Opioid Use Disorder Overview

Opioid use disorder is when a person's life is taken over by opioid medications: finding them, taking them, recovering from their effects, then starting the cycle over again. The condition is usually long-term and involves alternating periods of recovery and relapse. Doctors diagnose opioid use disorder based on the presence of different symptoms. It can be treatable with a combination of medications and behavioral interventions. Opioid use disorder has reached epidemic proportions in the US and was declared a Public Health Emergency in 2017. That year, almost 50,000 Americans died from opioid overdoses.

What Is It?

Opioids are strong painkillers which doctors typically prescribe after an injury, surgery, or dental procedure, or when you have cancer. Examples are heroin, morphine, fentanyl and oxycodone. While the drugs may be initially taken for legitimate reasons, opioid use disorder happens when the use spirals out of control. The person eventually needs higher and higher doses to get the same pleasurable or euphoric effect, often resulting in relationship difficulties, money problems, and criminal behavior.

Types

Drug tolerance, drug dependence, and drug use disorder or addiction are different things. You can develop physical tolerance or dependence to a drug without the accompanying mental obsession. A substance use disorder, or addiction, is when the drug dominates every aspect of your life. You feel like you can't live without it and keep using despite negative consequences. With opioid use disorder, the more symptoms you have, the more serious your disease.

Symptoms

Many signs can indicate that a person is abusing opioids. Friends and family may notice the symptoms before the patient does:

• Inability to stop using the opioid or opioids.
• Overwhelming cravings.
• Drowsiness.
• Changed sleep patterns.
• Weight loss.
• Flu-like symptoms like muscle aches.
• Dramatic mood swings.
• Slurred speech.
• Constipation.
• Agitation.
• Irritability.
• Reduced coordination.
• Slow or shallow breathing.
• Reduced sex drive.
• Poor hygiene.
• Isolation from family or friends.
• Criminal behavior such as stealing.
• Money problems.
• Apathy.
• Anxiety attacks.

Symptoms of an opioid overdose can be life-threatening. They include:

• Not responding to stimuli.
• Slow, irregular or stopped breathing.
• Slow, irregular or no pulse.
• Vomiting.
• Small pupils.

People who are withdrawing from opioids may experience cravings and anxiety as well as abdominal cramps, diarrhea, elevated blood pressure, sweating, shakiness, insomnia, and dilated pupils.

Using opioids, especially if the drugs are administered by injection, can increase your risk for other serious health conditions including HIV, hepatitis B and hepatitis C.

Causes

Addiction, including opioid use disorder, is one of the most complicated illnesses confronting humankind. All addictions are generally the result of genetic, biologic, and environmental factors.

One of the main environmental factors contributing to opioid addiction is access to medications. The number of opioid prescriptions has risen steadily over the years and as many as 12% of people who are prescribed opioids for chronic pain end up with an opioid use disorder. You don't have to have a legitimate prescription to become hooked, you could also be a friend or family member of someone with a prescription. Other environmental factors include poverty and living in a rural area.

The biological effects of opioids also play a role. Some people may be using these drugs to compensate for having lower-than-normal levels of dopamine and other neurotransmitters (chemical messengers) in the brain. This is often referred to as self-medication. A history of depression, anxiety, childhood trauma, or post-traumatic stress disorder (PTSD) may put you at risk for opioid use disorder, as can other substance use issues.

Although scientists are still teasing out exactly which genes may be involved in opioid use disorder, research shows that people who have a first-degree relative (a child, parent or sibling) with a similar disorder are more likely to abuse opioids. Men are also more likely than women to abuse opioids and to overdose. Older individuals (those between the ages of 40 and 50) are more likely to die of an overdose.

Diagnosis

There's no single test or defining physical symptom to diagnose opioid use disorder. Instead, doctors rely on a comprehensive medical history as any underlying health conditions that may predispose you to drug abuse. Diagnosis can be complicated by the fact that many people with opioid use disorder don't acknowledge that they have a problem and the fact that health care professionals have to judge whether the person is taking prescription opioids for legitimate reasons.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, says that opioid use disorder is when two of 11 problems have occurred within a one-year period. The 11 items are:

1. Spending an inordinate amount of time finding opioids, using them, or recovering from their effects.
2. Restricting other activities in order to concentrate on using opioids.
3. Strong cravings for opioids.
4. Taking more drugs than originally intended or for a longer period of time than intended.
5. A desire to control opioid use, or many unsuccessful efforts to control addictive behavior.
6. Continuing to use the drugs even when having social or personal problems probably caused or made worse by opioids.
7. Continued use in the presence of deteriorating physical or psychological health.
8. Trouble meeting work, school or personal obligations.
9. Tolerance to the drugs (needing ever larger amounts to get the same effect).
10. Withdrawal symptoms such as agitation, abdominal cramps, sweating, insomnia and diarrhea, or taking opioids to relieve withdrawal symptoms.
11. Using opioids in hazardous situations.

The more symptoms a person has, the more severe the disease.

Treatment

Just as there is no straightforward way to diagnose opioid use disorder, there is no single treatment or cure. Effective therapy commonly involves medication plus behavioral interventions, either inpatient or outpatient.

The Food and Drug Administration has approved three drugs to combat opioid use disorder.

• Methadone is a replacement or substitute for opioids which blocks the pleasurable feelings of opioid use while also reducing cravings and withdrawal symptoms. It is a "maintenance therapy," which means it has to be taken for years or longer. It is administered in specialized medical settings.
• Buprenorphine is also a maintenance therapy for opioid use disorder and, like methadone, curbs cravings and symptoms of withdrawal while preventing the mood and pain-relieving aspect of the drug.
• Naltrexone similarly works by preventing the "high" of opioids and is available in clinical settings. It can only be given to people who have been free of opioids for at least seven days.

Another drug, naloxone (brand name Narcan), works differently. It can actually reverse an opioid overdose if it is given quickly. Unlike the three maintenance drugs, it is not a long-term treatment for opioid abuse.

Medications are typically used in combination with counseling and behavioral therapies. Together, these are called medication-assisted therapy. Healthcare professionals will also seek to diagnose and treat any underlying mental illnesses which could be contributing.

Prevention

An individual's best way to prevent opioid use disorder is to never take opioids in the first place, or, if you are prescribed an opioid for pain or another condition, not to take it more than one week. If your doctor suggests taking an opioid, ask if it's really necessary and if there are any alternatives in the form of other drugs or even non-drug therapies.

Unfortunately, the wide availability of prescription opioids has stoked the US opioid crisis. There are now efforts underway to combat the epidemic by improving access to treatment, curtailing the availability of the medications, fostering better pain management strategies, and educating physicians and patients on the dangers of these medications.

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