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Opioid Use Disorder

Definition:

Opioids are drugs that work on the nervous system to relieve pain. Opioid use disorder includes signs and symptoms that show compulsive, prolonged self-administration of opioid substances that are used for no legitimate medical purpose or, if another medical condition is present that requires opioid treatment, that are used in doses greatly in excess of the amount needed for that medical condition.  Individuals with opioid use disorder tend to develop such regular patterns of compulsive drug use that daily activities are planned around obtaining and administering opioids. Opioids are usually purchased on the illegal market but may also be obtained from physicians by falsifying or exaggerating general medical problems or by receiving simultaneous prescriptions from several physicians.  Examples of these types of drugs include: Morphine, heroin, oxycodone, Tylenol with codeine, OxyContin, Percodan, Percocet, Demerol, and Dilaudid.

Symptoms:

Mild=2-3 symptoms present

Moderate= 4-5 symptoms present

Severe= 6 or more symptoms present

If there is a pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period, then the diagnosis of opioid use disorder applies:

1. Opioids are often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.

3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.

4. Craving, or a strong desire or urge to use opioids.

5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.

6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.

7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.

8. Recurrent opioid use in situations in which it is physically hazardous.

9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

10. Tolerance, as defined by either of the following: a. a need for markedly increased amounts of opioids to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of an opioid.

11. Withdrawal symptoms such as: anxiety, restlessness, nausea, vomiting, diarrhea, and abdominal cramps

Causes:

Using opioids, especially in a way not prescribed by a doctor, can cause addiction. Opioids are highly addictive, so even infrequent use can lead to physical dependence. Habitual opioid use causes changes in the brain, specifically in the pain center. This brings on addiction.  While opioid use is a choice, some factors may increase risk of addiction. People with a family history of drug dependence and those who grow up in certain social or economic situations could be more at risk. Also, people who abuse alcohol or other drugs or who have a mental illness have an increased risk of opioid dependence.

Treatment:

Opioid addition is a complex disease, with physical, mental, social, and environmental factors. To be successful, treatment plans must address all these components. In some cases, hospitalization may be required.  Detoxification is often the first attempt at treatment. It is done in combination with other treatment options. It includes supervised withdrawal from the drug, with support and medication to help with the withdrawal symptoms.  Some opioid addicts have success with taking milder prescription opioids, such as methadone or buprenorphine, and slowly lowering the dose to wean them off the drug. This process, known as replacement therapy, is a common treatment for opioid addiction.  Cognitive-behavioral therapy teaches individuals in treatment to recognize and stop negative patterns of thinking and behavior. For instance, cognitive-behavioral therapy might help a person be aware of the stressors, situations, and feelings that lead to substance use so that the person can avoid them or act differently when they occur.