Opioids and Addiction

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

The use of oral opioids, pain medications, is escalating dramatically throughout the U.S. and we are seeing the end result in our treatment program. This class of drugs includes morphine, Vicodin, Oxycontin, methadone and heroin. These medications are extremely easy to obtain, whether from physicians, dealers or the internet. Prescriptions for oral opioids have increased since 1995 when it became apparent that pain was not being adequately treated, and when Oxycontin was released for use. Emergency room admissions for problems secondary to use of these drugs have escalated, in fact they doubled between 1997 and 2002. Treatment center admissions for opioid addiction doubled during the same period and continue to rise. With increased access to these drugs we have seen increased problems.

Often people start with legitimate use, but find that they like the effects for more than pain relief. Opioids provide a euphoric experience and numb psychological pain as well as physical pain. Oddly enough the opioids provide energy to most people who become addicted to them so when they run out or stop they not only experience terrible withdrawal symptoms, they have very little energy. The opioids are known for extreme withdrawal, and although it is miserable, it is not life threatening.

We have seen many young people seduced by the high associated with these drugs. Recently we met a 22-year-old who began to use these drugs during his days as a high school football player in one of Portland’s suburbs. He was given Vicodin for an injury. It was legitimate use of the medication, but he was already experimenting with other drugs and found he liked this one. He overused it and became very adept at convincing doctors that he needed more for various pains. Some of his friends on the team began to do the same thing and now several of them are in the midst of opioid addiction. The price of these drugs is high; Oxycontin costs between 50 cents and a dollar a milligram and comes in 40, 80 and 160 milligram tablets. Many of these people use as much as 240 milligrams per day, requiring either a good job or regular illegal activity. Unfortunately the cost is so high that heroin is less expensive, which results in many people switching over to save money. This can result in intravenous use adding to the danger.

Beyond Addictions provides outpatient detoxification and treatment for opioid addiction. We attempt to discern who could benefit from abstinence based treatment versus who would be better served by using buprenorphine for maintenance treatment of opioid addiction. We have equal numbers in our outpatient program. We require that those on maintenance buprenorphine enter into the outpatient addiction treatment program so that they are establishing recovery with multiple tools, not just relying on a medication.