Opioids

What Are Opioids?

Opioids are a type of medication used to treat pain. They’re also used as anesthetics because they can alter someone’s awareness. Opioids can be natural or synthetic. Natural opioids typically are made from latex found on the seeds of the opium poppy. Synthetic and semi-synthetic opioids are created to produce the same effects as natural opioids but involve at least some artificially made chemicals.

What Is the Difference Between an Opioid and an Opiate?

Many people use the terms opioid and opiate interchangeably. However, opiates are really only naturally-occurring opioids like morphine, codeine, and heroin. Opioids can be naturally-occurring, semisynthetic, or completely synthetic.

How Does an Opioid Work?

An opioid works by acting upon the opioid receptors, which can be located in the following locations:

• Brain
• Digestive tract
• Spinal cord
• Peripheral neurons

What Are Some Common Opioids?

The following are some commonly prescribed opioids:

• Oxycodone – OxyContin, Percodan, Percocet, Roxicodone
• Fentanyl – Duragesic, Pristiq, Abstral, Ionsys, Subsys
• Hydrocodone – Norco, Lortab, Vicodin
• Codeine – Tylenol no. 3, Phenergan-AC, Robitussin AC
• Propoxyphene – Darvocet N-100 (discontinued)
• Morphine – MS Contin
• Hydromorphone – Dilaudid

What Do Opioids Treat?

Opioids are most commonly prescribed to treat pain. However, they have also been used to treat the following conditions:

• Cough
• Constipation
• Diarrhea
• Hyperalgesia
• Shortness of breath

When Are Opioids Prescribed?

Opioids are often prescribed following surgery or an injury. They may also be prescribed to treat pain caused by cancer or a chronic condition. While opioids have been used to treat pain since their discovery, they have recently been prescribed more and more frequently. Because opioids are highly addictive substances, this has led to an epidemic of opioid abuse.

What Are Some Commonly Prescribed Opioids?

Some opioids that are commonly prescribed include:

• Oxycodone – OxyContin, Percodan, Percocet, Roxicodone
• Fentanyl – Duragesic, Pristiq, Abstral, Ionsys, Subsys
• Hydrocodone – Norco, Lortab, Vicodin
• Codeine – Tylenol no. 3, Phenergan-AC, Robitussin AC
• Propoxyphene – Darvocet N-100 (discontinued)
• Morphine – MS Contin
• Hydromorphone – Dilaudid

What Are the Side Effects of Opioids?

When used as directed, opioid-based medications can have the following side effects:

• Constipation
• Nausea
• Dry mouth
• Vomiting
• Sweating
• Itching
• Dizziness
• Sleepiness
• Depression
• Confusion
• Dependency on the opioid (withdrawal symptoms when stopping the medication)
• Lower testosterone levels
• Reduced sex drive
• Reduced energy
• Reduced strength
• Increased tolerance (needing more to produce the same effect)

Taking opioids can also result in addiction and, in some cases, death.

Are Opioids Illegal?

Because they are so highly addictive, opioids can only be legally obtained through a doctor’s prescription. Certain opioids, like heroin, are more commonly known for their illegal usage than for their legal prescription. Any non-prescription use of opioids is illegal. Because opioids are not only addictive but also can induce a feeling of euphoria, these drugs are sought out by many for non-medical purposes. Because of this, there is an opioid epidemic in the United States.

What Opioids Are Illegal?

Heroin (diacetylmorphine) is also an illegal opiate that is not an approved medication in the U.S. and is sold as a “street drug”. It has also been sold in combination with fentanyl, leaving the user unaware that the drug may be much stronger than intended and more likely to result in overdose and death.

Fentanyl and a newer form, carfentanil which is even more potent, have also been transported illegally into the U.S. to be used in the making of other illegal drugs and have created serious concern for law enforcement as a very small amount of the drug can be fatal.

Are Legal Opioids Controlled?

The use of opioids for pain relief is not a new development as most drugs originated as derivatives or extracts that came from the opium poppy plant. Today, many newer synthetic or semi-synthetic opioid medications are available by controlled substance prescription.

