From painkillers to heroin: opioid addiction

Few addiction stories are as revealing and as little known as the one that connects a simple prescribed painkiller with a serious dependence. Opioid addiction has a feature that makes it especially insidious: it often does not begin in a party setting or with a search for risk, but in a doctor's surgery, with a legitimate prescription to relieve real pain. The road that leads from painkillers to substances such as heroin is not an abrupt leap, but a slope that many people descend without realising it.

Understanding how this addiction works, why it is so powerful and how it can be treated is essential at a time when the use of opioid painkillers has grown notably. This article traces that road rigorously and without drama, with the aim of informing and, above all, of conveying that there are ways out.

What opioids are

Opioids are a group of substances that act on specific receptors in the brain and nervous system, the opioid receptors, which take part in the perception of pain and in the sensation of wellbeing. Under this name are grouped very different realities:

• Prescription painkillers, used to treat moderate or severe pain.
• Opioids of natural origin derived from the opium poppy.
• Synthetic opioids, some of them extraordinarily potent.
• Heroin, an illegal opioid with a fast, intense action.

They all share a common mechanism of action and, therefore, an addictive potential. The difference between a prescribed painkiller and heroin is not as great, pharmacologically, as we tend to think: they act on the same receptors and produce related effects. This is one of the keys to understanding how the transition from one to the other comes about.

How the addiction begins: from pain to dependence

Most opioid addiction stories do not begin with a decision to "take drugs". They begin with pain: an injury, surgery, an illness, chronic pain. The doctor prescribes an opioid painkiller, which does its job and relieves the suffering. So far, everything is correct and necessary.

The problem arises when use is prolonged. Opioids generate tolerance quickly: the body adapts and more and more is needed to obtain the same relief. At the same time, they generate physical dependence, so that the body comes to need the substance simply to function normally. Without it, the discomfort of withdrawal appears. The person begins to take the painkiller not only to calm the original pain, but so as not to feel unwell, and that is a border that is crossed almost without noticing.

The wellbeing component

As well as relieving pain, opioids produce a sensation of wellbeing and emotional calm. For some people, especially those who carry anxiety, stress or psychological distress, this effect becomes as important as the pain relief. The opioid stops being used only against physical pain and comes to be used against emotional pain, which greatly reinforces the dependence.

The leap to heroin

How does one go from a pharmacy painkiller to heroin? The transition, when it happens, usually follows an understandable logic. There comes a moment when the prescription runs out, the doctor stops prescribing or the person needs ever-larger doses that they can no longer obtain by legal means. Then withdrawal sets in, with its physical and psychological discomfort, and the need to avoid it pushes them to look for alternatives.

Heroin, in that context, sometimes presents itself as a more accessible and cheaper option that produces similar effects, since it acts on the same receptors. Not everyone who becomes addicted to painkillers goes on to heroin, but the fact that this bridge exists explains why addiction to prescription opioids is considered such a dangerous gateway. What began as a medical treatment can end in dependence on an illegal drug, and those who go through it are usually the first to be surprised at having got there.

Opioid withdrawal syndrome

One of the factors that makes opioids so hard to give up is the harshness of their withdrawal syndrome. Although it rarely puts life at risk as can happen with alcohol, it is extremely unpleasant, and the fear of going through it keeps many people trapped in use. Its symptoms include:

• Intense muscle and bone pain.
• Anxiety and agitation.
• Sweating, chills and goose bumps.
• Nausea, vomiting and diarrhoea.
• Insomnia.
• Watering eyes and a runny nose.
• An intense, imperious craving to use.

This withdrawal is often described as a very severe flu combined with profound distress. The good news is that there are medical treatments that make it possible to get through it far more manageably and safely, which makes facing it alone both unnecessary and inadvisable.

Signs that use has become a problem

Given that many opioid addictions begin with legitimate medical use, recognising the moment when the line into a problem has been crossed is especially important. Some warning signs are:

• Taking more, or for longer, than prescribed.
• Needing increasing doses to obtain the same effect.
• Feeling physical discomfort when use is reduced or stopped.
• Seeking prescriptions from several doctors or through alternative channels.
• Using the opioid to calm emotions and not only pain.
• Continuing use even though the original physical problem has already been resolved.
• Feeling that control over use has been lost.

Recognising these signs is nothing to be ashamed of. Opioid addiction affects people of all ages and backgrounds, many of whom came to it through a medical treatment. It is not a sign of moral weakness, but the expected consequence of the action of these substances on the brain.

The treatment of opioid addiction

Opioid addiction is one of those that responds best to a comprehensive approach, and this is worth emphasising because it is often perceived as a sentence with no way out. It is not. Treatment combines, depending on the case, different elements.

Addressing withdrawal

There are medical approaches that make it possible to manage withdrawal and stabilise the person, reducing discomfort and the risk of relapse. This support should always be carried out under professional supervision, never on one's own, and it forms the base on which the rest of the process rests.

The therapeutic work

As in any addiction, overcoming physical dependence is only the beginning. The deeper work consists of understanding what function the opioid served, especially when it was used to manage emotional pain, and of developing other ways of facing distress. Addressing the anxiety, depression or chronic pain that often underlie it is essential for recovery to be sustained.

Relapse prevention and sustained support

Recovery from opioid addiction requires sustained support over time, with strategies to identify high-risk situations, manage the craving to use and rebuild a life without the substance. Ongoing support makes a decisive difference to the prognosis.

Chronic pain and opioids: a delicate balance

One aspect that deserves mention is the situation of people with chronic pain who depend on opioids for their treatment. Here it is not simply a matter of withdrawing the substance, but of finding a balance between managing the pain and preventing addiction. These cases require an especially careful and coordinated approach, one that attends to both the physical pain and the dependence, without leaving the person defenceless in the face of their suffering. Simplifying the situation by blaming someone who was only seeking to relieve real pain would be as unjust as it is ineffective.

A road with a way out

If one thing must be clear, it is that opioid addiction, however severe it may seem, has treatment and has a way out. The brain recovers, withdrawal can be gone through with medical support and life can be rebuilt. Many people who came to depend on painkillers or even heroin have managed to recover their health, their relationships and their life plans. The first step, so often the hardest, is to recognise the problem and ask for help.

Stigma as an obstacle to asking for help

One aspect that greatly hinders the treatment of opioid addiction is stigma. Many people who develop dependence from a legitimate medical treatment feel a deep shame, because they do not identify with the social image of the "drug addict" and do not understand how they got there. That clash between their self-image and their reality frequently leads them to hide the problem, to minimise it and to delay asking for help for too long.

It is important to insist that opioid addiction does not distinguish between social classes, ages or levels of education, and that its origin in pain treatment makes it especially democratic in the saddest sense of the term. No one chooses to become dependent; dependence is the predictable result of the action of these substances on the brain when they are used over a prolonged period. Understanding this frees one from a guilt that serves only to keep the person trapped and silent.

The sooner help is asked for, the better the prognosis and the less the accumulated suffering. That is why combating stigma, both the kind that comes from outside and the kind one imposes on oneself, is part of the work. Talking about the problem naturally, without demeaning labels, is what allows those affected to dare to take the step towards treatment.

If you or someone close to you have begun to notice that the relationship with an opioid painkiller has become problematic, or if the dependence has advanced towards more dangerous substances, you do not have to face it alone or on your own. At Reconectar we accompany recovery from opioid addiction with outpatient, individual and personalised treatment, in a confidential, non-judgmental setting in Las Palmas de Gran Canaria. Consulting a professional commits you to nothing, but it can be the beginning of a process that gives back the health and freedom the addiction had taken away. We are here to help you walk that road.