioid receptors in the brain, block pain sensations, and slow down some of the autonomic functions of the central nervous system. The presence of dopamine, one of the chemical messengers the brain uses to send signals that induce feelings of pleasure, is increased by opioid drugs, making opioids popular drugs of abuse. The “high” from opioids is both mellowing and pleasant.
Between 26.4 million and 36 million people around the world abuse opioid drugs, the National Institute on Drug Abuse (NIDA) publishes. This includes both the illicit drug heroin and prescription opioid drugs. Opioid drugs are highly addictive, and these prescription narcotics can cause dependence even when used for medical reasons under the direct supervision of a doctor. Prescription information for Oxycontin, published by the U.S. Food and Drug Administration (FDA), reports that both medical and recreational use of the drug can lead to addiction. The Drug Enforcement Administration (DEA) classifies many prescription opioids as Schedule II controlled substances, meaning that they do have medical use, but they also carry a high risk of abuse, dependence, and addiction.
Some of the most addictive prescription opioids include:
Opioid Dependence and Addiction
The American Society of Addiction Medicine (ASAM) estimates that around 2 million Americans battled addiction to prescription opioid drugs in 2014. When a person takes an opioid drug, it fills opioid receptors in the brain and causes a flood of dopamine. Respiration, heart rate, and blood pressure slow down, leaving a person feeling relaxed and happy. Regions of the brain that help to regulate emotions, control willpower, advance memory functions, and process rewards are disrupted. A person under the influence of an opioid may be more social and less inhibited than usual, which can open the door to poor decision-making and questionable behaviors that may be risky and have negative and far-reaching consequences.
With regular use of an opioid drug, the body can become tolerant to the drug’s effects, and the person will need to increase the dosage, or take the drug more often, to garner the same results. Taking higher doses more frequently can raise the risk for developing dependence.
When someone is dependent on an opioid, brain chemistry and circuitry are altered, and the brain will no longer work the way it did before the drugs interfered. Mood swings, drug cravings, and difficult withdrawal symptoms are side effects of drug dependence. When an opioid drug wears off, individuals may suffer from flu-like physical symptoms as well as depressed moods, anxiety, insomnia, and difficulty feeling pleasure. Drug dependence can often manifest into addiction as an individual may lose control over their ability to regulate how much and how often they take opioid drugs.
Specifics of Most Addictive Prescription Opioids
Opioid drugs were initially derived from the opium poppy plant indigenous to Asia and the Mediterranean. Today, opioid drugs are either natural (derived from the plant), synthetic (meaning they are manmade in a laboratory), or semisynthetic, which is a mix of the two types. Both naturally derived opiates and manmade opioid drugs interact in the body in a similar fashion, and both can cause dependence and addiction with chronic use.
In general, the faster a drug reaches the brain, the more addictive it can be. This means that drugs that are commonly injected, snorted, or smoked may be more addictive than those that are typically swallowed. Prescription opioids that take action more quickly and are extremely potent are also more addictive, as they become active in the bloodstream faster than those with a slower onset of action. Mixing a prescription opioid with another mind-altering substance can also increase the risk for addiction.
Some of the most addictive prescription opioid drugs are outlined below.
Fentanyl (Duragesic, Aqtic, Fentora, Sublimaze)
A synthetic opioid that is 50-100 times more potent than the natural opiate morphine, NIDA reports, fentanyl is an extremely powerful and fast-acting drug. The DEA publishes that it takes effect quickly and also wears off relatively quickly.
Fentanyl is made into buccal tablets, oral transmucosal lozenges (often termed fentanyl “lollipops”), injectable formulations, and transdermal patches. The patches are often frozen and cut up, absorbed into a beverage, or sucked on, or the gel is inhaled or harvested for injection. This is extremely dangerous and can more quickly lead to dependence as well as increase the risk for overdose, as the extended-release formulation of the fentanyl patch is bypassed when it is altered. The entire dose of the drug is sent straight across the blood-brain barrier for an intense high that can rapidly overwhelm the system and cause a potentially fatal overdose. The Centers for Disease Control and Prevention (CDC) reports that fentanyl, and synthetic opioid, overdoses are on the rise, as there were twice as many fatalities in 2014 than 2013 involving a synthetic opioid drug in the United States.
