Doctors use opioid pain medicines for pain relief. Opioids do not treat the cause of pain. Instead, they attach to opioid receptors in the body. These tell the brain to increase the production of a neurotransmitter that causes pleasure. This makes the person feel pleasure instead of pain.

Types of opioids

Legal opioids include:

• Codeine (Tylenol 3, certain cough syrups)
• Hydrocodone (Vicodin^®, Lortab)
• Oxycodone (Percocet, OxyContin^®)
• Hydromorphone (Dilaudid)
• Morphine (MS Contin, MSIR)
• Fentanyl (Duragesic^®)
• Methadone
• Buprenorphine (semisynthetic opioid)
• Propoxyphene (Darvocet, Darvon)

Illegal opioids are not used by doctors. People mostly use them for the high or good feelings they cause. Heroin and krokodil (desomorphine) are illegal opioids.

Opioids for pain relief

Some pain is acute. It is short-term. It usually has a specific cause, like a broken bone or surgery. Some pain is chronic. It is long-term. It is often caused by a chronic illness or condition. Opioids are best used for acute pain. They can help people feel less pain while they heal. Doctors also use opioids for chronic pain. This can be risky. Causes of chronic pain do not often heal and go away. They keep making pain. This means using opioids for longer times. People who take opioids longer have higher risks of side effects and complications.

Side effects

Opioids can be used safely as part of a pain management plan. But they can come with side effects, or unwanted symptoms. Constipation is the most common side effect. Others include:

• Trouble sleeping
• Feeling sick to your stomach or throwing up
• Increased pain
• Muscle stiffness
• Itchiness

Another common side effect is trouble breathing. This is not only a dangerous short-term problem. Opioids cause less oxygen to reach the brain. This is called hypoxia. Over time, hypoxia can cause nerve issues, coma or permanent brain damage.

Long-term use of opioids can lead to tolerance and physical dependence. Tolerance means you need more and more medicine to get the same pain relief. Plus, your body stops making a hormone that causes pleasure. This increases pain. Tolerance can make a “pain loop.” This means your body needs more and more medicine for similar pain control.

Physical dependence means your body gets used to the medicine and needs it to work well. Without it, you will experience withdrawal symptoms. These include:

• Anxiety and worry
• Aches and pains
• Problems sleeping
• Sweating
• Tearing eyes and runny nose
• Stomach cramps and diarrhea
• Feeling sick to your stomach or throwing up
• Large pupils
• Fever

Long-term use of opioids can also lead to misuse or addiction.

Is physical dependence the same as addiction?

No. Physical dependence means your body needs the medicine. This happens with all sorts of medicines. Addiction is the misuse of a substance. It means you keep using something even when it causes problems in your life. You may have problems with work, school, or relationships. Misuse can cause emotional, behavioral, or physical problems. People sometimes mess up big parts of their lives just to keep getting and using opioids. Some signs of opioid misuse are:

• Taking more opioids than prescribed
• “Doctor shopping” or going to many doctors for opioids
• Being obsessed with getting opioids
• Reckless actions to get opioids
• Looking for a high, not pain relief
• Missing work or school
• Personality changes
• Physical or behavioral health changes
• Relationship troubles

Research suggests that opioid addiction, or misuse, is a problem with no quick fix. In fact, the medical community views it as a long-term or chronic illness. As with all chronic illnesses, treatments need to deal with all parts of opioid misuse. This includes medical, emotional and behavioral parts.

“Abstinence-only” used to be the treatment for opioid use disorders, however, medication-assisted treatment (MAT) is now an evidenced-based best practice that helps many people. Examples of MAT are methadone or buprenorphine with Naloxone. Pregnant women should inform their prescribers before taking Naloxone or Suboxone. When someone is on MAT, he is not using one drug instead of another. When someone is on MAT he is in recovery, not still using. MAT is medicine, similar to how someone with diabetes might need to take insulin.

Risk factors for opioid misuse

Anyone can become addicted to opioids. It is a major problem in the United States. More than four million people misuse opioids. However, some things increase a person’s risk, including:

• Chronic or long-term use
• Genetics
• Mixing alcohol or other substances with opioids
• Emotional or behavioral problems
• Personality

Dangers of illegal opioids

All opioids can cause the side effects and risks discussed above. But illegal opioids have dangers all their own. Illegal opioids are dangerous because they are not regulated.

The production of legal opioids is highly controlled. In the United States, all drugs must be tested and approved by the Food and Drug Administration (FDA). The FDA controls how drugs are made. They check ingredients, doses, and quality. This lets doctors and people who use it know exactly what they are getting. No one checks illegal opioids to see if they are what they say they are. The doses may be high or low. They may have poisonous ingredients. These unknowns can lead to trouble, including overdose and death.

For example, heroin is a strong illegal opioid. It can be inhaled, smoked, or injected. It is usually mixed with other substances. This can include fentanyl, another strong opioid that has contributed to deaths. Heroin is not controlled. People do not know the strength of their heroin. A person never knows what their heroin is mixed with. If she gets pure heroin or heroin mixed with fentanyl, she can easily overdose.