A controlled substance or “scheduled drug” requires more stringent prescribing guidelines and procedures and may be tracked by state and federal agencies including the U.S. Drug Enforcement Agency. Misuse of controlled substances may carry much higher consequences and punishment than other non-controlled medications.

How Do Opioids Cause Addiction?

Opioids can trigger the release of endorphins in the brain. These are the chemicals that not only reduce pain by blocking pain receptors but also create feelings of pleasure. Over time, the same dosage can become less effective, requiring that one take more in order to achieve the same feelings as before. While the drug may continue to block pain, you would need to take more and more over time in order to induce the same euphoric feelings.

What Are the Stages of Opioid Addiction?

The first stage of opioid addiction is the desire to take more than before in order to achieve the same euphoric effects as before. The next stage would involve trying to seek out higher doses of the drug or altering the drug in some way to increase the effects. Typically, it’s difficult to convince a doctor to either increase the dosage or even renew a prescription for an opioid medication because of the addictive nature of the drug. Those who seek out more opioids legally but are unable to obtain them may then turn to illegal opioids.

What Are the Risk Factors of Opioid Addiction?

While anyone could become addicted to opioids, there are certain factors that can increase the chances of addiction occurring:

• Prior drug rehabilitation
• Prior alcohol rehabilitation
• Younger age
• Regular contact with others at risk of addiction
• Regular contact with an at-risk environment
• Unemployment
• Underemployment
• Poverty
• History of substance abuse in one’s family
• Substance abuse in one’s own history
• Thrill-seeking behavior
• Taking risks
• A history of committing criminal acts
• A history of legal trouble
• Heavy use of tobacco
• Stress
• Anxiety
• Depression
• Mental disorder
• Problems with employers
• Problems with friends
• Problems with family

Women are more likely to experience chronic pain, which means that they’re also more likely to be prescribed opioids. Typically, women are also often prescribed higher dosages of opioid medication for longer periods of time than men, which also increases the risk of opioid addiction.

What Are the Symptoms of Opioid Addiction?

While opioid addiction may be diagnosed by a doctor, it’s possible for the patient or their loved ones to keep an eye out for its symptoms. If you notice that you are craving more opioids than before and are considering changing your behavior or asking for a higher dosage, talk to your doctor about your concerns. It’s better to address possible addiction as early as possible to prevent misuse and the risk of death.

The symptoms of opioid addiction can include:

• Weight loss
• Flu-like symptoms
• Drowsiness
• Uncontrollable cravings for the opioid
• Stealing from work, friends, or family members
• Financial trouble
• Isolation from friends and family
• Poor hygiene
• Decrease in libido
• Change in sleeping patterns
• Lack of ability to control one’s use of the opioid
• Changes to exercise habits

What Is the Opioid Epidemic?

Pharmaceutical companies had assured those in the medical community that their opioid-based medications would not be addictive to patients back in the 1990s. Because of these reassurances, many medical professionals increased their prescriptions of opioids to treat pain, confident that their patients would not become addicted.

Since then, however, millions of Americans have become addicted to opioids. Thousands have died. In 2017, the United States Department of Health and Human Services (HHS) declared the opioid epidemic to be a public health emergency and outlined steps to combat the crisis.

What Is the HHS’ Plan to Combat the Opioid Epidemic?

The HHS’ plan to combat the health crisis surrounding the use of opioids includes the following five steps:

1. Improve access to services for the prevention and treatment of and recovery support for opioid addiction
2. Increase the distribution and availability of drugs that can reverse overdoses
3. Improve the reporting and collection of public health data
4. Improve research on both pain and addiction
5. Improve pain management practices

What Is an Opioid Overdose?

An overdose can occur with any substance that is taken in too large a quantity. It can occur with any type of medication, whether it’s prescription or over-the-counter, and can be either purposeful or accidental. Technically, an overdose can occur any time someone takes more than what is considered to be the recommended dose of a medication, even if the amount isn’t enough to cause harm.

Overdoses are dangerous because too much of a drug can cause health problems or even death.

What Are the Symptoms of an Opioid Overdose?

