Managing and Treating Opioid Addiction

Opioid addiction is a chronic and relapsing condition that can develop from prescription or illicit opioid use. The disorder affects both the brain and behavior, causing profound changes in how a person thinks, feels, and acts. However, recovery is possible through comprehensive treatment approaches that address both the physical and psychological aspects of addiction.

What are Opioids?

Opioids are a powerful class of substances that interact with the body’s opioid receptors to alleviate pain and produce feelings of well-being and euphoria. Often, opioid substances are prescribed to manage pain, but illicit and prescription forms are both commonly misused to produce a euphoric high. 

Opioids are grouped into three main categories, namely natural, semi-synthetic, and synthetic ^[1]: 

• Natural opioids, such as Morphine and Codeine, are directly sourced from the opium poppy plant. Natural opioids are known as opiates.
• Semi-synthetic opioids, including Hydrocodone and Oxycodone, are produced in laboratories using natural opiates as a foundation ingredient. 
• Synthetic opioids, like Fentanyl, are manufactured through chemical processes without any natural components. 

While opioids can be effective for pain relief, they also carry significant risks that can adversely affect health. Users may experience side effects such as extreme drowsiness, confusion, nausea, and constipation. Dosage strength and duration of use can also lead to serious cardiovascular issues. If mixed with certain substances or taken in excess, opioids can cause dangerously slow breathing, loss of consciousness, and even fatal respiratory failure ^[1]. Additionally, continued opioid misuse can lead to tolerance, dependence, and addiction.

What is Opioid Addiction?

Opioid addiction, clinically known as opioid use disorder, is a chronic and relapsing medical condition characterized by compulsive drug seeking and use despite negative consequences. This disorder develops through a complex interplay of biological and environmental factors, often beginning with either prescribed pain medications or experimentation with illicit opioids.

The progression from initial use to addiction typically follows a predictable path. When someone takes opioids, their brain releases chemicals that create feelings of pleasure and reward. Over time, the brain adapts to the presence of opioids, requiring increasingly larger amounts to achieve the same effects, a process known as tolerance. As use continues, physical dependence develops, causing uncomfortable withdrawal symptoms when the person stops taking the drug or significantly curtails use. 

This cycle of tolerance and dependence can lead to compulsive drug-seeking behavior, even when the person recognizes the negative consequences of their use. At the same time, the brain’s reward system becomes rewired, making it increasingly difficult to resist cravings or make rational decisions about opioid use. What might begin as a prescription for pain management can transform into a consuming disorder that affects every aspect of a person’s life.

In terms of prevalence, insights from the 2023 National Survey on Drug Use and Health (NSDUH) reveal that among those 12 and older, 8.6 million individuals misused prescription opioids in the last year. Within this same age group and time period, 5.7 million people developed an opioid use disorder ^[2].

Signs of Opioid Addiction

The signs of opioid addiction often manifest through noticeable changes in behavior, physical health, and daily functioning. When it comes to diagnosis, medical professionals use behavioral criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria examine various aspects of opioid use, including tolerance, withdrawal, and impact on daily life. 

Key diagnostic indicators include using opioids in larger amounts or for longer periods than intended, experiencing strong cravings, continuing use despite physical or psychological problems, and developing tolerance or withdrawal symptoms ^[3]. 

People struggling with opioid addiction may also exhibit the following signs of drug use ^[4]: 

• School or Work Issues: A sudden disinterest in, absences from, or marked performance declines at school or work 
• Physical Health Concerns: Diminished motivation, lack of energy, red eyes, and weight loss or gain
• Money Concerns: Unexplained need for additional money or sudden financial issues
• Relationship Changes: Drastic changes in relationships with family and friends
• Appearance: Decreased interest in personal grooming or appearance 
• Secretive Behavior: Efforts to bar family members from personal spaces or being secretive about whereabouts
• Doctor Shopping: Visiting multiple healthcare providers to obtain opioid prescriptions

Although there are various types of opioids, the signs and symptoms associated with their use tend to be consistent across different substances. For instance, the indicators of heroin addiction can closely resemble those seen in oxycodone addiction.

Opioid Addiction Treatment

Healing from opioid addiction requires a comprehensive approach that addresses both the physical and psychological aspects of the disorder. Within the various levels of care, treatment for opioid addiction involves multiple therapeutic approaches.

Evidence-based treatments include cognitive behavioral therapy (CBT), which helps individuals identify and change harmful thought patterns and contingency management, which provides rewards for maintaining sobriety. Group therapy and family counseling sessions offer additional support and help to repair relationships damaged by addiction.

Some treatment facilities also offer specialized programs for specific substances. For example, individuals struggling with heroin addiction may benefit from inpatient or outpatient heroin treatment programs and heroin-specific aftercare and relapse-prevention techniques that address the unique challenges associated with this particular opioid. 

Opioid Detox and Withdrawal

Treatment for opioid withdrawal typically marks the first step in a comprehensive opioid addiction recovery program. This crucial phase, known as detoxification, helps individuals safely manage the physical and psychological symptoms that emerge when stopping opioid use, setting the foundation for longer-term treatment success.

