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The Abuse Potential Difference Between Immediate-Release and Extended-Release Opioids

Opioids are prescribed to treat pain. Unfortunately, these prescription medications have a high potential for abuse and are addictive. Last year alone, 11 million Americans abused prescription opioids. This is because prescription opioids are easily accessible. It’s not hard to find doctors who are willing to prescribe these medications. If these numbers aren’t shocking enough, consider the fact that 6 out of 10 overdoses involve opioids. That’s not a small sum. With that said, there are different types of opioids: immediate-release opioids and extended-release opioids. Both of them do the same job of relieving moderate to severe pain. Their effects last different amounts of time, and each prescription opioid has a different effect on the body. Here is a look at which types of opioids have a higher abuse potential than others. We’ll also look at which opioids are more addictive.

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Difference Between Immediate-Release and Extended-Release Opioids

There are two different types of opioids available to treat pain. They include immediate-release (IR) opioids and extended-release (ER) opioids. Both are painkillers, and used to treat moderate to severe pain. Immediate-release opioids relieve pain for a shorter duration of time. They work in a faster manner. They are usually the first type of opioids prescribed by physicians to deal with pain. For example, they are often used in post-surgical care. They are designed for patients dealing with immediate pain. Extended-release opioids relieve pain for a longer amount of time. The medication works in a slower manner. In general, extended-release opioids are safer. They use lower doses and offer much more consistent results. They are also more likely to bypass “end-of-dose failures”. Extended-release opioids are less likely to cause symptoms like:

  • Constipation
  • Nausea
  • Pruritus
  • Sleep disturbances

With that said, there’s still a lot of scientific debate about the advantages of each type of opioid. Many generic opioids come in both immediate-release and extended-release forms. They are available in various forms, such as in a liquid form or as capsules.

Types of Extended-Release Opioids

There are plenty of different types of extended-release and long-acting opioids. Although they are similar, each type has its own merits. A doctor will explore each option with Before these opioids can be prescribed, a Risk Evaluation and Mitigation Strategy (REMS) is needed. Some popular options include:

  • Avinza, which are morphine sulfate extended-release capsules
  • Butrans, which is a buprenorphine transdermal system
  • Dolophine, which are methadone hydrochloride tablets
  • Duragesic, which is a fentanyl transdermal system
  • Embeda, which are morphine sulfate and naltrexone extended-release capsules
  • Exalgo, which are hydromorphone hydrochloride extended-release tablets
  • Fentanyl, which relies on a fentanyl extended-release transdermal system
  • Kadian, which are morphine sulfate extended-release capsules
  • MS Contin, which are morphine sulfate controlled-release tablets
  • Nucynta ER, which are tapentadol extended-release oral tablets
  • Opana ER, which are oxymorphone hydrochloride extended-release tablets
  • OxyContin, which are oxycodone hydrochloride controlled-release tablets
  • Palladone, which are hydromorphone hydrochloride extended-release capsules

There are many options to choose from. These extended-release opioids treat conditions like osteoarthritis and lower back pain. They can improve sleep conditions and many other unwanted symptoms, and are usually prescribed to deal with long-term pain.

Types of Immediate-Release Opioids

There is also an array of short-acting and rapid-onset opioids. These prescription opioids last between 3 to 6 hours. Some options include:

  • Buprenorphine
  • Codeine
  • Fentanyl buccal soluble film
  • Fentanyl buccal tablet
  • Hydrocodone
  • Hydromorphone, which include Dilaudid
  • Intranasal fentanyl
  • Morphine
  • Oral transmucosal fentanyl citrate
  • Oxycodone, which include pills like Percocet
  • Oxymorphone
  • Sublingual fentanyl
  • Tapentadol

These prescription medications are a form of extended-release tablets. They are often prescribed to provide relief for acute pain. In most cases, patients are only expected to take these opioids for several days or a week at the most.

How Opioids Work

Both extended-release and immediate-release opioids work in similar way. They relieve pain by binding to μ-opioid receptors in the brain. This activates the receptors, and creates an analgesic effect. In short, opioids fool the brain in believing that they are getting a natural signal. The molecular compositions of most prescription opioids are like natural neurotransmitters. Whether an opioid is effective or not will depend on factors like the:

  • The molecular composition of the drug
  • Patient condition
  • Route of administration

Once the opioids attach to the brain, they send abnormal messages to different parts of the brain. The goal is to flood the brain with dopamine. Dopamine regulates emotion, motivation, cognition and feelings of pleasure. By flooding the brain with dopamine, it over-stimulates the brain. This causes a sense of euphoria. This sense of euphoria is what causes addicts to misuse the drug. This is what causes an addiction to opioids.