On the street, fentanyl may be laced with heroin and synthesized in clandestine laboratories. It is often diverted from medical channels through pharmacy or nursing home theft and fraudulent prescriptions. The high potency and quick onset of action make fentanyl one of the most addictive and dangerous prescription opioid drugs.
Traditionally a popular drug of abuse, oxycodone is a commonly prescribed semisynthetic opioid painkiller that comes in multiple formulations, release formats, and strengths. The DEA reports that it is commonly abused orally, intravenously, or by inhaling the vapors of a tablet that has been heated on a piece of foil.
Due to its widespread abuse, OxyContin was reformulated in 2010 into an abuse-deterrent formulation; however, the Pharmaceutical Journal publishes that it is still a drug of abuse due how highly addictive it can be. It may be swallowed, or the abuse-deterrent formulations may be bypassed in order to inject or snort the drug after crushing the tablets.
Extended-release morphine (MS Contin)
Morphine is a naturally occurring opiate used to treat moderate to severe pain. MS Contin is an extended-release version of morphine intended for patients who require around-the-clock pain management and for those who may be tolerant to other opioids, per Purdue Pharma. It may be abused by chewing the tablet, by snorting or smoking crushed tablets, or by dissolving crushed tablets into liquid and injecting the resulting substance. This sends all of the drug into the bloodstream at once, raising the odds for overdose and increasing the risk for addiction and dependence.
Primarily prescribed to be taken only in a hospital setting, Demerol is highly potent and designed for the short-term relief of pain. The prescribing information published by the FDA warns that the drug can easily be habit-forming. As with other prescription opioids, it is often swallowed, crushed and snorted, or injected when abused.
Hydromorphone has a shorter onset of action than many other opioids, and it has analgesic properties that are 2-8 times more powerful than morphine, the DEA reports. Hydromorphone also has a greater sedative effect. Often termed “footballs” due to the shape of its tablets, hydromorphone is also manufactured in an injectable formulation.
The rapid activation of the drug in the bloodstream can increase its addictive qualities and more quickly lead to drug tolerance and dependence. Mayo Clinic publishes that hydromorphone is often prescribed for individuals who need a higher and more potent dose of opioids or for those who are tolerant to other opioids. More powerful and quicker-acting opioids like hydromorphone can be highly addictive.
Combination hydrocodone products (Vicodin, Lorcet, Lortab)
According to the DEA, hydrocodone is always manufactured as a combination product (often in conjunction with other over-the-counter analgesics, such as acetaminophen or aspirin), and it is the most widely prescribed, diverted, and abused prescription opioid drug.
Hydrocodone products were rescheduled into the stricter Schedule II classification from Schedule III under the Controlled Substances Act (CSA) by the DEA in 2014, in part due to their high rate of abuse and diversion. Tighter regulations are meant to make it harder to obtain for illicit and recreational use. Hydrocodone is similar in potency to morphine. It has both pain-relieving and cough-suppressing effects, and it is formulated for medical use in tablet, liquid, and capsule form.
Combination oxycodone products (Percocet)
Containing both the opioid oxycodone and the over-the-counter analgesic acetaminophen, Percocet is prescribed to relieve moderate to significant pain symptoms. Percocet has a “boxed warning” on its prescribing information, published by the manufacturer Endo Pharmaceuticals, warning individuals as to its propensity to expose those taking it to addiction, misuse, and abuse, which can lead to death by overdose. Percocet is a highly addictive semisynthetic combination opioid drug.
Curbing Prescription Opioid Addiction
Prevention is the first line of defense when it comes to opioid addiction, as avoiding abuse of these substances is obviously the best way to keep from becoming addicted to them. Any use of a prescription medication without medical need and supervision from a trained healthcare professional is considered abuse and can manifest into addiction. That being said, these drugs can be used safely and without incident when taken as directed and under the careful supervision of a medical provider.
Opioid drugs are some of the most widely abused prescription drugs, according to NIDA, and they can cause dependence with very few illicit uses. Opioid drugs should not be stopped suddenly, or “cold turkey,” as the withdrawal symptoms can be intense. Instead, a medical detox program can safely allow the drugs to process out of the body while minimizing withdrawal symptoms and drug cravings with the help of medications and supportive methods. After detox has allowed a person to achieve physical stability, an addiction treatment program can foster recovery through behavioral, pharmacological, supportive, and therapeutic techniques. Opioid addiction is a treatable disease when the right help is available.