Opioid Use Disorder
Opioid-use disorder is a life-threatening condition that has become all too familiar in the United States over the past two decades.
The damage began when the increased prescribing of opioids in the 1990s began a disturbing trend of opioid-related deaths that continues today.
Between 1999 to 2017 the number of overdose deaths involving prescription opioids rose nearly 5 times prompting the declaration of a National Public Health Emergency in October 2017.
One in four people prescribed opioids can become addicted to them. About 45% of heroin users start with an addiction to prescription opioids. Many people experiencing opioid use disorder were introduced to these drugs through legitimate medical practitioners.
What are opioids?
Opioids are natural, semi-synthetic, or synthetic chemicals that interact with opioid receptors in the body and brain and reduce the perception of pain.
Prescription opioids are used to treat acute pain (recovering from injury or surgery), chronic pain, active-phase cancer treatment, palliative care, and end-of-life care. Opioids can also cause drowsiness, confusion, euphoria, nausea, and constipation. At high doses, they can slow breathing which can lead to death.
Fentanyl and heroin (respectively synthetic and semi-synthetic opioids) are created in a laboratory to mimic the effects of natural opiates such as morphine. They are developed to be stronger and more potent than natural opiates. Synthetic opioids—particularly fentanyl—account for 87% of opioid deaths and 65% of all drug overdose deaths as of June 2021.
Fentanyl
Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. Pharmaceutical fentanyl is prescribed to manage severe pain. Because fentanyl is cheaply, easily, and often illegally made, it is frequently found in combination with heroin, counterfeit pills, and cocaine.
Risk factors
Opioid use disorder is a chronic disorder, with serious potential consequences including disability, relapses, and death.
As with other substance use disorders, both family history and environmental factors, such as poverty, exposure to trauma, or limited access to care, contribute to the risk of opioid use disorder. Access to prescription opioids and to heroin has contributed heavily to the current opioid epidemic.
Withdrawal from opioids offers a risk in itself. Physical dependence can begin within days or weeks of taking opioids. Once dependent, or addicted, the body has difficulty functioning without opioids. Even when they wish to stop, many people continue using opioids to prevent the severe withdrawal symptoms. Abruptly stopping opioids use leads to symptoms including generalized pain, chills, cramps, diarrhea, dilated pupils, restlessness, anxiety, nausea, vomiting, insomnia, and very intense cravings.
Symptoms
Opioids produce feelings of euphoria which increase the odds that people will continue using them despite negative consequences. Opioid use disorder is diagnosed when at least two of the following occur within a 12-month period:
Taking larger amounts or taking drugs over a longer period than intended.
Persistent desire or unsuccessful efforts to cut down or control opioid-use.
Spending a great deal of time obtaining or using the opioid or recovering from its effects.
Craving, or a strong desire or urge to use opioids.
Problems fulfilling obligations at work, school, or home.
Continued opioid use despite having recurring social or interpersonal problems.
Giving up or reducing activities because of opioid use.
Using opioids in physically hazardous situations such as driving.
Continued opioid use despite ongoing physical or psychological problems likely to have been caused or worsened by opioids.
Tolerance (i.e., need for increased amounts or diminished effect with continued use of the same amount)
Experiencing withdrawal or taking opioids to relieve or avoid withdrawal symptoms.
Treatment
Opioid use disorder often requires continuing care to be effective. Evidence-based care for opioid use disorder can and should be based on what works best for the individual, and may include a combination of the following:
Personalized diagnosis and treatment planning tailored to the individual and family.
Long-term management – Addiction is a chronic condition with the potential for both recovery and recurrence. Long-term outpatient care and support is important.
Access to FDA-approved medications.
Effective behavioral interventions delivered by trained professionals.
Coordinated care for addiction and other conditions.
Recovery support services: mutual aid groups, peer support specialists, and community services.
Different levels of treatment may be needed, including outpatient counseling, intensive outpatient treatment, inpatient treatment, or long-term therapeutic communities.
Medication
Medications for opioid use disorder are used to relieve cravings, relieve withdrawal symptoms, and block the euphoric effects of opioids. These medications do not “cure” the disorder, but rather improve patient safety by controlling withdrawal symptoms that can lead to relapse or continued drug use.
The U.S. Food and Drug Administration emphasizes that these medications do not substitute one addiction for another. The dosage given in treatment does not cause euphoria (a high)—it helps reduce opioid cravings and withdrawal. It helps restore balance to the brain circuits affected by addiction.
These three FDA-approved medications are commonly used to treat opioid use disorder.
Methadone – Prevents withdrawal symptoms and reduces cravings but does not cause a euphoric feeling. It is available only in specially regulated clinics.
Buprenorphine (Subutex)– Partially blocks the effects of other opioids, displaces opioids in the body, and reduces or eliminates withdrawal symptoms and cravings.
Naltrexone – Blocks the effects of other opioids preventing the feeling of euphoria. It is available from office-based providers in pill form or monthly injections.
Medication-assisted treatments can help people stay in treatment. They reduce opioid use, overdoses, and other risks associated with opioid use disorder, including HIV and Hepatitis C infection.
In emergency situations, Naloxone (Narcan, Evzio) can reverse and block the effects of an opioid overdose. It is available as a prefilled auto-injection device, as a nasal spray, and as an injectable. Naloxone is safe and has no effects if administered to someone not experiencing an opioid overdose.
Psychotherapy
Cognitive behavioral therapy (CBT) can encourage motivation to change destructive habits and to provide education about treatment and relapse prevention.
Avoiding opioids
One of the best ways to prevent opioid addiction is to avoid using them in the first place. The American Medical Association recommends talking with a physician about pain medications or treatments that are not opioids to avoid bringing opioids into the home.
Depending on the type of pain being experienced, options may include:
Acetaminophen (Tylenol®), ibuprofen (Advil®), naproxen (Aleve®)
Cognitive behavioral therapy (CBT) – a psychological, goal-directed approach in which patients learn how to modify physical, behavioral, and emotional triggers of pain and stress
Exercise therapy, including physical therapy
Certain medications for depression or for seizures, some of which can also treat pain
Interventional therapies, like injections
Exercise and weight loss
Other therapies such as acupuncture and massage
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