Abuse Potential Between Different Types of Opioids

Many studies have researched the abuse potential of both immediate-release and extended-release opioids. Studies have shown that addicts abuse both types of opioids. With that said, immediate-release prescription opioids are abused more often than extended-release options. Most addicts preferred immediate-release opioids as well. There are two reasons why immediate-release opioids are more addictive than extended-release alternatives. For one, immediate-release opioids are able to provide an immediate high. This gives addicts the reward that they are looking for. The high is also perceived to be stronger and more potent. Many addicts also claim that IR opioids are much easier to get since IR opioids are usually a doctor’s first choice. This applies to all types of IR and ER opioids regardless of how they are administered. It doesn’t matter whether the prescription opioids were injected, or taken in a tablet form. Immediate-release opioids have a higher potential for abuse. They are highly sought after by addicts.

Signs of an Opioid Addiction

Regardless of whether patients are addicted to immediate-release or extended-release opioids, they should experience the same signs. Physical signs of an addiction include:

  • Confusion
  • Constricted pupils
  • Constipation
  • Cravings
  • Drowsiness
  • Euphoria
  • Loss of consciousness
  • Slowed breathing

The intensity of the symptoms will differ from patient to patient. It depends on the type of opioids they are taking and the length of use. It also depends on each patient’s condition.

Ease of Quitting

While immediate-release opioids have a higher potential for abuse, they are easier to taper off of. Patients, who are prescribed 4 pills of immediate-release prescription opioids a day, can quit quite easily. They usually do not need a taper. Patients who use extended-release opioids will usually need a taper. This is because a longer term of prescription opioid exposure is usually linked to more intense withdrawal symptoms. The intensity of the withdrawal symptoms makes it difficult to quit. To taper off of extended-release prescription opioids, lower the dose by 10% to 20% each week. In most cases, the first 50% of the opioid dose is easy to taper from. The most difficult part lies in the last 25%. To help patients taper off of extended-release opioids, many doctors will prescribe immediate-release opioids. Detox programs involving methadone and buprenorphine are highly effective.

Withdrawal Symptoms of Opioid Abuse

Most addicts will agree that withdrawal symptoms feel like the flu. Common symptoms include:

  • Anxiety
  • Diarrhea
  • Fatigue
  • Headaches
  • Insomnia
  • Nausea
  • Sweating
  • Vomiting

The intensity of the withdrawal symptoms will also differ from patient to patient. It depends on the dosage taken, the type of prescription opioids taken, and the length of use.

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Prescription Recommendations to Prevent Opioid Abuse

Opioid abuse and addiction is quite common. 1 in 4 patients prescribed with long-term opioid therapy will become addicted.  Patients using immediate-acting opioids are more likely to develop an addiction. To prevent this from happening, the CDC has recommended several guidelines. They include:

  • Avoiding the use of opioids as a first-line therapy
  • Discussing risks and benefits with patients, so they can make an informed decision
  • Implementing various strategies to mitigate addiction risk
  • Prescribing immediate-release opioids instead of extended-release opioids when starting off
  • Prescribing the shortest duration and the lowest dose possible
  • Using the prescription drug monitoring program (PDMP) to keep track of prescription drug use of each patient
  • Watching out for concurrent opioid and benzodiazepine use

When implemented, these guidelines are supposed to help prevent opioid addiction and abuse. They can help put a stop to the growing opioid epidemic in America.

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Treating Opioid Addictions and Abuse

Prescription opioids are often prescribed to treat moderate to severe pain. They are quite effective, but can also be rather addictive. It’s not unusual for patients to get addicted to them. Many patients will even graduate from prescription drugs to illicit drugs, like heroin. If you believe that you might be addicted to prescription opioids, take our addiction quiz. This self-assessment can give you a better understanding of how opioids affect your life. It’ll also give you a better idea of whether you need to seek help or not. Speak to your doctor about your concerns. Don’t hesitate to reach out to one of our counselors for more information. Our staff can assess your situation to determine whether you need help. They can also design a personalized opioid addiction treatment plan that caters to your need. Don’t let your addiction get further out of hand. We’re here to help.