Risks and benefits of opioids
Uses, benefits and risks
Opioids are a potent group of medications primarily used in the management of pain; they are also used in the treatment of some other ailments, namely diarrhoea and coughs. In cases of severe or chronic pain where other treatment may be deemed ineffective, opioids are usually prescribed; an estimated five to eight million Americans use opioids for chronic pain alone, whilst other uses include for cancer-related pain, post-surgical pain, and acute pain. In terms of other treatments, opioids such as codeine are useful as cough suppressants, and loperamide (known over the counter as Imodium) is used to treat IBS (Irritable Bowel Syndrome) and diarrhoea due to its effects in increase absorption time and decreasing intestinal motility. The most common opioid prescription in the UK is codeine, while the most common stronger opioid prescription is Tramadol, used to treat moderately severe pain. Despite their many benefits, the use of opioids comes with a wealth of risks, with addiction, overdose, and death being among the most severe consequences. In 2014, an estimated 2.5 million adults in the United States were recorded to have been misusing opioids. Much of this risk stems from the fact that even short-term use of opioids can lead to physical dependency, a common side effect of this drug group. If opioids are stopped abruptly when a patient becomes opioid dependent, they will suffer withdrawal symptoms, including vomiting, anxiety, hyperthermia, muscle aches, etc., often leading to them seeking continued access to opioids (legally or illegally) to prevent these symptoms. Other common side effects of opioid use include dizziness, nausea, and vomiting. However, one of the most dangerous, alongside physical dependence, is the fact that opioid tolerance can quickly increase, meaning addiction is likely when these drugs are not prescribed and controlled carefully. The illicit use of opioids heightens the chances of overdose, an event that occurs when a person has excessive unopposed stimulation of the opiate pathway. Drug overdose is the leading cause of accidental deaths in the US, with opioids being the most common group of drug. A critical component of the broader opioid epidemic is the fentanyl crisis, with fentanyl now being a leading cause of drug-related deaths in many countries, particularly in the US. As mentioned previously, fentanyl is a synthetic opioid, up to 100 times more potent than morphine, and around 50 times more potent than heroin, making the smallest amounts of this drug potentially lethal. Whilst it is typically used in post-surgery pain treatment, its use illegally has faced a recent spike, whether intentionally or unintentionally, due to its relatively low production cost and because it takes so little to produce a high. Because of this, some drug traffickers mix fentanyl with other drugs, which is highly hazardous and has caused a sharp rise in the number of drug overdoses. Chemically, fentanyl is far more potent than heroin due to the difference in their chemical structures. While both contain chemicals that bind to the MOP/mu receptor in the brain, fentanyl molecules reach the receptors faster and pass through the brain fat more easily, as well as binding to the receptor so tightly, due to fentanyl molecules containing a piperidine ring ((CH 2 ) 5 NH) that allows for stronger interactions, that even a minuscule amount is enough to start the molecular chain of events that initiates the drugs’ effects on the body. This rapid binding also leaves little time for onset, making it more likely that an overdose will be fatal.
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