Another example is krokodil (desomorphine). It is a very strong and dangerous street drug. It is even stronger than heroin. Years ago, the drug desomorphine was legal in Switzerland. Krokodil is a street version of desomorphine. It is made with codeine and cooked with other substances. Krokodil’s strength is not the only problem. It is also full of poisonous chemicals. Krokodil can damage a person’s veins, kidneys or liver. It also causes skin infections, tooth loss and problems with memory.

People sometimes buy oxycodone, fentanyl, or other legal opioids illegally. They often take more than a doctor would prescribe. They also do not know if these drugs are real or fake.

One piece of crystal meth may look small, but it has a huge impact on a person’s mind and body, even after one use.

In fact, methamphetamine is so strong, few people are satisfied using it once or twice. Not everyone gets hooked on it the first time, because the causes of addiction are complex. Some people are more likely to get hooked on pleasurable things—like alcohol, gambling, drugs, sex, eating, or shopping—than others. But anyone who gets caught up in those pleasures should never try meth. Not even one time.

Nic Sheff wrote a book about his longtime experience with the drug. He started using alcohol, marijuana, and other drugs before he was 14 years old (the average age for starting drug use in those who become hooked), so by the time he was out of high school, he was looking for something different.

“When I took those off-white crushed shards up that blue, cut-plastic straw, well, my whole world pretty much changed after that,” Sheff says in his book Tweak: Growing Up on Methamphetamines. “There was a feeling like, my God, this is what I’ve been missing my entire life. It completed me. I felt whole for the first time.”

Who would not want to repeat an experience like that?

What meth does

In the short term, here are some of the drug’s effects:

• Strong positive reaction to surroundings—colors are brighter, music is sweeter, smells are unusually strong, and the person may feel very much at peace with himself and others.
• Energy and alertness—meth makes it easy to stay awake and alert for a long time.
• More confidence—shyness goes away.
• More desire for excitement and sex—meth is a staple at parties built on drugs and anonymous sexual encounters.

Our brains are very complex organs that get information, and then tell us what to do with it. Sometimes we react right away to those signals without thinking, such as when we touch a hot stove. Other times, we mull over the information, and then act on it very deliberately.

You could say the receiving part of the brain has two doors, one marked go and the other marked stop. When we get positive signals—such as the sight of a sunset, or the sound of music we like—the go door opens wide to get a bigger signal. If the signal is unsafe or harmful, our brain tells us to close the stop door, to keep us from harm.

In very basic terms, meth opens the go door wide, over and over, but stops us from closing the stop door. The thinking part of our brain does not have the chance to make the choice. The chemicals in the drug make the choice for us. That is simply how addiction works.

Of all the drugs a person can use, including alcohol, methamphetamine is very likely to make us go back, time and again, to do something we know is bad for our body and mind, but we want to use it anyway.

“It’s like I‘m being held captive by some insatiable monster that will not let me stop. All my values, all my beliefs, everything I care about, they all go away the moment I get high,” says Sheff.

Meth fires up the brain by amplifying each signal that comes in. It can do that because it is very close, chemically, to dopamine, one of the natural fuels our brain runs on. Unlike the chemicals we are born with, meth burns out nerve endings so that the only way we can feel normal is to use more and more of the drug.

Long-term effects

Over time, here are some of the things meth will do to a person. Someone who uses meth will experience:

• Aggressive, violent behavior—he may do something out of character, such as start a fight, steal, lie, or attack strangers for no reason
• Big changes in sleep patterns—sometimes a person using meth will stay up for days or sleep for days
• Loss of appetite and weight—people who have used meth for a long time are often very skinny
• High blood pressure, which can lead to kidney failure, heart attack, or stroke
• High blood sugar, which might lead to diabetes
• Irregular heartbeats, bad chest pains, or other heart problems
• Depression or flat emotions, putting her at risk for suicide
• Meth mouth—a mixture of gum disease, tooth decay, mouth sores, and tooth loss brought on by the harmful ingredients in meth
• Skin infections and unusual skin color, often pale grey or yellow
• Muscle wasting—this adds to the skinny and misshapen appearance
• Nose problems, including sinus infections and nose bleeds
• Trouble breathing because of a chronic cough or bronchitis
• Urinary tract infections, diarrhea, or constipation
• Sexual problems
• Muscle twitches and tics
• No control over repetitive motions
• Psychosis, hallucinations, mental breakdowns that can take years to recover from
• Birth defects, if a mother uses meth during pregnancy

Where does meth come from?

Some meth comes into the U.S. from other countries but much of it is made in small local labs built in homes, garages, warehouses, or vacant buildings.

To prevent vapors from escaping the lab, people who make it sometimes cover over or tape up windows. This can cause a violent explosion or fire. While they are working, they breathe in unsafe fumes and touch chemicals that can eat away their skin. These chemicals are so unsafe that, long after the lab closes, whatever is left behind can harm neighbors or anyone who lives or works in that space. Meth ingredients will even kill grass and other plants near a lab. Only trained and licensed experts wearing hazmat suits are allowed to clean up these sites.

Police often find labs after they burn or explode. But sometimes a lab goes unnoticed and someone buys the property years later. The new owner may not realize what he has bought until people living there show signs of nerve damage, skin rashes, breathing problems, or learning disabilities. The invisible and odorless residue left behind on the walls, floors, countertops, and soil around a meth lab is bad for everyone, but especially children and pregnant women.