Opioid Use Disorder

What are opioids?

Opioids are often prescribed as painkillers, but some street drugs also come under this category. Traditionally derived from the opium poppy, some opioids are now made synthetically. Common examples of opioids include:

• Morphine
• Codeine
• Oxycodone
• Fentanyl
• Tramadol
• Heroin

Aside from relieving pain and anxiety, they can also affect the brain by creating a feeling of numbness and euphoria, often experienced as a ‘high.’

What is opioid dependence?

Opioid use disorder is the consequence of using opioids beyond their intended purpose, often leading to both physical and mental addiction. Opioid addiction can stem from the misuse of prescription drugs, leading to cravings, a harmful preoccupation with sourcing more, and intense withdrawal symptoms if unable to do so.

Over time, increased resilience often leads to increased dosage, which can severely impact the person’s physical health, mental health, and social well-being.

How common is opioid dependence?

The opioid crisis was declared a nationwide Public Health Emergency on October 27, 2017. Around 3 million people in the United States are living with opioid use disorder or have experienced it in the past. ^[3]This has led to a dramatic rise in the number of opioid overdose cases, primarily due to an influx of fentanyl on the streets, a synthetic opioid that is 50 times stronger than heroin. The risk of overdose from fentanyl is far greater than with other opioids and will often end in death without intervention.

According to the American Medical Association (AMA), between 3 - 19% of people who use prescribed pain medications develop an addiction, and about 45% of heroin addictions originate from an addiction to prescribed opioids ^[4].

Signs and symptoms of opioid dependence

Opioid dependence and addiction can manifest in various physical and mental symptoms and behavioral changes. It is a chronic, lifelong disorder that can have serious consequences, including death. Once an addiction has formed, abstinence from opioids can cause severe withdrawal symptoms, which can lead to further drug use.

Signs of abuse and addiction

• Taking different amounts of medication than prescribed could mean a higher dose, taking them more frequently, or taking them for a longer period than advised by your doctor.
• Taking the drugs differently than advised, such as crushing pills to be inhaled or injected.
• An uncontrollable inability to stop or cut down despite physical, mental, and social problems.
• Taking drugs for purposes other than pain relief, such as physical cravings or a desire to experience a high.
• Spending a lot of time trying to get more opioids from different sources. This might involve lying to your doctor, sourcing them from numerous doctors, ordering drugs online, stealing from others, purposefully hurting yourself to get a new prescription for pain relief, or buying them off the street.
• Signs of neglect might take the form of self-neglect, such as a lack of personal hygiene; neglecting responsibilities, such as household chores, paying bills, and attending to your job; or neglecting your relationships, including with friends and family members.
• Other symptoms include excessive sleeping, extreme weight loss or gain, and mood changes, including becoming nervous, on edge, and angry.
• Another key sign of opioid dependence is experiencing withdrawal symptoms.

Withdrawal symptoms

Even people with a very slight dependence on opioids can experience withdrawal symptoms. The intensity and duration of the withdrawal process depends on the type of opioid, how long the user has been dependent, and the amount they have been taking.

Symptoms include:

• Sweating
• Nausea, vomiting and diarrhea
• Cramps and muscle aches
• Tremors
• Flu-like symptoms
• Yawning
• Loss of appetite
• Disorientation
• Enlarged pupils
• Anxiety
• Insomnia
• Intense opioid cravings

While not usually life-threatening, withdrawal’s physical and mental discomfort can be extreme. Its unpleasantness can lead people to turn back to opioids to relieve the symptoms or because they believe the symptoms of opioid dependence are preferable to the symptoms of withdrawal.

Long-term complications

Long-term opioid dependence can impact multiple organs, including the brain. For example, it can impair the brain’s production of natural feel-good chemicals (dopamine and serotonin) and interfere with inbuilt pain-killing processes. In addition, over time, the body develops a tolerance to opioids, requiring higher doses to feel the same effect, which in turn increases addiction and associated symptoms.

Other long-term complications can include:

• A weakened immune system
• Hallucinations
• Risk of mental illness
• Slow breathing rate
• When opioids are injected, this can increase the risk of hepatitis, HIV or infectious diseases, and collapsed veins.

