When prescription pain killers are factored in, more people die from opiate-related complications than from all other substances of abuse combined, excepting alcohol. This is clearly evidenced by the alarming growth rate of prescription drug abuse in the United States, resulting in thousands of deaths and an entire new generation of opiate addicts. Unfortunately, opiates kill addicts with frightening regularity when compared to other drugs. This is because there are 5 primary ways that opiate addiction kills addicts, and evidence indicates that this is not a new problem.
Opiate addicts die from overdose, suicide, disease, violence and from various aspects of withdrawal and drug treatment – most notably opioid replacement therapies and rapid detox. But while this might seem like a modern problem, the only the only thing new about the human battle with opioid addiction is the formulation of the final product; yesterday’s opium pipe is today’s crisp white pills.
However, the reality is that opiate addiction has been a part of human existence for thousands of years, starting in the cradle of civilization with the Sumerians, followed by the Egyptians, the Babylonians, the Greeks, Romans and on down the line of history until today. With few exceptions, it’s likely that our ancestors died similar opiate related deaths as those addicts that die today, indicating that little has changed when it comes to substance abuse and addiction.
The following are the 5 primary ways that opiate addicts die:
The body’s natural response to opiate consumption is to develop a type of “partial immunity” called tolerance to help mitigate the effects of the drug. This defense mechanism backfires in the case of opiate abuse because repeated use develops a stronger level of drug tolerance, which in turn causes the user to require increasingly higher doses in order to achieve the same or greater euphoric effects. (Drug Tolerance: The 7 Clinical Types Recovery )
Most users quickly become aware of the effects of tolerance and actively seek out ways to overcome it, primarily by increasing the amount of opiates taken, or by taking other drugs to enhance the effects of opiates. Tolerance is also overcome by taking opiates in the most effective way possible; generally by direct injection into the blood stream.
In an effort to overcome the effects of tolerance, many addicts increase their consumption too rapidly and suffer an overdose episode. For some, the ultimate consequence is death.
Another way that addicts attempt to defeat tolerance is to take a break from using for several days or even longer. This “cooling off” period lowers the body’s resistance to opiates, allowing the user to obtain more significant euphoric effects. Unfortunately, users often overestimate the amount of drug they can safely take and subsequently overdose; sometimes fatally.
Additionally, users that have entered a cooling off period and then return to opiate use may not be able to acquire the type of opiate they are accustomed to using. For instance, a user of Vicodin may take a break to lower their opiate tolerance, but then only be able to obtain Fentanyl (a drug that is many times stronger than morphine) when they resume use. As a much stronger drug being used by a person with reduced tolerance, this type of scenario can lead to a deadly overdose.
According to the US Centers for Disease Control, there were approximately 36,000 deaths from drug overdoses in 2008, and 75% of those were caused by opioid based painkillers. (Policy Impact: Prescription Painkiller Overdoses Centers for Disease Control and Prevention) These figures do not account for the hundreds and possibly thousands of addicts that die each year from overdoses related to illicit opiates like morphine and heroin.
The joy of using opium has been reported scientifically and anecdotally for two thousand years, starting with ancient medical texts in Greece and later in China. But while this class of drugs does deliver a potent high that many feel as joy or euphoria, the fact of the matter is that opiate based drugs eventually rob the user of the ability to feel happiness, arousal, excitement and many other positive feelings. This is a state referred to as Dysphoria – the opposite of euphoria.
The basic explanation is as follows: by chemically stimulating the brain to obtain feelings of joy or euphoria, the body becomes desensitized to the processes that causes these feelings in the first place. This results in a person who cannot feel joy unless they are high; and eventually not even then as the effects of tolerance become more permanent.
Finally, when an opioid addict makes an attempt to get clean, withdrawal and detox will generally cause symptoms that are the opposite of those felt while the user is high on their drug of choice: joy becomes sadness, excitement becomes depression and relaxation becomes anxiety. Now, the addict cannot feel normal because the opiate they have been using isn’t working as it once did, and when they stop using they cannot return to normal as a result of the reversal of symptoms during acute abstinence.
Consequently, many people who are addicted to opiates become despondent and lose hope. Most of these people will try repeatedly to stop using and fail, and because of the neurological nature of the disease of addiction, they are unable to regain a state of normalcy and instead simply give up: the easiest way to end the addiction often seems to be suicide.
According to the Centers for Disease Control, 16% of all suicide victims tested positive for opiates in a study involving 13 US States. Although the figures are not clear from an absolute cause of death standpoint, the CDC indicates that when victims were tested as a result of suspicion of poisoning (overdose is a poisoning death) more than 39% were positive for opiates. This evidence supports the idea that opiate users are especially prone to suicide. (Morbid and Mortality Weekly Report Toxicology Testing and Results for Suicide Victims 13 States, 2004 Centers for Disease Control)
Opiate addicts often look for the best way to get high. The hierarchy for most opiate users is direct consumption, followed by smoking, snorting and direct injection. Because direct injection provides the most intense and fastest acting high for users, disease is often a significant problem for opiate addicts. HIV and Hepatitis C are especially common among this group as a result of needle sharing.
Deaths from disease related to opiate addiction also occurs as a result of septic shock, cardiac arrest, respiratory depression and in severe cases, malnutrition.
A heroin or Oxycontin user in the deepest throes of addiction will sometimes do anything to get their next dose. This often includes committing crimes in order to fund their substance abuse; sometimes resulting in violence. Additionally, the illegal nature of the illicit drug trade means that opiate addicts expose themselves to serious risk when engaging in transactions with dealers, transporters, suppliers and law enforcement.
Because opiate addicts are generally not capable of sound judgment, they may find themselves in compromising situations; especially while incapacitated by the effects of the drug. This means that addicts are likely to take dangerous risks that they would not normally take, and because the user often has impaired faculties, they are less equipped to deal with potentially violent situations. Consequently, violence is a common fate of the heroin, morphine or prescription opiate junkie.
There are a number of ways that people who are dependent on opiates can die while in treatment or while undergoing withdrawal. In most cases death can occur when an addict has recently stopped using, undergone complete or partial withdrawal and consequently lowered their tolerance to opiates. When they relapse or return to using drugs they often take too much and die from overdose because they did not account for their reduced state of tolerance. (National Institutes of Health, Medline Plus Opiate Withdrawal )
Additionally, addicts in treatment programs may abuse opiates while being treated with other types of drugs (including benzodiazepines, which are also extremely potent and addictive, as well as Opiate Replacement Therapy drugs including Methadone, Suboxone and Naltrexone), resulting in severe complications, new addictions and death in some cases. Because drugs used in ORT programs work by blocking the euphoric effects of most opiates, many addicts will attempt to overcome this effect by taking more of the treatment drug than prescribed, or by mixing the prescription with street drugs or alcohol in order to intensify its effects. (Opiate Replacement Therapy During Drug Detox Safe Drug Detox Organization)
A special note on Rapid Detox for Opiates:
Rapid Detox is a relatively new drug treatment method that medically hastens the process of withdrawal while the patient is under sedation. While some successes have been reported, this practice has also been linked to a number of deaths primarily involving opiate addicts in the US and Australia. In addition to the risk of death, the long term effects of rapid detox – if any – have not been sufficiently studied.
When it comes to opiate addicts, death is a common occurrence as a result of the complications listed herein. But it doesn’t have to be like this; there are effective treatments available for addicts, and no one needs to die. If you or someone you care about is addicted to opiates, it’s up to you to take action now, because the person you love could be high today, but gone tomorrow.