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Parts of the United States are experiencing an epidemic of opiate addiction, with many turning to heroin as a cheaper substitute for opiates like Oxycontin. The problem is not, however, just a moral issue. The need for pain relief is in part genetic.

It's easy for someone who doesn't deal with chronic pain to condemn the desperate actions of those who do. The epidemic of opioid and opiate addiction, often leading to heroin addiction, now sweeping parts of the United States is not due to the moral failings of the addicts. In many cases, genetics make a difference.

What Are Opiates and Opioids? Why Do Doctors Prescribe Them?

An opiate is a psychoactive compound found in the opium poppy. Opiates include morphine, codeine, and thebaine. An opioid is any drug, including synthetic drugs, that mimic the actions of opioids on the brain. Opiates are a much broader class of drugs that includes semi-synthetic drugs that are chemically modified plant compounds, such as hydrocodone, oxycodone, hydromorphone, oxymorphone, and heroin, and completely synthetic drugs that have the same properites as other opioids, including buprenorphine, methadone, and fentanyl.

All of these drugs are highly addictive and highly regulated. However, even though opiates have been around for thousands of years, opiates and opioids are still among the best alternatives for pain relief available to medicine. These drugs don't just relieve pain. They also improve functionality. People who have severe back pain, for instance, who can't walk before they take opioid pain relievers might be able to lift a pen, open a laptop, or drive a car again. People who have arthritis that keeps them confined to a wheelchair without pain relief might be able literally to get up and walk when they get relief.

All the Opiates and Opioids Have Serious Side Effects

However, the opioids come with problems. Short-acting drugs in this class have to be taken multiple times per day for real pain relief. The manufacturers of oxycodone, for instance, usually recommend taking no more often than once every twelve hours. The pain relief it provides, however, usually wears off in just six hours. During those six hours, the user may be more active than usual and aggravate the underlying problem. This activity may cause breakthrough pain that is worse than the pain for which the drug was originally prescribed, and for which there is no relief for six hours at a time.

Doctors get around this problem by prescribing more of the drug than the manufacturer recommends and taking the drug more often than the manufacturer recommends. These work-arounds also cause problems. Some opioids like morphine cause nausea and vomiting. Some opioids like Oxycontin cause constipation. Missing a dose of the drug can throw the digestive tract in reverse so that several days of constipation are followed by a sudden urge to evacuate the bowel all at once with painful diarrhea. People have to get up in the middle of the night to take their pain relievers, and if they don't, they may be dealing with severe gastrointestinal distress the next morning as if they were coming off the drugs.

Continue reading after recommendations

  • Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
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