Opioid Dependence

Opioid Dependence

Opioid Dependence

Opioid use disorder is a dependence on the use of opioids that leads to great distress and impairment. Many people begin taking them for pain management and then keep increasing the dose to get the same level of pain reduction, becoming reliant on the destructive doses in as few as 1 to 8 weeks. Misuse can quickly lead to physical and mental disability and death, depending on the potency of the opioid used.

Opioids are substances that mainly act on pain receptors in the central and peripheral nervous system and the gastrointestinal tract. These receptors facilitate both the mind-changing and bodily effects of opioids.

Opioids are mostly prescribed to provide pain relief. They can also be prescribed to treat diarrhea or induce cough suppression, but they are frequently used recreationally for their euphoric effects. They can be ingested orally, injected, or snorted. Opioids include substances such as fentanyl, oxycodone, and hydrocodone. Side effects of opioids may include itchiness, sedation, nausea, respiratory depression, constipation, and intense feelings of happiness.

Prevalence

According to the Center for Disease Control and Prevention (CDC), there were approximately 47,000 prescription or opioid-related overdose deaths in the United States in 2018 — 194% higher than deaths from heroin use, and 213% higher than deaths from prescription painkillers. The opioid crisis was declared a nationwide public health emergency in late 2017.

Long-term opioid use occurs in approximately 4% of people following their use for trauma, surgery-related pain, or cancer care. Onset is often in young adulthood, and males are affected more often than females.

US prevention measures to address the opioid crisis include monitoring prescriptions through insurance claims, pharmacy prescriptions, and licensed healthcare practices; and educating providers, patients, and the public about the risks of misuse of prescribed opioids.

Diagnosis of Opioid Dependency:

OUD is a problematic pattern of opioid use leading to distress, with at least two of the following occurring within a 12-month period:

  1. Taking higher doses to get the desired effect
  2. Wanting to quit or to control amount used / frequency of use but never succeeding
  3. Spending a lot of time each day to get, use, or recover from using the opioid
  4. Strongly craving opioids
  5. Difficulty fulfilling responsibilities at work, school, or home
  6. Continuing to use opioids in spite of the social and relational consequences
  7. Giving up previously enjoyed activities in order to spend more time using opioids
  8. Putting others in danger by performing life-endangering activities while high — driving, operating heavy machinery, etc.
  9. Continuing to use opioids despite the obvious physical or mental problems caused by using them
  10. Tolerance – need for increased amounts to get the same “high”
  11. Experiencing withdrawal – opioid withdrawal syndrome
  12. Taking opioids or a similar substance to lessen or avoid withdrawal symptoms

Opioid withdrawal syndrome is characterized by:

  • Nausea, vomiting
  • Muscle aches, chills, cramps
  • Diarrhea
  • Trouble sleeping, yawning, restlessness
  • Runny nose
  • Dilated pupils
  • Agitation, irritability, low mood, anxiety, goosebumps
  • Severe cravings

Risk factors for Opioid Dependence:

Opioid Use Disorder (OUD) is a chronic lifelong disorder with serious potential consequences including disability, relapses, and death. Fentanyl, in particular, can be lethal due to its potency and damage to the brain and body.

Risk factors for OUD include a history of substance use — even nicotine, substance use among family and friends, mental illness such as severe depression or anxiety, low socioeconomic status, and race.

Complications of OUD include the acquisition of blood-borne viruses such as HIV and hepatitis C in users who inject and share needles; and overdose, which in many cases is lethal.

Treatment for Opioid Dependence:

Treatment should be tailored to the individual based on the level of opioid dependence and work and home support levels. Medication-assisted treatment (MAT) combines meds with counseling and therapy, and this decreases the risk of death.