In the most serious cases, opioid use disorder can result in coma or death.

Causes of opioid dependence

Anybody can develop opioid use disorder - simply using opioids beyond a few days can increase your risk of dependence. However, there are other factors, both biological and social, that make some people more susceptible to opioid addiction than others.

Biological risk factors include:

• Personal or family history of substance misuse
• History of severe depression or anxiety
• Being female: women are more likely to be prescribed opioids for chronic pain, and a higher propensity for developing opioid dependency is linked to women having a smaller average body size than men ^[1]

Social/environmental risk factors include:

• Stressful living circumstances linked to poverty, unemployment and abuse
• Lack of access to medical care
• History of criminal activity
• Regular contact with people or places that increase the risk of substance abuse

Diagnosing opioid dependence

To diagnose opioid use disorder a doctor or psychologist will examine your current usage and medical history and might ask for a urine sample. They will ask about your pattern of opioid use over a 12-month period and measure it against a set of 11 criteria of addiction outlined in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Based on these findings, and factors about your work, housing situation, history of substance use, and support system, they will work with you to decide the best course of substance use disorder treatment.

Treatment for opioid use and dependence

To stop using opioids successfully, an individual must be fully committed to treatment. It involves physical, psychological, and behavioral aspects and often requires continuing care to have the highest chance of success.

Treatment can take place at home or in a hospital, or if problems are particularly advanced or complex, you might be transferred to a specialist residential rehabilitation center. Treatment centers offer medical supervision to manage withdrawal symptoms and effective treatments for opioid abuse such as talking therapies and holistic activities.

Medication

Medication-assisted treatment (MAT) is a common form of opioid substitution treatment. It involves behavioral therapy combined with medication that alleviates withdrawal symptoms and restores chemical balance to brain processes impacted by addiction. These opioid medications also reduce cravings and block the addictive, euphoric feeling of other opioids.

FDA-approved medications for treating opioid use disorder include:

• Methadone
• Buprenorphine
• Naltrexone

Longer-term use of such medications can help to sustain recovery and prevent relapse. However, it is important to note that these medications are not designed to replace the opioid dependency they are treating - their dosage is tightly controlled to prevent further drug abuse and does not result in the same euphoric high. Using medication to treat opioid addiction is also known as maintenance therapy.

At some point during maintenance therapy, you can choose to detox, which involves gradually withdrawing from opioids altogether. After detoxification, the physical dependency will have subsided, but many people still experience signs of psychological addiction. To avoid relapse in circumstances that might be triggering, ongoing counseling, therapy, and self-help are recommended.

Therapy

Therapy for opioid dependence usually involves cognitive behavioral approaches and can help to:

• Manage cravings
• Navigate triggering situations
• Build positive thoughts around treatment and recovery
• Help with any co-occurring mental disorders
• Encourage a healthy lifestyle
• Work on relationships with family, friends, employers, and the wider community
• Educate about how to prevent relapse

Therapy can also include people close to you or take place as part of a group with similar dependency issues. Other support services, such as Narcotics Anonymous, can also benefit long-term recovery.

FAQs about opioid addiction

What is the outlook for people with opioid addiction?

Opioid use disorder is a serious condition. People who misuse opioids are at a higher risk of critical health complications and premature death. The only way to reduce this risk is to quit.

It is a life-long illness, and it is common for people to relapse at some point on the road to recovery. However, there is plenty of support for those seeking help, and many people overcome opioid addiction with the right treatment. Studies show that 75% of people with substance use disorders, including opioid use disorder, survive and report being in recovery ^[2].

How can you avoid opioid dependence?

Unlike with illicit drugs such as cocaine, it is easy to develop an addiction to opioids simply by misusing prescription amounts. It is important to take medication containing opioid agonists only as directed by your doctor and to understand the risks of doing otherwise.

When used only for a few days, the risk of becoming addicted to prescription opioids is significantly reduced. To treat long-term pain, speak to your doctor about an alternative medication.

You can also keep others safe from opioid use disorder by storing your medication securely, away from others, and by disposing of it properly. Your pharmacist, trash and recycling service, local law enforcement agency, or the Drug Enforcement Administration (DEA) should all have information about returning or safely disposing of unwanted opioids.