Using opioids a delicate balancing act

Opioids are the strongest painkillers available to us. They respond to certain receptors in the nervous system, especially in the brain.

"When used with drugs, they alleviate pain or lead to freedom from pain," Norbert Wodarz told DW. He's an addiction researcher at the Regensburg University Hospital in southern Germany. "Only anesthetics have a stronger effect than opioids," adds Wodarz.

Opiate or opioid? 

Opiates are psychoactive substances derived from opium poppy. The latex of the plant, which is used for this purpose, consists of three to 23% morphine, which forms the main component. Morphine is the oldest and most important opiate. Codeine is also an opiate.

Opioids are partly synthetically produced substances. Heroin is the best-known opioid. Methadone and fentanyl also belong to this group. They are produced by a chemical process. Morphine is also necessary for this.

"The separation between opiate and opioid has been abandoned. They're now only called 'opioids'", explains Wodarz. This includes all substances, both natural and synthetic. 

The stuff dreams are made of

If opioids are used as a drug and not as a painkiller, they have a euphoric effect. "Heroin users, for example, inject the substance because it works within 30 seconds. It creates euphoria, but it is also relaxing," says Wodarz, "because the heroin that is injected into the vein quickly enters the brain via the blood."

People addicted to the drug feel as though all their problems and difficulties dissolve, and are happy and content. Heroin also dampens mental activity, and feelings such as fear or emptiness often occur.

Death via prescription?

The effect of opioids as intoxicants is not always the same. Consequently, someone addicted to them must constantly increase the dose so that they feel something or, at some point, nothing at all. They become physically and psychologically addicted.

Dependency becomes the central focus of life. Everything revolves around organizing and injecting the next dose. Often alcohol consumption, psychotropic drugs or other drugs are added. The danger of contracting hepatitis or HIV, for example, also increases. Unclean drugs, which are mixed with various substances, are also dangerous, as they compound the body's suffering.

However, the widespread assumption that heroin damages the organs is wrong.

The physical and psychological withdrawal symptoms, however, are awful: Just a few hours after the last 'shot', sweat can break out and trembles, nervousness, stomach cramps and nausea can occur, as well as circulatory disorders.

Opioids as painkillers

Opioids have become indispensable in pain therapy. Doctors mainly prescribe them as tablets or patches that release the active ingredient continuously. When administered as a drug, there is no euphoria. The effect takes longer to develop than when injected into the vein. It can take up to three hours for the patient's pain to subside.

"It first has to be absorbed from the intestine, then into the bloodstream and then to the receptors," explains Wordarz. "Because the effect develops so slowly, the euphoria that people addicted to the drug doesn't occur."

Reliable medical drug

The side effects of opioids as a drug are comparatively low. Many people suffer from nausea, vomiting or constipation. Some opioids are metabolized by the liver and can put a heavy strain on it.

"What is important is that opioids are extremely important drugs. Anyone who has an accident, an operation or a tumor disease will be glad to know that these drugs exist. However, if the treatment lasts longer than two months, the body gets used to the substance and the dose.

"If a 25-year-old has severe chronic back pain and it's a problem that won't change for the next 30 years, then opioids are not well suited as a permanent medication," Wodarz cautions.

However, opioids are crucial painkillers for cancer patients, Wodarz emphasizes — saying opioids are used too rarely in palliative care patients.

Painless but dependent

Often patients ask their doctors to prescribe strong painkillers. Understandably, they want to reduce their pain as quickly as possible or even get rid of it completely. This works best with opioids.

But opioids are not always the best choice. For complaints such as menstrual pain or a bit of stomach ache, for example, they are a risky option.

"That," says Wodarz, "is like shooting at sparrows with cannons."