Opioids

The term opioid is broad and refers (among other things) to all natural and synthetic drugs that act on the opioid receptors in the body. They have a similar effect to morphine. Opioids are used as a medication to relieve pain, for example, during surgery, or disease such as cancer. However, opioids are also used recreationally and abused because it has a highly addictive effect.

The term opiates refers to all psychoactive substances that are derived from the poppy plant (Poppy somniferum) and thus have a natural source. Today, technology has advanced to the point where the natural varieties can also be made synthetically. This makes it more difficult to distinguish between them.

Effects of opioids on the body

Opioids act on the so-called opioid receptors in the body. When these receptors are triggered, the functioning of the central nervous system slows down. As a result, the brain's communication is suppressed and the body receives fewer stimuli. Opioids therefore have the major function of stilling pain. The heart rate and breathing slow down and this can even go so far that a person stops breathing completely.

At the same time, the production of the neurotransmitter dopamine is stimulated. This substance plays an important role in experiencing pleasure and enjoyment. It also plays a major role in eliminating pain. All drugs and medications that act on the dopamine system have an additional addictive effect because the brain automatically sends signals that the behavior needs to be repeated.

Opioids also mimic the action of endorphins. Endorphins are released in the body during injury, strenuous exercise, excitement and having an orgasm, among other things. They reduce pain and cause drowsiness and pleasure.

Difference between opioids and opiates

These two terms are often used interchangeably. Opioids are substances that have a similar effect to morphine. These can be natural, synthetic or substances produced by the body. The body also produces its own substances that are absorbed and give an analgesic effect, such as endorphins. These are produced by the body during heavy exertion or injury.

For this encyclopedia we use the broad term opioids and focus on the (semi) synthetic forms, including various medications and (illegal) drugs. Examples of drugs include hydrocodone, oxycodone, and fentanyl.

Opiates fall under the category of opioids. This older term refers to substances derived from the poppy plant that have opium as their source. Examples include morphine and codeine.

Opioid epidemic

In the U.S., people have been talking about a so-called opioid epidemic for several years. In the late 1990s, pharmaceutical companies assured patients that they would not become addicted to opioid painkillers. Doctors began prescribing this type of medication more and more often.

A few years later and it became clear that these medications are absolutely highly addictive and have a high risk of abuse. In 2017, a "public health emergency" was announced by the Health and Human Services (HHS). From June 2019 to June 2020, there were more than 48,000 deaths due to overdoses with synthetic opioids.

At the same time, there is also a growing problem in the Netherlands due to abuse and addiction regarding opioid medication.

Every year, about 1 million Dutch people are prescribed an opioid. One in five uses this medication for longer than 3 months. This is evident from figures from the Nederlandse Ziekteverzekering. There is talk of a 'silent epidemic', whereby the figures for long-term users are gradually increasing. The number of people who die each year from an overdose is also growing.

The painkiller oxycodone is prescribed more often and users keep taking it for too long. This increases the risk of dependency.

Oxycodone is very powerful and is used for serious injuries, surgery and cancer, among other things. It is chemically almost identical to morphine and heroin.

Effects of opioids

• Analgesic
• Sedative
• Suppression of breathing (in high doses, this can lead to abnormal breathing patterns, where breathing can even stop completely, resulting in coma or death)
• Itching
• Constipation
• Nausea
• Cramps
• Decreased libido
• Difficulty reaching orgasm

Opioids induce a feeling of euphoria, where the user is in a (temporary) state of happiness. There is also a desire to use again.

In the long-term, opioids cause hormone imbalance in both men and women. In men, sex hormones, including testosterone, decrease to abnormal levels. This can have consequences including: depression, fatigue, erectile dysfunction, reduction in muscle and weight gain. 

Another long-term effect is that a user becomes increasingly sensitive to pain. 

High risk of addiction

Because of the euphoric effects, the chance of addiction is very high. Users who experiment with these drugs and use it recreationally expose themselves to great risk. 

At the same time, one builds up tolerance very quickly, increasing the dosages. This increases the risk of overdose. 

Dangerous combinations with other drugs and medications.

Combining opioids with certain drugs and medications can be life-threatening and even deadly. This list is not exhaustive. 

• Alcohol: combined with a heavy painkiller, it can take too much of a toll on the body and can cause unconsciousness or suffocation. Respiratory problems can also occur.
• Amphetamines: the opposite effect of amphetamines (accelerated heart rate, rapid breathing) along with the sedative effect of an opioid produces a dangerous reaction in the body. 
• MAOIs: combining an opioid with an MAOI (monoamine oxidase inhibitor) increases the risk of serotonin syndrome. This is a poisoning caused by too much of the neurotransmitter serotonin in the body. 

Relieving pain

Experiencing pain has a drastic impact on your life, especially when it is chronic. It affects your mood, contact with others and quality of life. Reasons for (chronic) pain can be an accident, surgery, illness, trauma or an unknown source. 

Opioids have the function of taking away this pain. This can significantly increase the quality of life. Patients are therefore quickly prescribed a (heavy) painkiller when their pain becomes too severe. Unfortunately, many synthetic opioids are highly addictive and have various side effects. Also, their efficacy changes after longer use, which can make the benefits outweigh the many disadvantages of their use. 

A major problem experienced by regular users of opioids is the fact that one builds up tolerance, requiring increasingly larger doses to experience the desired analgesic effect. 

More and more patients are looking for alternatives to relieve their (chronic) pain. 

CBD as a natural painkiller

Sirius sells several pain relief products that come straight from nature. Countless experience stories and studies show that this medicine is effective and can relieve all kinds of different complaints. The big advantage is that there are hardly any side effects and no chance of addiction. 

CBD is a substance that is extracted from the cannabis plant and among many patients a tool in quenching pain, helping with sleeping problems and calming the body and mind. All this in a subtle way, without any unwanted side effects. You cannot get stoned or high from CBD, as is the case with THC.

Medical cannabis and THC oil 

It is illegal by law to sell THC oil. With a doctor's prescription, a patient may be eligible for medicinal cannabis and oil. However, there are numerous users who take matters into their own hands and make their own medicine.

Cannabis has been used by humans as medicine for thousands of years, due to its analgesic and therapeutic effects. While it should be mentioned that THC oil obviously has a psychoactive effect, which is not always desirable, for many users there are far more benefits to it, than taking synthetic opioids in the long run. 

Kratom as an acute pain reliever

Sirius sells kratom (Mitragyna speciosa). The leaf of the kratom tree is known in various parts of Asia, including Thailand, for its analgesic and sedative effects. The action of kratom is similar to that of opioids, but is much less addictive. Many (former) addicts or regular users of opioids, including opium and heroin, switch to kratom to better cope with withdrawal symptoms. In Asia, kratom has been used for centuries as a natural alternative to opioids. 

This 2020 study, done by John Hopkins University, shows that kratom provides similar pain relief effects and has a lower risk of abuse, addiction and other negative side effects, than prescribed "regular" medication. 

Cutting down or stopping prescription medication: warning

Always discuss with your doctor when you want to reduce or stop taking medication. If you want to switch to another form of pain management you should also discuss it. It can be very dangerous to combine prescribed medication with other forms of painkillers, even if they are natural!