The Run Down
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Opioids or Opiates? What's the Difference?
At one point, there used to be a difference between opioids or opiates with opioids being only synthetic drugs from the pharmacy with a prescription. Today, opioids now refer to the entire family from illegal to legal substances.
NIDA (National Insitute on Drug Abuse) uses the following description of opioids:
"Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, or pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, etc. These chemically related drugs interact with opioid receptors on nerve cells within the body as well as the brain. Opioid pain relievers are generally safe when taken for a short time as prescribed by a doctor, but because opioids produce euphoria in addition to pain relief it often leads to misuse (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence. When misused, opioid pain relievers can lead to overdose incidents or death. An opioid overdose can be reversed with the drug naloxone when given right away."
What is opioid misuse?
Opioid misuse is when someone goes against the doctor's prescription for recommended dose, frequency, or for a condition that isn't truly justified for the amount or type of opioid(s) your taking—especially if it's from the streets.
What is an opioid disorder?
(Referenced from the Diagnostic and Statistical Manual of Mental Disorder-5)
- Strong desire to use opioids
- Inability to control or reduce the use
- Trouble meeting social or work obligations
- Having legal problems due to drug use
- Spending large amounts of time to obtain opiates
- Development of tolerance (meaning the need to use more significant amounts over time)
- Having withdrawal symptoms after stopping or reducing use (such as depressed mood, stomach upset, insomnia, muscle aches)
Signs of heroin or opioid misuse:
- Analgesia (feeling no pain)
- Euphoria (feeling high)
- Respiratory depression (shallow or slow breathing)
- Small pupils
- Nausea, vomiting
- Itching or flushed skin
- Slurred speech
- Confusion or poor judgment
Heroin or opioid withdrawal symptoms:
- Craving for the drug
- Rapid breathing
- Runny nose
- Nasal stuffiness
- Hot flashes
- Muscle aches
- Abdominal cramping
- Enlarged pupils
- Loss of appetite
Withdrawal Timeline (Self-Detox)
Most relapses will occur within the first 24 to 48 hours, due to an intolerance of the manifesting symptoms or the premonition of them arriving soon. This point is what the character Mark Renton (Ewan McGregor) from Trainspotting refers to as "junkie limbo." The first of these symptoms could include nausea, abdominal cramps, tearing, runny nose, sweats, chills, yawning a lot, muscle or bone aches—including the dreaded restless legs. Symptoms like aggression, headaches, or irritation can sometimes start as often as 12 hours after the last dose.
Day 3 – 5
Once past the first 3-5 days, you're doing pretty good for yourself. You'll start to notice a reduction in overall symptoms, but probably still feel it. Slow-acting opioid withdrawal symptoms will have reduced by now. However, with long-acting opioids it's possible to still be experiencing sweating, lack of appetite, trouble sleeping, or digestion issues. Back or leg pain will begin to diminish.
Day 6 – Beyond
Once day six is reached in recovery from opioid withdrawals the most painful part of the symptoms should be over, but still, may be experiencing mild symptoms or difficulty with eating. This point isn't where it's time to go back out to do more opioids to reward yourself for getting through the very thing that caused your problems in the first place.
To assess the severity of symptoms clinicians typically use the Clinical Opiate Withdrawal Scale, COWS for short. Use our COWS scale below to test the severity of your withdrawals.
Measure the Severity of your Withdrawals
Post-Acute Withdrawal Syndrome
The most common post-acute withdrawal symptoms are:
- Mood swings
- Variable energy
- Low enthusiasm
- Variable concentration
- Disturbed sleep
Post-acute withdrawals or PAWS come after the initial detox from opiates. When PAWS happens if it happens at all is unique for each person. Just expect these changes to come then go, but are typically easier to deal with as time goes on when in recovery. Maintaining your health with diet, exercise, or even socializing will all be beneficial towards getting through it. Some people don't even experience PAWS at all or to such a small degree that it's barely noticeable.
