Clarifying the difference between dependence and addiction is important to better understand the issues in opioid use and abuse. Dependence is the physical tolerance of the drug that requires increased amounts of the drug to achieve the desired response. Withdrawal of the drug will result in physical symptoms such as shaking, tremors, nausea and vomiting.
Addiction is a behavioral disorder that refers to the emotional desire for the drug and the desired effects it brings, which often creates strong drug-seeking behaviors. Generally, those who are dependent on opioids will vary between feeling sick without the drug and the desired high after taking the drug. Being addicted to the drug will motivate a person to do whatever it takes to get and take the drug to avoid the withdrawal symptoms.
Withdrawal symptoms include the following:
- Intense drug cravings
- Depression, withdrawal fears, anxiety
- Sweating, watery eyes, runny nose
- Restlessness, yawning
- Fever and chills
- Muscle spasms
- Tremors and joint pain
- Stomach cramps
- Nausea and vomiting
- Elevated heart rate and blood pressure (NIDA, 2018; Kosten, 2013).
Populations at Risk
People at risk for opioid dependence and addiction are seen in every age, gender, ethnicity, and culture. The physical dependence varies as a genetic component has been identified, which influences how quickly a person may slide from occasional use to physical need and addiction to the drug (Kreek et al., 2005). Susceptible populations include those who are taking prescription opiates for pain relief. Having been given initially for acute pain, some people may become quickly dependent on opioids due to their unique chemical makeup or addictive personality.
Others who have typically been at risk for overdose included the homeless, alcoholics, and those with personality or mental health disorders who look for opiates to block the emotional pain of life stressors. People who use street drugs such as marijuana or cocaine for entertainment or social pleasure are at risk to develop a stair-step increase to more potent drugs in order to gain the same effect after they reach dependence and tolerance.
Overdose is often seen in those who use street drugs such as marijuana, Oxycontin, and cocaine that are laced with fentanyl to reach more potency. Drug dealers and manufacturers add fentanyl to help their customers reach a better high, thus ensuring they become a return customer. Because of the potency of fentanyl and difficulty in measuring, there may be large variations in their products that cannot be identified by either the dealer or user.
Healthcare professionals who also experience great work stress have a higher risk of becoming dependent or addicted to opiates due to back injuries and easier access to narcotics in their work setting (Kenna & Lewis, 2008).
The Cost of Fentanyl
The trust cost of fentanyl abuse is in the thousands of lost lives and millions more of destroyed families and the devastating effect upon family members left behind. The 2016 street cost of the drug for 1 kilogram was $3,500 in the United States and 1 kilogram can make about 1 million tablets, so the cost is less than 0.3 cents/tablet to manufacture, which make the illegal market attractive. One million pills can sell for up to $20 million, according to the DEA (Saul, 2016).
Test Your Knowledge
What is the definition of dependence?
- A drug user wants the drug for a party.
- The drug user depends on his dealer for a steady supply.
- A person who uses the drug regularly now physically depends on an increase of the drug to avoid withdrawal symptoms.
- The person takes opioids occasionally for entertainment and to feel pleasure.
Apply Your Knowledge
Q: What are the first symptoms you see when a patient has had too much oxycodone?
A: Changes in level of consciousness and pinpoint pupils.
Face the Fentanyl: Tina’s Story [2:33]