Once the patient regains consciousness, complaints such as pruritus, sneezing, tearing, piloerection, diffuse body pains, yawning, and diarrhea may appear. These are the recognizable symptoms of the opioid abstinence, or withdrawal, syndrome described later. Consequently, an antidote must be used with great caution in an addict who has taken an overdose of opioid, because in this circumstance, it may precipitate withdrawal phenomena. Nausea and severe abdominal pain, presumably because of pancreatitis (from spasm of the sphincter of Oddi), are other troublesome symptoms of opiate use or withdrawal. Seizures are rare.
Just 50 years ago there were an estimated 60,000 persons addicted to narcotic drugs in the United States, exclusive of those who were receiving drugs because of incurable painful diseases. This represented a relatively small public health problem in comparison with the abuse of alcohol and barbiturates. Moreover, opioid addiction was of serious proportions in only a few cities—New York, Chicago, Los Angeles, Washington DC, and Detroit. Since the late 1960s, a remarkable increase in opioid addiction has taken place. According to statistics from the Centers for Disease Control and Prevention (CDC), as of 2016, 66 percent of the more than 63,000 drug overdose deaths in the United States involved an opioid (including both prescribed and illicit opioids) and on average, 115 Americans die every day from an opioid overdose. A serial rise in opioid-related deaths is traceable to three trends: increased prescribing of opioids (natural and semisynthetic opioid and methadone) in the 1990s, increases in overdose deaths involving heroin around 2010, and increases in overdose deaths involving synthetic opioids around 2013. The precise number of opioid addicts is unknown but is estimated by the Drug Enforcement Administration to be well more than 500,000. The problem assumes enormous importance when one recognizes that a significant number of addicts are seropositive for HIV and thus a source of transmission to each other, to newborns and to the nonaddicted population.
A number of factors—socioeconomic, psychologic, and pharmacologic—contribute to the genesis of opioid addiction. The most susceptible to opioid addiction are young men living in economically depressed areas of large cities, but significant numbers of addicts are found in suburbs and in small cities, and among affluent populations as well. The onset of opioid use is often in adolescence; fully two-thirds of addicts start using the drugs before the age of 21. Many have psychiatric disturbances, conduct disorder and sociopathy being the most common (“dual-diagnosis,” in psychiatric jargon) but vulnerability to addiction is not confined to one personality type. Monroe and colleagues, using the Lexington Personality Inventory, examined a group of 837 opioid addicts and found evidence of antisocial personality in 42 percent, emotional disturbance in 29 percent, and thought disorder in 22 percent; only 7 percent were free of such disorders. Association with addicts is an additional explanation for becoming addicted. In this sense, opioid addiction is contagious, and partly as a result of this pattern, opioid addiction has attained epidemic proportions.