Common Medications Used for Detox or Medication-Assisted Therapy
Suboxone contains a combination of buprenorphine with naloxone. Buprenorphine is an opioid medication. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse.
Subutex is an opioid partial agonist-antagonist. It works by binding to receptors in the brain and nervous system to help prevent withdrawal symptoms in someone who has stopped taking narcotics (eg, heroin, oxycodone).
Vivitrol (naltrexone) blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. Vivitrol is used as part of a treatment program for drug or alcohol dependence.
Vivitrol injection is used to prevent relapse in people who became dependent on opioid medicine then stopped using it. Naltrexone can help keep cravings at bay.
Vivitrol injection is also used to treat alcoholism by reducing your urge to drink alcohol. This may help with drinking less or to stop drinking altogether. Naltrexone will not decrease the effects of alcohol that was recently consumed.
Narcan Nasal Spray contains naloxone hydrochloride. Naloxone blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness.
Narcan Nasal Spray is used to treat an opioid overdose in an emergency situation. This medicine should not be used in place of emergency medical care for an overdose.
What is Stigma?
Stigma is a mark of disgrace that sets a person apart from others. When a person is labeled by their illness, they're no longer seen as an individual but as part of a stereotyped group. Negative attitudes or beliefs toward a group create prejudice which leads to adverse actions—even discrimination.
Does it matter?
By calling someone an addict, junkie, or drug abuser, it taking away from their identity as a human being. Imagine for a second walking into a hospital to pass by someone receiving chemotherapy for cancer would you say to yourself, "that person is cancerous" then start to avoid them? No! You'd probably start to feel some level of empathy for that person.
Well, people that use substances aren't contagious. You're not going to run into someone with a substance use diagnosis then find yourself locked up in a bathroom 10 minutes later trying to use.
When someone has a history of substance use, they automatically assume society has pushed them to the side before there has even been any cause for that type of reasoning! Not only do they have to deal with the fact their use has gotten out of control but they will also feel they have to deal with it alone. Resulting from the stigma or belief that substance use is the bottom of bottoms was already within them before they started to use drugs or alcohol in the first place. That's the belief our culture has held onto for hundreds of years. A conviction initially grounded in the old ways of religious thought with receiving retribution to achieve enlightenment.
As a result, a person's use became their retribution. A suffering that needed to take place to achieve enlightenment, hence,"they haven't reached a deep enough bottom yet" which is what most people would say when they can't figure out why someone continues to use. In the end, all that achieves is reinforcing the stigma a person has about themselves, which in turn reinforces the stigma another person has of them. Keeping everyone at arm's length never to connect as a society or as human beings.
Characteristics of Stigma:
- loneliness, isolation or social exclusion
- stereotyping/derogatory labels
- misrepresentation in the media
- being treated differently than the rest of society
- discrimination in housing, employment or services
Better ways to phrase addiction related terms:
A Stigma Phrases
- Addict or Addicts
- Drug addicts
- Drug abuser
- Drug abuse
- Heroin or opioid dependency
- Clean, Dirty (when referring to drug test results)
An Empowering Phrases
- Human being
- Substance use
- Substance misuse
- Heroin addicted
- Person in Recovery
Living with Shame
Shame is having thoughts or feelings of "I am a bad person", compared to "I did a bad thing", which would be considered guilt. Shame is focused on the entire being of a person, while guilt is focused on the behavior. Guilt allows space for a person to realize they did something wrong with the power to make an amends where needed. When a person is experiencing shame they're more prone to withdrawing from the situation feeling less than without empowerment. Living with shame is very debilitating, and limiting to an individual.
Tools to Help Towards Recovery from heroin
Let People Know
One of the most powerful tools is a tool you already possess. It's you! That may sound cliche, but let's be real—a gust of wind isn't going to blow by then all of the sudden you're no longer affected by opioids and cravings. It's going to take a much more powerful force to do that. The force I speak of isn't God although it could be if you decide to make that choice for yourself. What we're talking about is the power of vulnerability popularized and founded by Brene Brown a shame and vulnerability researcher at the University of Texas.
