Most people are familiar with taking prescription medications like antibiotics when they get sick. Some people also are prescribed medication to help with a problem like depression or ADHD. Did you know that some (not all) drug addictions actually can be treated with prescription medications, too? It may seem odd that someone addicted to a drug like heroin would start taking another drug so they can stop using heroin. But, research shows that some people respond very well to what is called “medication-assisted treatment.”
Why Does Medication Help?
If a person is addicted to an opioid (like heroin or prescription pain relievers), medication can help him or her get back to a better state of mind—beyond just thinking about seeking and using the drug. It also can help ease withdrawal and cravings, which can give a person who is addicted the chance to focus on changes needed to recover.
Taking medication for opioid addiction is like taking medication to control heart disease or diabetes. It is not the same as substituting one addictive drug for another. Used properly, the medication does not create a new addiction.
How Does Medication Work?
Medications to treat opioid addiction (like methadone and buprenorphine) affect the same brain areas as the drugs of abuse they are opposing (like heroin and OxyContin)—but in different ways. Anti-addiction medications “trick” the brain into thinking it is still getting the drug, which stops withdrawal. They help the person feel normal, not high, and reduce drug cravings.
Alcohol dependence also may be treated with medication. Three oral medications and one that is injected have been shown to help patients reduce drinking, avoid relapse to heavy drinking, or stop drinking altogether. Of course, these medications aren’t available over the counter at your local pharmacy. They are dispensed at treatment centers or by primary care doctors approved to prescribe them.
Medication isn’t the only treatment for opioid or alcohol dependence—adding counseling or therapy can help, and the support of family and friends is often crucial to a person’s success. See NIDA’s new treatment resource, Seeking Drug Abuse Treatment: Know What To Ask.
To learn more about medication-assisted treatment for opioid addiction, read the brochure, Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends.
Did you know that morphine, codeine, and heroin are produced from the seeds of certain kinds of poppy flowers? Morphine and codeine are often used as medications for treating pain, and all three—known as opiates—can be abused.
Poppy seeds are also used as a flavorful ingredient in many popular foods, including muffins and bagels. Although poppy seeds used in food are produced legally, they can contain high enough levels of the opioid to trigger a positive result on some types of drug urine tests.
So, you may wonder, if you ate a poppy seed bagel for breakfast, could results of a drug test come out positive for these opiates?
Once poppy seeds are eaten, the body develops detectable levels of opiates almost immediately. As a 2003 “MythBusters” episode notes, someone can test positive for opiates as soon as 2 hours after eating a poppy seed-loaded item. Other studies have shown that the levels remain elevated for up to 3 days.
School athletes may want to pay attention to this. Across the country, about one in seven school districts perform some sort of drug testing on their students. Students in middle school, high school, or college may be asked to take a drug test in order to participate in athletic activities or other programs.
False positives (when the test wrongly reports someone used drugs) can and do happen. For example, Federal prisoners, who undergo drug tests with some frequency, are forbidden to eat foods that contain poppy seeds.
Over the past 20 years, legal cases by law enforcement officials, workers, athletes, or students “caught” or penalized for positive urine tests for opiates have made famous the “poppy seed bagel defense.” A series of lawsuits and evolving research have proven that an individual’s urine can indeed produce a positive test result for opiates after the person eats poppy seed-containing cakes, muffins, or bagels. In one large study, up to 87% of tests considered positive for opiate use were due in part to poppy seeds in foods as well as prescription medications.
When positive test results are proven to have been due to eating poppy seeds, they are overturned. More accurate measurement of opiate levels can be done by analyzing a blood or hair sample. These tests cost more and may be used to double-check a positive urine result.
To all you poppy seed lovers out there: They can be a tasty treat in favorite foods, but may be one to avoid before undergoing drug testing. Keep things simple: Try an onion bagel instead.
Jack Maypole, M.D., is the Director of Pediatrics at the South End Community Health Center as well as the Comprehensive Care Program at Boston Medical Center. He is also an assistant professor of pediatrics at Boston University School of Medicine. Cartooning has been a lifelong fascination and hobby.
In recent months, gossip magazines have reported on Justin Bieber’s erratic behavior, such as wearing a gas mask, fainting at a London concert, and traveling with a monkey. Mixed in with these reports is speculation about Bieber’s alleged use of a drug concoction called “Sizzurp.”
