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Opioid Use Disorder

(OUD; Opioid Abuse; Opioid Addiction; Opioid Dependence)

Definition

Opioids are a class of drugs made from opium. Other synthetic or semi-synthetic drugs are also made to act like opium and are included here. Opioids include those that are:

  • Legal when prescribed by a doctor—oxycodone, codeine, morphine, and fentanyl
  • Illegal such as heroin—called narcotics

Opioid use disorder (OUD) is an out-of-control need and craving for these drugs. It is severe enough to affect how you relate to people and how you act at work and school. Habits that suggest OUD include:

  • Snorting pills
  • Mixing with other drugs and alcohol
  • Using opioids for the wrong reasons like to get high or fall asleep

Causes  ^

Opioids are very addictive. They cause changes in the pathways in the brain. These pathways impact your sense of reward and well-being. Opioids create a quick, deep feeling of pleasure. A sense of well-being and calm follows. The problem is that your brain will begin to need more of the drug to get the same effect. This is called drug tolerance.

Other things that may play a role in OUD are:

  • Your genes
  • The support of your peers
  • Your personality

How it Affects the Brain
neurotransmitter

Opioids help release chemicals in the brain that cause joy. Over time, you need more drugs to cause the same release. This leads to misuse.

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Risk Factors  ^

OUD is more common in males and people under 30 years old. The risk gets lower with age. Other things may raise the chance of abuse:

Symptoms  ^

OUD can lead to:

  • Rapid increase in the amount of medicine needed
  • Moving from one doctor to another for more medicine
  • Craving the opioid
  • Being unable to stop or limit your use
  • Using a lot of effort to get more of the opioid
  • Use that gets in the way of doing normal things
  • Making a habit of using the opioid even though it causes problems

The drugs also change other systems in your body. This can lead to a physical dependence. Your body begins to need the drug to get through the day. When you stop or lower the medicine you can get ill. This can include intense nausea, vomiting, shaking, and sweating. This can make it even harder to stop using.

Diagnosis  ^

OUD can be hard to detect. It often starts in someone who needs pain medicine for a long-term problem. This can make it hard to tell if you have OUD or a problem with pain.

Your doctor will ask about your symptoms and your health history. The doctor will also ask about your use of opioids. A physical exam will be done.

Treatment  ^

The first step is to stop using the drug, also known as detox. The second step is to change behaviors to stop from using the drug again. Get help from your doctor and a support team to help your through. Treatment may include a combination of approaches such as:

Rehabilitation

Rehabilitation (rehab) may be inpatient or outpatient. Inpatient rehab means staying in a care center for many weeks up to 1 year. The time needed depends on the addiction and factors that lead to it. Before going home, some inpatients live at halfway houses. This can help you slowly meet challenges in the real world. Outpatient rehab can also last up to a year, but you can live at home. Outpatients make frequent visits to clinics for support. All rehab involves:

  • Removal and controlled withdrawal with medicines (detox)
  • Treatment for other mental health problems like depression or anxiety
  • Therapy and support to make behavioral changes

Support Groups

Narcotics Anonymous is a 12-step support program. It helps to support people who are recovering from OUD.

Behavioral Therapy

Behavioral therapy changes people’s views and actions about OUD. You will learn how to stay away from settings in which you are most likely to use drugs. You will also learn new coping skills to better deal with stresses. Therapy sessions may be one on one, in a group, or with your family.

Medicines

Certain medicines can help to decrease withdrawal symptoms. You may continue some so you don’t get cravings or start using again. Common medicine options include:

  • Methadone
  • Buprenorphine
  • Naltrexone
  • Buprenorphine/Naloxone—a combined drug

The choice of medicine will depend on drugs you abuse, your health history, and how much you want to recover.

Other medicines can treat issues like depression or anxiety. These may help you return to your life and avoid using again.

Nerve Stimulation

A small electrical nerve stimulator is placed behind the ear. It sends electrical pulses to the brain. It may ease withdrawal symptoms.

Prevention  ^

The best way to prevent OUD is not to use opioids.

RESOURCES:

Family Doctor—American Academy of Family Physicians
https://familydoctor.org

National Institute on Drug Abuse
https://www.drugabuse.gov

CANADIAN RESOURCES:

Canadian Centre on Substance Abuse
http://www.ccsa.ca

Centre for Addiction and Mental Health
http://www.camh.ca

REFERENCES:

Edlund M, Steffick D, Hudson T, Harris KM, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007;129(3):355-362.

FDA grants marketing authorization of the first device for use in helping to reduce the symptoms of opioid withdrawal. US Food & Drug Administration website. Available at: https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm585271.htm. Updated November 15, 2017. Accessed April 18, 2018.

Hall W, Doran C, Degenhardt L, Shepard D. Illicit opiate abuse. National Center for Biotechnology Information website. Available at: http://www.ncbi.nlm.nih.gov/books/NBK11797. Accessed April 18, 2018.

Opiate addiction treatment programs. Addiction-Treatment website. Available at: https://www.addiction-treatment.com/research/opiate. Accessed April 18, 2018.

Opioid abuse and dependence. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T219069/Opioid-abuse-and-dependence. Updated March 5, 2018. Accessed April 18, 2018.

Opioid addiction. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/opioid-addiction. Updated July 24, 2017. Accessed April 18, 2018

Opioid withdrawal. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115893/Opioid-withdrawal. Updated November 17, 2017. Accessed April 18, 2018.

Praveen KT, Law F, O'Shea J, Melichar J. Opioid dependence. Am Fam Physician. 2012;86(6):565-566.

The science of addiction. National Institute on Drug Abuse website. Available at: https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preface. Updated July 2014. Accessed April 18, 2018.

Treatment approaches for drug addiction. National Institute on Drug Abuse website. Available at: https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction. Updated January 2018. Accessed April 18, 2018.

Types of treatment programs. Principle of drug addiction treatment: A researched-based guide. National Institute on Drug Abuse website. Available at: https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs. Updated January 2018. Accessed April 18, 2018.

Last reviewed March 2018 by EBSCO Medical Review Board Adrian Preda, MD  Last Updated: 4/25/2018

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