Listening to Shame
"Shame is an unspoken epidemic, the secret behind many forms of broken behavior. Brené Brown, whose earlier talk on vulnerability became a viral hit, explores what can happen when people confront their shame head-on. Her own humor, humanity and vulnerability shine through every word."
— Ted Talks
The Power of Vulnerability
"Brené Brown studies human connection -- our ability to empathize, belong, love. In a poignant, funny talk, she shares a deep insight from her research, one that sent her on a personal quest to know herself as well as to understand humanity. A talk to share."
— Ted Talks
If you're not quite ready for what Brene Brown discusses then try some resources referenced from Kristin Neff's research at the University of Texas on self-compassion.
How do you typically act towards yourself in difficult times?
Use the Self-Compassion Scale below to find out.
The next time you find yourself in the grip of negative emotions, try generating some positive emotions to go alongside them. Use the following phrases when you're stuck in negativity, designed to validate your feelings while also focusing on your desire to be happy:
It's hard to feel (fill in the blank) right now.
Feeling (blank) is part of the human experience.
What can I do to make myself happier at this moment?
The first phrase compassionately acknowledges the difficulty of having negative emotions. The second phrase is a reminder that negative emotions are a normal, natural part of being human, which shouldn't be judged. The third phrase helps you get in touch with your desire to be happy.
How to Start Recovery Again After a Lapse or a Relapse
- Just get back to it.
- People slip up all the time whether it's a diet, exercise, Netflix. You get the picture.
- If all you are able to do is muster one extra day of sobriety. Well, guess what? That's progress!
- Try taking away at least one lesson from your lapse or relapse.
- Remember that there's plenty of people out willing to help if you ask.
Learn or Do Something New
This may not seem like something worth trying when your struggling with a heroin addiction, but it's actually more powerful than you think. When you learn or do something new your brain creates new neuro-pathways or reinforces ones that don't receive much stimulation. When your out running and gunning your repeating and reinforcing the same neuro-pathways day in and day out that are associated with the addictive actions that your trying to move away from. With that in mind give some other neurons in your brain a chance to live and breathe. That's how we start changing old behaviors—by teaching ourselves a new way of living!
Some ways you could start practicing new behaviors or changing the way you think are:
- Reading - Get curious about yourself and redefine how you perceive the world.
- Learn a new skill - Maybe this could lead up to a new career or favorite hobby.
- Travel to a distant country - Seeing other cultures and how they live could influence your perspective on how you choose to live.
- Start hanging out with more positive people.
- Get involved with the community.
Opioid Recovery + Treatment Services At Granite Mountain BHC
You can also receive treatment in our opioid programs directly from us at Granite Mountain by a dedicated team of opioid recovery specialists. Granite Mountain's team includes skilled clinicians, therapists, and staff that come from a history of substance use. Some of the opioid recovery treatments we offer include:
- Stabilization Treatment Programs - 30-day programs similar to traditional inpatient rehab.
- Structured Sober Living Homes
- Transitional Living Programs
- Intensive Outpatient Treatment Programs
- Therapy Programs for Recovery (group/individual)
- Dual Diagnosis Programs (Co-Occurring Conditions)
- Life Skills & Coping Mechanisms Development
Often, when someone is using opioids, all other responsibilities get pushed aside. An individual will experience a loss of a job, educational goals, relationships, which is often a cause of lingering guilt or shame. At Granite Mountain, we help those who are struggling with opiate recovery not only by helping them with clearing their system of heroin but also to develop the coping mechanisms to overcome the strong desire to use again.
Overcoming heroin addiction IS possible when you have the right supportive treatment team behind you. Be courageous. Do something for yourself by giving us a call. Remember you’re the one with a beating heart—it's not heroin's!