Tolerance and Withdrawal from Opiates

Opioids include:

• narcotics
• analgesics
• opium
• morphine
• heroin
• codeine
• methadone
• Demerol
• Dilaudid
• Percodan
• Vicodin
• OxyContin
• other pain killers

The term “opiate” comes from the Greek word, opion, which refers to poppy juice “joy” plant. Ancient civilizations knew of its pain relieving properties and also its dependence and withdrawal problems.

Withdrawal effects are caused by cessation of opiod use and abuse that has been heavy and prolonged that includes at least three of the following symptoms:

• dysphoric mood
• nausea
• muscle aches
• lacrimation
• papillary dilation
• sweating
• yawning
• anxiety
• runny nose
• insomnia

The term “kicking heroin” comes from the extreme muscle aches, cramps, and involuntary contractions of leg muscles during withdrawal from opiates.

Categories of Opiates

There are three different categories of opiates. The opiate group includes opium and opiate derivatives which are obtained from the Oriental poppy and synthetic drugs that have similar physiological and behavioral actions to opium.

The first category, natural opiates, is obtained directly from opium, like morphine and codeine. This alkaloid is obtained by drying the milky discharge of the cut, unripe seed of the opium poppy that appears after petals fall. The milky discharge is dried in the air to form a brown, gummy paste as opium.
The second category of opiates, semisynthetic opiates which are chemically created derivatives of opium or codeine such as heroin, dilaudid from morphine, and percodan from codeine.

The third category, synthetic opiates, are chemically synthesized analgesics with effects similar to morphine including methadone, Demerol, Darvon, Vicodine, Oxycontin, and Fentanyl.

Seeking Help for Opioid Addiction

It is important to get treatment for opiate dependence as soon as possible from a drug treatment facility such as Sierra by the Sea. The addiction experts at Sierra by the Sea have years of expertise in treating opiate addiction.

Although withdrawal from opiates is not fatal, the pain and discomfort may be so severe that the person may wish they were dead.

The major hazard at this point is relapse to ease withdrawal symptoms. The supportive environment, medication management, and psychological support at Sierra provides many options that can be personalized for every individual including Celebrate Recovery Christ-centered care.  Developing constructive coping strategies is a key to continued sobriety. We urge you to call us for more information: (949) 612-2210.

The desire for relief from pain and the experiencing of pleasure combined with tolerance, tissue dependence, and withdrawal are the main reasons for the the addictive nature of opioids. Tolerance occurs when the body tries to neutralize the opiate, or any other psychoactive drug, by a variety of methods.  It may speed up the metabolism, particularly in the liver.  It may desensitize the nerve cells to the psychoactive drug’s effect.  It may excrete the drug more rapidly out of the body through urine, feces, or sweat.  Or, it may alter the brain and body chemistry to compensate for the effects of the drug.

The body’s adjustment requires the user to increase dosage if to achieve the same desired effect.  Since tolerance occurs rapidly with opioids, users might require ten times as much of the drug in as little as ten days to achieve the same effect.  There is almost no limit to the development of opioid tolerance.  After a year of opioid use one terminal cancer patient was using 5 fentanyl patches, 20 Demerol tablets, and continuous morphine suppositories.  The limitless tolerance compares to a drug such as nicotine where three packs a day are usually the limit.

Tolerance develops at different rates for different individual body systems.  High tolerance will develop for the opioid effects on pain relief, respiratory depression, sedation, vomiting, and euphoria.  However, there is little tolerance for constriction of pupils or for constipation.

Tissue Dependence

The adaptation of the body to the effects of a strong opioid will temporarily and sometimes permanently alter brain chemistry.  An animal study by Dr. Eric Nestler from Yale University showed that chronic administration of morphine to rats actually reduced the size of dopamine-producing cells by 25%.  This means that when chronic opiate use is stopped, the body has less ability to produce its own dopamine and therefore less ability to feel elated or even feel normal pleasure.  This dopamine depletion intensifies the desire to use the drug again, or relapse.

This and many other changes in body chemistry result in tissue or physical dependence since the body relies on the drug to feel normal.  Researchers also found that animals that became physically dependent, then were withdrawn from the drug, and then were re-administered the drug would redevelop tissue dependence more rapidly.