Opioid withdrawal produces a distinct set of symptoms that can begin within hours after stopping or significantly curtailing use. Early symptoms often include anxiety, agitation, muscle aches, insomnia, sweating, and runny nose. As withdrawal progresses, individuals may experience nausea, vomiting, diarrhea, dilated pupils, and goosebumps. While rarely life-threatening, these symptoms can be extremely uncomfortable ^[5]. 

Medical supervision during detoxification provides crucial support and monitoring. Healthcare providers may prescribe medications to manage specific withdrawal symptoms, such as anxiety, nausea, and gastrointestinal distress. Additionally, medical professionals carefully monitor vital signs, fluid intake, and overall health status throughout the withdrawal process. 

Beyond medication management, supportive care plays an essential role during detoxification. This care includes maintaining proper hydration, ensuring adequate nutrition, and providing a quiet, comfortable environment. Medical staff also offer emotional support and encouragement, helping individuals understand that their symptoms are temporary and manageable. This combination of medical intervention and supportive care helps individuals complete the withdrawal process safely and transition into the next phase of their recovery journey.

Levels of Care for Opioid Use Disorder

Treatment programs typically offer various levels of care to match each individual’s specific needs and circumstances. In effect, programs meet individuals wherever they are in their recovery journeys.

• Inpatient Care: Following detox, inpatient treatment (aka residential care) is the most intensive level of addiction treatment. It involves 24/7 supervision and care in a structured environment, making it ideal for individuals with severe substance use disorders or those who have not succeeded with other treatment methods. 
• Partial Hospitalization Program (PHP): PHP is a step down from inpatient care, but it still offers a high level of intensity. Patients attend treatment sessions for several hours a day, multiple days a week, while living at home or in a sober living environment.
• Intensive Outpatient Program (IOP): IOP provides a structured treatment plan with therapy sessions several times a week, but it does not require overnight stays. It’s often suitable for individuals who need significant support but can manage their recovery without 24-hour supervision. 
• Traditional Outpatient Care: This level of care involves periodic therapy or counseling sessions, typically once or twice a week. It is the least intensive form of treatment and is best suited for individuals who have already completed higher levels of care 
• Aftercare: Once a treatment plan is complete, heroin rehab aftercare and relapse prevention is paramount. Continuing care programs focus on long-term recovery and may include support groups, continued therapy, or sober living arrangements. 

Medications for Opioid Addiction 

The use of prescribed medications, referred to as medication assisted treatment (MAT), plays a vital role in treating opioid use disorder, offering individuals a scientifically proven path to recovery.

When combined with counseling and behavioral therapies, the following medications help reduce cravings, manage withdrawal symptoms, and support long-term recovery success ^[6]: 

• Buprenorphine, one of the primary medications used in MAT, works as a partial opioid agonist. Available in various forms, including sublingual tablets and implants, buprenorphine helps reduce cravings and withdrawal symptoms while having a lower risk of respiratory depression compared to full opioid agonists. This medication can be prescribed by qualified healthcare providers in office-based settings, making it more accessible than some other treatment options. 
• Methadone, a long-acting full opioid agonist, can only be dispensed through federally certified, accredited opioid treatment programs (OTPs). These specialized clinics provide structured environments where patients receive their medication under direct supervision. After careful monitoring and demonstrated stability, patients may eventually qualify for take-home doses, allowing for greater flexibility in their daily lives. 
• Naltrexone represents a distinct treatment approach that any healthcare provider can prescribe without special certification. Available as either a daily oral medication or a monthly injection, naltrexone completely blocks opioid effects and carries no risk of dependence. However, patients must complete detoxification and be opioid-free for seven to 10 days before starting this medication to avoid triggering withdrawal symptoms. 

Healthcare providers work closely with patients to determine the most appropriate medication (if any) based on individual circumstances, treatment goals, and lifestyle considerations.

Paying for Opioid Addiction Treatment

Access to opioid addiction treatment has become more widely available through recent healthcare legislation. The Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) require most insurance plans to cover substance use disorder treatment as an essential health benefit. While individual plans vary, full or partial coverage typically includes services such as assessment, MAT, counseling, and both inpatient and outpatient care ^[7].   

For individuals without insurance, affordable opioid addiction treatment options are also available. Many treatment facilities offer sliding fee scales, adjusting treatment costs based on income and ability to pay. Additionally, state and federal grants often provide funding for treatment services, particularly for specific populations such as pregnant women or individuals involved in the criminal justice system. 

What’s more, treatment centers regularly work with patients to develop manageable payment plans, spreading costs over time to make treatment more accessible. Some facilities also maintain relationships with healthcare lending companies that specialize in financing medical treatments, offering another pathway to accessing necessary care. The point is, financial concerns need not be a barrier to care.

Life After Opioid Treatment

Overcoming opioid addiction represents a challenging but achievable journey that has transformed countless lives. Through comprehensive treatment approaches, including detox, behavioral therapy, and medication assistance, individuals can build strong foundations for lasting recovery. The availability of various treatment options, combined with increased insurance coverage and flexible payment solutions, means help is more accessible than ever before.

However, recovery from opioid addiction extends beyond simply stopping drug use. It also involves rebuilding relationships, developing healthy coping mechanisms, and creating a fulfilling life free from substance dependence. With proper support, dedication, and evidence-based treatment, individuals can overcome the challenges of opioid addiction and move forward toward a healthier, more stable future. The path to recovery may be different for each person, but the possibility of healing and renewal remains constant for everyone.