Posted By on Apr 19, 2018 |

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When they’re taken as prescribed, opioids can manage pain effectively. They can improve quality of life for people with chronic pain. In fact, using opioids under the proper supervision of a doctor rarely leads to addiction or dependence. However, when used long-term, opioids may lead to drug abuse with physical dependence and/or addiction. Prescription opioids can also be life threatening in an overdose as can heroin. When they are taken with substances that depress the central nervous system like alcohol, barbiturates, or benzodiazepines, there is a greatly increased risk of respiratory distress, and even death. In 2016 about 63,600 people died of drug overdoses in the U.S., most of them being from Opioids. Opioids are sometimes called narcotics.


Generally speaking, an opiate is a drug made from the poppies of opium plants. These include codeine and morphine.  Opioids, heroin included, are synthetic versions of this.  The addiction treatment community has settled on “opioid” as the umbrella term for opioids and opiates both. Virtually all opioids are legal by prescription except one.


Not surprisingly, heroin is considered by most measures to be the world’s most addictive drug.  Heroin use in America continues to increase at a frightening rate.  Twice as many Americans used heroin in 2012 as did in 2007 and those numbers are rising.    In 2014, about 11,000 persons died of heroin overdoses. Fatal overdoses involving heroin skyrocketed from 8% in 2010 to 25% in 2015 — essentially tripling. Heroin’s extreme danger can be shown in some key areas. Its street value is cheap. Its withdrawal is brutal, and relapse often seems guaranteed.

EFFECTS of heroin intoxication include drowsiness, pleasure, and slowed breathing. Withdrawal can be intense and can include vomiting, abdominal cramps, diarrhea, confusion, aches, and sweating.

COMPLICATIONS from heroin are many, mainly because it is usually injected, often with dirty needles. Use of the drug can trigger other health complications including destruction of the heart valves, HIV/AIDS, infections, tetanus, botulism, and hepatitis B and C.

OVERDOSE symptoms from heroin include:  bluish nails or lips, depressed breathing, weak pulse, pinpoint pupils, disorientation/delirium, extreme drowsiness, loss of consciousness, coma.

RELAPSE rates for heroin are very high.  Some estimates suggest as high as 90% after 3 months without recovery treatment, and 50% with such treatment.


40% of all opioid overdose deaths involve a prescription opioid. Four times more prescriptions were written for opioid painkillers in 2014 than in 1999 even though there is no evidence Americans are suffering more physical pain.

EFFECTS of medical opioid use include deadening of pain, controlling coughing and stopping diarrhea.  Non-medical use is meant by the user to drown emotional pain, get a rush, induce euphoria, and prevent withdrawal symptoms.

OVERDOSE symptoms include: constipation, pinpoint pupils, nausea, vomiting, weak pulse, seizures, breathing problems, blue lips or finger nails, coma.

RELAPSE rates and dangers are high in prescription opioid addictions, as they are in heroin.  A challenge to recovery is the high level of tolerance these medications induce.  Tolerance occurs when the person no longer responds to the drug as strongly as before, thus necessitating a higher dose to achieve the same effect as before the recovery began.


Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When these drugs attach to their receptors, they reduce the perception of pain.

  • Codeine (Tylenol 3) Minor  to moderate pain. No longer favored for cough relief.
  • Morphine (Avinza) Moderate to severe pain. Around the clock treatment
  • Fentanyl (Actiq, Duragesic) Post-surgery pain. Much more potent than morphine. Cut in heroin.
  • Hydrocodone with Acetaminophen (Vicodin, Norco) Limits placed on scrips because of abuse.
  • Hydrocodone (Zohydro ER, Hysingla ER) Extended release for around the clock relief.
  • Hydromorphone (Dilaudid) Moderate to severe pain.
  • Meperidine (Demerol) Moderate to severe pain.  Similar to morphine.
  • Methadone (Dolophine, Methadose) Reduces opioid withdrawal symptoms without the high.
  • Oxycodone (OxyContin) Likened to heroin. Euphoric, sedative effect. The most addictive.
  • Oxycodone with Acetaminophen (Percocet) Euphoric high. Also among most addictive.
  • Oxycodone and Naloxone (Targiniq ER) Around the clock treatment of severe pain.


Anyone who takes prescription opioids can become addicted to them. In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. Once addicted, it can be hard to stop. In 2014, nearly two million Americans either abused or were dependent on prescription opioid pain relievers. Taking too many prescription opioids can stop a person’s breathing—leading to death.

If you are abusing prescription drugs like opioids, you may be taking larger doses than your doctor prescribed, or using them for reasons other than prescribed. For instance, if your doctor prescribed a pain medication to be taken three times daily and you find yourself taking the same medication more frequently or taking twice as much, you are abusing prescription drugs.

If you take the same pain medication for reasons other than prescribed –you’re bummed or bored, for instance — this is also an abuse of the prescription medication.  Your doctor may notice that you’re calling more frequently for refills for the medication or that you’re asking for increasing amounts of medications. This may also be a sign of abusing prescription drugs. In addition, your pharmacist may notice prescription drug abuse by spotting false or altered prescription forms or multiple prescriptions for controlled substances from different doctors.


According to the FDA, guidelines for using prescription medications safely include:

  1. Always follow the prescription medication directions carefully.
  2. Don’t increase or decrease medication doses without talking with your doctor first.
  3. Never stop taking medication on your own.
  4. Don’t crush or break pills (especially important if the pills are time-released).
  5. Be clear about the drug’s effects on driving and other daily tasks.
  6. Learn about possible interactions of the prescription medicine with alcohol and other prescription and over-the-counter (OTC) drugs.
  7. Talk honestly with your doctor about any history of substance abuse.
  8. Never allow other people to use your prescription medications and don’t take theirs.


There are treatments, including non -addictive medications that can help people counteract the symptoms of prescription drug addiction.

Buprenorphine is a drug used to treat opiate withdrawal, and is often combined with the drug naloxone, to create Suboxone, in order to prevent relapse.

A form of buprenorphine has become available that can be implanted under the skin called Probuphine and is used for maintenance treatment of opiate dependence in people who have been taking a stable dose of oral buprenorphine and are no longer in the midst of detoxification. It provides a constant dose of buprenorphine for six months.

Other drug treatments for opiate withdrawal include methadone and the blood pressure medicine clonidine. The drug naltrexone blocks the effects of opiates and is another treatment option for preventing opiate relapse. It can be administered orally—Revia —or as a monthly injection— Vivitrol.

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Sources:, (NIDA), (American Society of Addiction Medicine), Uppers, Downers, All Arounders (Inaba, Cohen, 2011),, (Centers for Disease Control and Prevention). (Business Insider).

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