Bieber isn’t the only musician associated with the drink. Back in March and again at the beginning of May, rapper Lil Wayne was admitted to the hospital with seizures, allegedly from his use of Sizzurp (although he denied it).
NIDA works to stay on top of new drugs. If celebrities are involved, it’s even more important for people—especially teens—to know the facts, because sometimes people may think something’s cool just because a star does it.
Facts About Sizzurp
First, it is not cool. In fact, it’s quite dangerous. Sizzurp, also known as "Lean" and "Purple Drank," is a mixture of cough medicine—often prescription strength, containing an opioid called codeine—and soft drinks and candy for flavor. Abuse of cough medicines, especially ones that contain opioids, can cause an overdose leading to coma or even death. Less grave (but still serious) symptoms include nausea, dizziness, impaired vision, memory loss, hallucinations, and seizures like Lil Wayne experienced.
Teens may think that just because something is available from the pharmacy, it won’t harm them—but that’s not true. When not used as directed on the label, cough and cold medicines (even over-the-counter ones) can be dangerous.
Tell us in comments: If a celebrity does something, do you feel the urge to try it? What would you say to a friend who wanted to try Sizzurp?
This past Drug Facts Chat Day, teens from across the country submitted their questions about drug abuse to NIDA scientists.
A teen from Walter Johnson High School in Maryland asked, “What types of opioids are there?”
In general, opioids are psychoactive chemicals that work by binding to opioid receptors in the body. These receptors are found principally in the central and peripheral nervous system as well as the gastrointestinal tract and can produce both the good and bad effects of opioid use.
Many teens don’t know that there are illegal opioids (like heroin) as well as legal opioids that are prescribed for pain relief (like hydrocodone, which has the brand name of Vicodin). This is why common painkillers like Vicodin are so often abused—because they provide a “high” while relieving pain.
Here are the main types of opioids:
- Natural opiates are alkaloids, nitrogen-containing base chemical compounds that occur in plants such as in the resin of the opium poppy. Natural opiates include morphine, codeine, and thebaine.
- Semi-synthetic opioids are opioids created in labs from natural opiates. Semi-synthetic opioids include hydromorphone, hydrocodone, and oxycodone (the prescription drug OxyContin), as well as heroin, which is made from morphine.
- Fully synthetic opioids are opioids that are completely manmade, including fentanyl, pethidine, levorphanol, methadone, tramadol, and dextropropoxyphene.
Some opioids (e.g., morphine, codeine, OxyContin) are used by doctors to treat various things, such as pain after surgery. But opioids also have addictive properties and negative health effects that make them dangerous when abused.
Do you have other questions about types of drugs? Tell us in comments.
America loves its football—watching an NFL game on a crisp fall Sunday with our friends and families is a big part of our culture. But that fun comes at a cost to the pros who get tackled over and over in pursuit of a touchdown. A study of retired NFL players found that prescription painkiller abuse among NFL players is rampant, and that abuse continues even into a player’s retirement. The study found that retired NFL players are 4 times as likely to abuse painkillers as other people.
Many players said they abused painkillers so they could play through pain from injuries they might get in a game as well as pain from past injuries that hadn’t gone away. Many also said that they didn’t know about the risks of such abuse or feel like they had a choice. They felt pressure to play on, despite the pain.
The Problem With Painkiller Abuse
When taken as prescribed by a doctor, painkillers safely help patients in pain. However, when taken without a prescription or not as prescribed, the effects on the brain and body can be serious. For instance, a large dose could cause breathing trouble that is severe enough to cause death.
Do We Expect Too Much of Pro Athletes?
The study found that many NFL athletes also used ketorolac, a medication that reduces swelling, to also help dim pain from injuries. A growing worry about ketorolac is that it thins the blood and could make players more susceptible to the effects of concussions. What’s more, players using medications just to cover pain, not for a specific injury their doctor diagnosed, may raise their risk for injury because they feel less pain while on the field.
So, what do you think? Should professional athletes like NFL players be expected to play through the pain, even if it requires abusing painkillers and other medicines? Let us know in comments.
Learn more about prescription drug abuse and its effects.