  • Medication – Individuals with OUD are often treated with opioid replacement therapy plans, which can include some of the following:

    • Methadone – Administered in regulated drug treatment clinics as a replacement for opioids to prevent withdrawal symptoms and gradually tapered off. Daily visits are required early on.
    • Buprenorphine – Administered in regulated drug treatment clinics during detoxification to prevent or reduce cravings and withdrawal symptoms. This is a safer gradual detox medication than methadone as daily visits are not required, and it partially blocks some of the negative effects of opioid.
    • Naloxone – An overdose can be reversed with naloxone if given within a very short time window. It blocks the body’s opioid receptors and restores breathing.
    • Naltrexone – can only be given if the patient has gone through a detox program and has no opioids in the body. It may also be useful to prevent relapse as it blocks the effects of opioids.
  • Therapy – Cognitive-behavioral therapy, motivational therapy, and individual or group therapy and peer support programs such as Narc-Anon can all contribute to a successful treatment plan.
  • Education – about the effects of opioid abuse and how to prevent a relapse. Long-term outpatient management is vital to avoid relapse.

Diagnosis of Opioid Dependency

OUD is a problematic pattern of opioid use leading to distress, with at least two of the following occurring within a 12-month period:

  1. Taking higher doses to get the desired effect
  2. Wanting to quit or to control amount used / frequency of use but never succeeding
  3. Spending a lot of time each day to get, use, or recover from using the opioid
  4. Strongly craving opioids
  5. Difficulty fulfilling responsibilities at work, school, or home
  6. Continuing to use opioids in spite of the social and relational consequences
  7. Giving up previously enjoyed activities in order to spend more time using opioids
  8. Putting others in danger by performing life-endangering activities while high — driving, operating heavy machinery, etc.
  9. Continuing to use opioids despite the obvious physical or mental problems caused by using them
  10. Tolerance – need for increased amounts to get the same “high”
  11. Experiencing withdrawal – opioid withdrawal syndrome
  12. Taking opioids or a similar substance to lessen or avoid withdrawal symptoms

Opioid withdrawal syndrome is characterized by:

  • Nausea, vomiting
  • Muscle aches, chills, cramps
  • Diarrhea
  • Trouble sleeping, yawning, restlessness
  • Runny nose
  • Dilated pupils
  • Agitation, irritability, low mood, anxiety, goosebumps
  • Severe cravings

Risk factors for Opioid Dependence

Opioid Use Disorder (OUD) is a chronic lifelong disorder with serious potential consequences including disability, relapses, and death. Fentanyl, in particular, can be lethal due to its potency and damage to the brain and body.

Risk factors for OUD include a history of substance use — even nicotine, substance use among family and friends, mental illness such as severe depression or anxiety, low socioeconomic status, and race.

Complications of OUD include the acquisition of blood-borne viruses such as HIV and hepatitis C in users who inject and share needles; and overdose, which in many cases is lethal.

Treatment for Opioid Dependence:

Treatment should be tailored to the individual based on the level of opioid dependence and work and home support levels. Medication-assisted treatment (MAT) combines meds with counseling and therapy, and this decreases the risk of death.

  • Medication – Individuals with OUD are often treated with opioid replacement therapy plans, which can include some of the following:

    • Methadone – Administered in regulated drug treatment clinics as a replacement for opioids to prevent withdrawal symptoms and gradually tapered off. Daily visits are required early on.
    • Buprenorphine – Administered in regulated drug treatment clinics during detoxification to prevent or reduce cravings and withdrawal symptoms. This is a safer gradual detox medication than methadone as daily visits are not required, and it partially blocks some of the negative effects of opioid.
    • Naloxone – An overdose can be reversed with naloxone if given within a very short time window. It blocks the body’s opioid receptors and restores breathing.
    • Naltrexone – can only be given if the patient has gone through a detox program and has no opioids in the body. It may also be useful to prevent relapse as it blocks the effects of opioids.
  • Therapy – Cognitive-behavioral therapy, motivational therapy, and individual or group therapy and peer support programs such as Narc-Anon can all contribute to a successful treatment plan.
  • Education – about the effects of opioid abuse and how to prevent a relapse. Long-term outpatient management is vital to avoid relapse.