Opioid use disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 21, 2016
StartDiseasesOpioid use disorder

According to the U.S. Department of Health & Human Services (HHS), the nation is currently in the grips of an ever-increasing number of opioid overdoses. Opioid dependence or opioid use disorder is part of a public health crisis involving the dangerous abuse of prescription narcotic painkillers as well as street drugs such as heroin.

Contents

Definition & Facts

Opioid use disorder is listed in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V). It is estimated that around half a million Americans are currently struggling with heroin use while 1.9 million are struggling with prescription drug addiction.

An opioid is a specific class of substances that are capable of binding together with specific opioid receptors in the brain and body. By binding with these receptors, opioids can kill pain. For this reason, opioids are sometimes prescribed in the form of medications such as oxycodone, codeine, oxycontin, and hydrocodone. Opioids are also manufactured and sold illegally - the most common form being heroin.

Unfortunately, both prescription opioids and street drugs can be deadly if abused. According to the Centers for Disease Control and Prevention, an estimated 78 Americans die every day from opioid overdoses, which amounts to about 28,000 deaths per year. This includes both prescription and black market opioids, though prescription drug overdoses were more common in 2014 than heroin overdoses.

Symptoms & Complaints

In the DSM, the chief symptoms are listed as follows: 

  • Persistent desire and craving to take opioids.
  • Any effort to reduce usage is unsuccessful.
  • Much of daily life revolves around obtaining and using opioids.
  • Opioid use has a significant negative impact on ability to carry out daily life tasks.
  • Opioid use continues despite a growing number of life and/or health consequences.
  • Opioid use continues even in dangerous conditions.
  • Opioid tolerance increases, resulting in the need for ever higher doses to achieve the same effect.
  • Opioid withdrawal symptoms set in when opioids are not taken or cannot be obtained.

Withdrawal symptoms include these common complaints:

Causes

While the causes of opioid use disorder are complex and debatable, the disorder essentially results from changes to a person's brain that arise from repeated abuse of the drug. In the absence of extreme physical pain, an opioid user experiences pleasure caused by the opioid bonding to certain receptors in the brain that produce a feeling of pleasure or 'reward.' This triggers repeated use.

As an individual develops a tolerance, they require more and more of the drug to achieve the same effect and to avoid experiencing unpleasant withdrawal symptoms. Once the brain and body have become dependent on the presence of opioids, the cravings and other symptoms of opioid use disorder begin to present. At some point, many individuals begin suffering from both a chronic physical dependency and a psychosocial dependency.

It is estimated that many Americans now suffering from opioid use disorder developed their disorder as a result of having been prescribed legal opioids by physicians as a form of pain management. These opioid painkillers are commonly prescribed after major surgery or while fighting chronic illnesses such as cancer. Because opioids are highly addictive, some individuals develop an addiction without realizing it while they are taking prescription opioids.

Other individuals develop opioid use disorder after having illegally obtained prescription opioids from the very beginning. In other cases, opioid use disorder develops as a result of experimenting with black market illegal drugs with heroin being the most common example.

Diagnosis & Tests

The first step that will occur in rendering a diagnosis of opioid dependence is that the physician will take a thorough individual medical history, paying close attention to reported symptoms. In addition, the diagnosing physician may take a family medical history to determine if there is a family history of substance abuse.

Diagnosing opioid use disorder relies heavily on presentation of individual symptoms, and the DSM-5 diagnostic criteria will be consulted. The physician may rate the symptoms on a range from "mild" (with two DSM-5 diagnostic criteria present) to "severe" (with all DSM-5 diagnostic criteria present). A referral may then be made to a psychiatric provider for testing. There are a number of clinical testing tools, including scales, questionnaires and surveys that can be administered to arrive at a precise diagnosis.

Treatment & Therapy

Treating opioid use disorder can take various forms depending on the severity of symptoms and whether treatment is being administered for opioid intoxication, opioid overdose and/or opioid withdrawal. Treatment for opioid intoxication typically includes the following:

Treatment for opioid overdose typically includes the following:

  • Administration of intranasal naloxone to rapidly counteract the effects of the overdose.
  • Monitor vital signs, including breathing and heart function, and provide interventions as needed.

Treatment for opioid withdrawal typically includes the following:

  • Administration of naloxone, methadone and other legal opioid agonists in various forms to minimize risk of return to use.
  • Full detoxification (physical) followed by psychosocial treatment, which can include talk therapy, life skills training, patient education and support groups.

In general, treating opioid use disorder involves a combination of medications and counseling and requires life-long care to avoid relapse.

Prevention & Prophylaxis 

How best to prevent opioid use disorder is a complex legal, medical, and societal question. Multi-pronged public health initiatives to prevent opioid use disorder can involve increasing public awareness about the dangers of opioid abuse and policy efforts that create incentives for physicians to select alternatives to opioids and limit medication refills. Often individuals who have been prescribed opioids for pain management do not know they have opioid use disorder until they attempt to cease taking the medication.

Interrupting black market supply lines and making parents and young adults aware of dangers and health consequences are all potentially powerful ways to prevent opioid use disorder from forming. To date, efforts at the federal and state levels to prevent opioid use disorder are ongoing.