After the news hit about the death of Michael Jackson and all the speculation about his possible prescription drug use, the NIDA press office phones rang off the hook. Why? News reporters wanted information on prescription drug misuse and abuse.
We talked to the NIDA Communications Director, Carol Krause (pictured right), about how they handle calls like that.
Sara Bellum Blog (SBB): How many calls does NIDA get when news like this hits?
Carol: Well it depends on the celebrity and how definite the news is. With Anna Nicole Smith, speculation was immediate that drug abuse was involved, so we got a lot of calls from the press right away. With Heath Ledger, people weren’t so sure, and the inquiries came gradually, over a period of weeks.
SBB: And Michael Jackson?
Carol: Within a few hours of his death, the NIDA press office got maybe a dozen calls from major news reporters wanting information on prescription drug abuse. They were doing research in case toxicology reports came back saying that medication misuse contributed to the pop icon’s death.
SBB: And what do you tell them?
Carol: We treat this like any other inquiry. We give them facts. The fact is that between the years of 1999 and 2005, the number of accidental deaths from drug overdoses in this country more than doubled.
SBB: Really? Why?
Carol: The biggest problem is the increased misuse and abuse of prescription painkillers—opioid narcotics like Vicodin and OxyContin.
SBB: Is this a problem with teenagers?
Carol: Absolutely. For the past 5 years, 1 in 10 high school seniors have reported they use Vicodin without a prescription—1 in 20 have used OxyContin.
SBB: Why isn’t the press reporting this?
Carol: Oh they are. The question is—are teens listening?
SBB: I’d like to think teens are smart enough to know that using medications without a prescription can be dangerous. What is the take away lesson from Michael Jackson’s death?
Carol: That we don’t need a tragedy like this to learn how to make smart decisions about your health. The information you need is right here on the NIDA website.
Mike “The Situation” Sorrentino recently opened up about his recovery from painkiller addiction.
Mike says he became addicted to the opioid painkillers he was prescribed after an injury he suffered on “Dancing With the Stars.” In an interview with the Associated Press, he recounts the moment when he knew he was addicted. It was during a family trip to Australia in February 2012, when he ran out of his pills. Mike says:
“All I had to do was get dressed for a family function and I couldn’t do that … The shirt was laid out, the belt, the pants, everything. The shower was on. I couldn’t even get out of bed.” He then realized: “If I can’t do that how am I going to continue?”
Soon after, he entered drug abuse treatment.
Medicine To Treat Substance Abuse
Mike says using Suboxone, combined with counseling, has kept him from relapsing and returning to drug abuse. In fact, he is now a paid spokesperson for the drug and continues to take it to maintain his recovery.
Mike and the drug company that makes Suboxone launched Reset Reality, a campaign to increase awareness about opioid addiction. Reset Reality aims to motivate people addicted to opioids like prescription painkillers to seek treatment and “reset their reality.” The Web site features several videos called “Words of Reality”—personal stories from Mike and others in recovery talking about their addiction and how medication-assisted treatment helped them.
Check out NIDA’s Opioid and Pain Reliever Drug Facts for more information about opioid addiction.
Teens have a lot of questions about drugs, which is why NIDA holds an annual Drug Facts Chat Day to explain the science behind drug abuse. At the last Chat Day, “casa grande” from Casa Grande Union High School in Arizona asked: What are opioids?
Opioids, also known as “opiates,” are a class of drugs with powerful pain-relieving properties. So, some are prescribed by doctors like Percocet, Vicodin, and codeine for people who need them. But then there are also street drugs like heroin that are also opioids—so yeah, Vicodin and heroin are in the same class of drugs!
When prescribed by a doctor, opioids can be used in a responsible way to reduce pain, treat diarrhea, or control coughing. Inside our bodies, opioids link to receptors in the brain, spinal cord, and gut, much like pieces in a puzzle. When they do, they can block the experience of pain. For example, morphine is sometimes given to people before or after surgery. However, opioids can also affect parts of the brain that control feelings of pleasure, producing a sense of euphoria that makes people want to take them again and again even when they’re not in pain. When people keep taking them like that, opioids can actually change the way the brain works, causing strong cravings that are of part of having an addiction.
NIDA scientists have put together a lot of information on opiates – learn more at Mind Over Matter: Opiates, Research Report Series - Prescription Drugs: Abuse and Addiction, NIDA InfoFacts: Heroin.