It’s important for friends and family members of someone who takes an opioid-based medication to know the signs of an overdose. Even if you don’t believe they’ve become addicted, it’s a good idea to know the signs because it could help you save someone’s life.

The signs of an opioid overdose can include:

• Limp body
• Extremely pale face
• Clammy skin
• Blue or purple fingernails
• Blue or purple lips
• Vomiting
• Gurgling noises
• Unable to speak
• Cannot be awakened
• Breathing slows or stops
• Heartbeat slows or stops

Any of the above symptoms is a sign of a medical emergency. If you witness any of those symptoms in a loved one, seek medical attention for them immediately. It could be a matter of life or death and prompt medical attention could save their life.

How Is an Opioid Overdose Treated?

Someone who is trying to help someone who has overdosed can do the three following things:

1. Call 911
2. Perform CPR if their breathing or heart has stopped
3. Use naloxone to treat the overdose if possible

What is Naxolone?

Naxolone is a drug that has been approved by the FDA to reverse the effects of an opioid overdose. It can be used in an emergency to treat an overdose because it is classified as an opioid antagonist. In particular, it reverses the slowed or stopped breathing that could result from an opioid overdose.

Why Are Plaintiffs Filing Opioid Lawsuits?

Plaintiffs have filed lawsuits against opioid manufacturers claiming that the companies have helped to fuel the opioid crisis by pushing doctors to prescribe opioids, claiming that they wouldn’t be addictive. In many cases, the plaintiffs aren’t individual people but are instead state and local governments that have sued opioid manufacturers to recover the costs of handling the opioid epidemic. For example, the Indiana Attorney General filed lawsuits against Purdue Pharma, McKinsey & Company, and more regarding the costs the state of Indiana incurred handling the opioid crisis.

What Opioid Lawsuit Settlements Have There Been?

Opioid lawsuits have been settled both for and against opioid manufacturers. In July of 2022, a federal judge ruled in favor of the opioid manufacturers in a lawsuit brought by Cabell County and the city of Huntingdon in West Virginia. The lawsuit had accused McKesson Corp, Cardinal Health Inc., and AmerisourceBergen Drug Co. of manufacturing an opioid crisis by distributing 81 million opioid pills over the course of eight years in the county, which has been suffering from the opioid epidemic.

Elsewhere, however, judges have found in favor of the plaintiffs. Purdue, the manufacturer of best-sellers OxyContin and MS Contin, has been the main target of lawsuits filed by a slew of governmental agencies including the U.S. Department of Justice. In September of 2019, Purdue agreed to settle lawsuits with several agencies for up to $12 billion and though many more agencies may still desire compensation, the company has already filed for bankruptcy protection. A number of other companies have also reached agreements for settlements of claims with nearly 3,000 local and state agencies which had filed lawsuits and were prepared to go to trial.

Agreements for as much as $45 billion in compensation, payments, and opioid addiction treatment medication were tentatively reached with pharmaceutical companies and distributors including:

• Teva Pharmaceutical Industries
• Johnson & Johnson
• Cardinal Health
• McKesson Corp
• AmerisourceBergen

The national settlement includes $4 billion from Johnson & Johnson, $22.5 billion from Teva, $23 billion in treatment medications such as Suboxone, and other payments from drug distributors Cardinal Health, McKesson, and AmerisourceBergen.

Are There Any Ongoing Opioid Lawsuits?

More recently, Johnson & Johnson, AmerisourceBergen, McKesson Corp, and Cardinal Health agreed to pay a total of around $26 billion in a February 2022 settlement. Johnson & Johnson paid $5 billion towards the settlement and the other three named corporations contributed a combined $21 billion. All of the proceeds are earmarked by the plaintiffs for drug treatment programs and health care designed to help treat those suffering from opioid addiction and to ease the impact of the opioid epidemic.

This recent deal settled thousands of ongoing lawsuits against the opioid manufacturers and they will be paying the settlement amount over the next decade. The payments began in April of 2022 and came at a time when state and local governments needed it most for combating an escalating opioid crisis.

Notwithstanding claims relating to this product, the drug/medical device remains approved by the U.S. FDA.