Opioid Use Disorder

Opioid Use Disorder is the abuse of opioids. This can include pain medications, heroin, fentanyl, and even over-the-counter substances that produce an opiate type high, for example, Kratom. Abusing opiates is not only life-threatening, but it is typically a long-lasting addiction that is difficult to overcome because of its powerful physical withdrawal effects which lead people to too often relapse.   

Prescription opiates include drugs such as Vicodin, Percocet, Oxycodone, Oxycontin, Morphine, Codeine, and others. These medications relieve pain but also evoke a euphoric high that can cause someone to experience feeling happy or excited. 

Overview

Opioid abuse has affected more than 16 million people worldwide, of which over 2.1 million users are in the United States. There is an average of 120,000 deaths worldwide that occur annually from opiate abuse. In the United States, there are as many individuals using opioids daily as there are individuals diagnosed with epilepsy, psoriatic arthritis, and obsessive-compulsive disorder. 

Opioid Use Disorder involves an addiction that includes the intense urge to use opioids, increased tolerance for opioids, and withdrawal symptoms when usage is stopped. Opioid use disorder also involves dependence. 

Opioid-Use-Disorder-overview

Signs and symptoms of opioid use disorder

Individuals who are high from opioids typically present with: 

  • Unclear speech
  • Appearing numb and sleepy
  • Pinpoint pupils
  • Disturbed social functioning

Individuals who abuse opiates tend to have relationship problems. They also spend all of their money on opiates which often leads to criminal behavior such as stealing, prostitution, or doing whatever is necessary to obtain money to purchase more opiates. 

Opioid withdrawal

When an individual has become physically addicted or dependent on opiates, the physical withdrawal is extremely difficult and it is best if they are monitored by admitting themselves to a detoxification unit. The use of opiates alters the way the nerve receptors work in the brain, and these receptors also become reliant on the drug to function properly. 

Symptoms of opioid withdrawal

Withdrawal symptoms begin within the first 24 hours of stopping opiates and can include: 

  • Muscular pain
  • Anxiety
  • Restlessness
  • Teary eyes
  • Rhinorrhea (runny nose)
  • Profuse sweating
  • Inability to sleep
  • Yawning and dizziness

As withdrawal continues, after the first 24 to 48 hours, symptoms include: 

  • Diarrhea
  • Abdominal cramps
  • Goosebumps
  • Vomiting / Nausea
  • Dilated pupils / blurry vision
  • Faster heartbeat
  • Higher than normal blood pressure

Painful and extremely uncomfortable physical symptoms start to subside between 72 hours and one week after stopping opiates. Detoxing with proper medical attention can help ease the discomfort of withdrawal symptoms. 

Babies who are born to opioid-addicted mothers or to those who used opioids while being pregnant also experience withdrawal symptoms. These symptoms include:

  • Digestion problems
  • Failure to thrive
  • Thirst
  • Nausea / Vomiting
  • Seizures

Complications of opioid overuse

  • Deteriorating physical or mental health
  • Social and relationship consequences
  • Diminished social or entertaining activities
  • Trouble achieving professional tasks at school or work
  • The individual gets uncontrollable cravings
  • The individual is unable to decrease the amount of opiates used
  • Using regardless of its physical and mental hazards
  • Withdrawal symptoms (see above)

Diagnosis of Opioid Use Disorder

The following tests are used for diagnosis: 

Urine drug tests: These tests are necessary before starting and while maintaining methadone or buprenorphine treatment.

Lab test: If the person has a history of intravenous drug abuse, X-Rays, CT scans, and/or an Echocardiogram may be ordered. 

  • A patient who is not conscious or is dull because of opioid overdose or intoxication may need a non-contrast CT scan of the head for assessment of probable hemorrhage.
  • A chest X-ray is required for the diagnosis of aspiration pneumonia.
  • In IV opioid users with bacteremia, an echocardiogram is required to find out endocarditis.
  • Neuroimaging and neuropsychological assessments show dysregulation of the transmission linked with impulsivity, emotion, and stress. Neuroimaging reveals both functional and structural brain alterations in patients having a substance use disorder.

DSM-5 diagnostic criteria for Opioid Use Disorder:

To confirm a diagnosis of an opioid use disorder, at least two of the following symptoms should be observed within 12 months:

  • Opioids are usually taken in larger amounts or over a longer period than was intended.
  • There is a continuous urge or ineffective efforts to cut down or limit opioid use.
  • Strong cravings or urges to use opioids.
  • Frequent opioid use results in trouble in fulfilling major obligations at school, work, or home.
  • Sustained opioid use despite having persistent or recurrent social or interpersonal problems beginning or worsening by the effects of opioids.
  • Frequent opioid use in situations in which it is physically dangerous.

Risk factors of opioid use disorder

Risk factors for abusing opiates involve a previous history of a drug use disorder, younger age, severe pain, and other mental disorders occurring side by side. In addition, a risk factor for the disorder involves a history of childhood abuse (e.g. sexual abuse, physical penalties, emotional abuse, or neglecting behaviors).

Treatment of Opioid Use Disorder

Evidence-based care includes several components, including:

  • Custom-made diagnosis and treatment planning provided to the individual and family
  • Long-term management of the disorder is required, as addiction is a chronic condition with the tendency for both recovery and recurrence. Long-term outpatient care is important.
  • FDA-approved medications are available (e.g., Suboxone, Vivitrol)
  • Effective behavioral and psychological interventions delivered by trained professionals (psychologists/psychiatrists).
  • Recovery support facilities, like mutual aid groups, peer support consultants, and community services.
Opioid Use Disorder-treatment

Three FDA-approved medications are commonly used to treat Opioid Use Disorder

  1. Methadone prevents symptoms of withdrawal and diminishes cravings in people addicted to opioids. It does not cause euphoric feelings once patients start adapting to its effects. It is available in specially regulated clinics only.
  2. Buprenorphine blocks the influence of other opioids and reduces the symptoms of withdrawal and urges. Buprenorphine treatment is provided only by specially skilled and qualified physicians, practitioners, nurses, and physician assistants in medical office-based settings.
  3. Naltrexone blocks the effects of opioids by preventing feelings of euphoria. It is also available only from office-based providers in pill form or a monthly injection.

Prevention of opiate addiction/dependence: 

Naloxone is life-saving medicine. It works extremely quickly to take away the effect of an opiate overdose and return the individual to a normal breathing pattern. As a life-saving measure, it is typically given by injection. It is also available as a nasal spray.