Have you ever heard the term ”psychoactive drugs?” Drugs in this category act on the central nervous system and and alter its normal, everyday activity, causing changes in mood, awareness, and behavior. Psychoactive drugs disrupt the communication between neurons (brain cells), so abusing them can have serious short- and long-term effects on the brain.
Psychoactive drugs include four groups of drugs: depressants like alcohol and sleeping pills; stimulants like nicotine and ecstasy; opioids like heroin and pain medications; and hallucinogens like LSD.
The term psychoactive drug might make you think of drugs, like LSD, that change your brain and behavior in really extreme ways. LSD is a hallucinogen, or “psychedelic” that significantly alters the brain and the user’s perception of reality. It is also an illicit, or illegal, drug.
But not all psychoactive drugs are illegal. Caffeine is a stimulant found in coffee and energy drinks, and opioids like Vicodin, OxyContin, or morphine are often prescribed by doctors to relieve pain. Abusing prescribed psychoactive drugs is illegal though, and can be as dangerous as abusing cocaine or heroin. That is one reason why they come with warning labels telling people not to drive or operate heavy machinery. Drinking too much caffeine is not good for you either (see chart)!
So legal or illegal, psychoactive drugs demand caution.
NIDA provides lots of information about the different types of psychoactive drugs:
Ever wonder how “real” those grueling scenes on reality TV shows are when actors and other celebrities check in for addiction rehab and are shown going through withdrawal? After all, these folks are all in show biz!
SBB was curious about exactly how withdrawal happens. Withdrawal is defined as: symptoms that occur after chronic use of a drug is reduced or stopped.
But that’s just where the story begins. The symptoms of withdrawal vary a lot by drug, including how harsh they are and how long they last.
Consider prescription opioids, or painkillers. These are drugs like oxycodone (better known as Oxycontin) or hydrocodone (Vicodin). Opioids are typically prescribed for someone having severe pain, from the ache after a root canal to a chronic condition like back pain from an injury. When opioids are taken as prescribed, they can provide temporary relief from severe pain. But, they are also highly addictive and must be taken only as prescribed.
Some people will abuse a prescription drug by taking more than prescribed, or in ways not intended, which can lead to serious problems, including slowed heartrate and breathing and even addiction. And just like with “illegal” drugs, quitting is hard and can bring on withdrawal symptoms. Opioid withdrawal symptoms can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps ("cold turkey"), and involuntary leg movements. Yikes.
Taking away the chemicals that alter your brain through drugs of addiction is a pretty harsh reality. Your body and brain react strongly, even violently sometimes, because of missing the chemicals they’ve come to depend on through repeated drug use.
If a person knew from the start that quitting drugs would be so difficult, would they think twice before trying them? Probably so… Know the facts.
At NIDA’s last Chat Day, we got this question from a high school student:
”Why do people scratch a lot when they are high on heroin?"
A NIDA scientist responded that he had done years of research on this topic. He explained: “Heroin activates connections in the brain called opioid receptors. These receptors then activate fibers that transmit itch information (aka ‘pruritus’) to the brain. Thus, heroin users feel itchy. Good question.”
But before heroin can activate opioid receptors, it has to enter the blood stream and reach the brain. So how does this happen?
People usually inject heroin into their blood stream with a syringe. Soon afterwards, the heroin crosses the “blood-brain barrier”—a protective membrane that separates circulating blood from brain fluid in the central nervous system. Once in the brain, heroin is converted to a chemical called morphine and binds rapidly to the opioid receptors already mentioned. These receptors recognize chemicals affecting pain, like morphine.
Heroin users typically report feeling a surge of pleasure, or a “rush,” which makes sense because heroin enters the brain so rapidly. This quality also makes it extremely addictive. Along with the rush usually comes a warm flushing of the skin, dry mouth, and a heavy feeling in the arms and legs, which may be accompanied by nausea, vomiting, and, of course, severe itching. Also, since heroin is a depressant, it clouds your thinking and can slow—or even stop—breathing.
Because heroin is mostly sold on the street, users can’t be sure of the purity (or strength) of the drug they’re taking. Also, because it’s so addictive, they may crave bigger and bigger amounts of the drug to get the same rush they got the first time—which often leads to overdose and death.