Opioids are a class of drugs that include prescription pain relievers like oxycodone, hydrocodone, codeine, morphine, fentanyl, and related drugs such as heroin. Opioids interact with opioid receptors on nerve cells in the brain and central nervous system. When opioids attach to these receptors, they can relieve pain and produce feelings of pleasure. However, they can also lead to potential harms, including overdose and death, especially when combined with other drugs or alcohol.
What is Opioid Use Disorder?
Opioid Use Disorder develops when a person takes opioids for non-medical purposes or takes them in amounts or by routes other than prescribed. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines opioid use disorder as a problematic pattern of opioid use leading to clinically significant impairment or distress. A diagnosis is based on evidence of impaired control over opioid use, social impairment, risky opioid use, and pharmacological criteria such as withdrawal. The severity of the disorder ranges from mild to severe based on the number of criteria met by an individual. Opioid use disorder is a chronic brain disease involving compulsive, prolonged self-administration of opioids despite harmful consequences.
Signs and Symptoms of Opioid Use Disorder
Common signs and symptoms of opioid use disorder include:
- Taking larger amounts of opioids or taking them over a longer period than intended
- Persistent desire or unsuccessful efforts to cut down or control opioid use
- Spending a great deal of time obtaining or using opioids or recovering from their effects
- Craving or a strong desire to use opioids
- Recurrent opioid use resulting in failure to fulfill major role obligations at work, school, or home
- Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids
- Important social, occupational, or recreational activities given up or reduced because of opioid use
- Recurrent opioid use in situations in which it is physically hazardous
- Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids
- Tolerance as defined by either a need for markedly increased amounts of opioids to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount
- Withdrawal manifestations as manifested by characteristic opioid withdrawal symptoms or opioids are taken to relieve or avoid withdrawal
Risk Factors for Developing Opioid Use Disorder
Several risk factors can increase someone's vulnerability to developing an opioid use disorder, including:
- Personal or family history of substance use disorders
- Exposure to childhood trauma like abuse or domestic violence
- Mental health conditions like depression, bipolar disorder, or schizophrenia
- Genetic factors that influence the brain's response to rewarding and addictive drugs
- Environmental factors like socioeconomic status, peer pressure, and social norms
- Being prescribed high doses or long-term opioid therapy for chronic pain
- Substance use at a young age
- Not having strong social support networks
Treatment Options for Opioid Use Disorder
Treating opioid use disorder is a complex process that typically requires long-term care. The goals of treatment are to reduce cravings and drug use, improve function, and help the individual remain engaged in treatment. The most effective treatment options include:
- Medication-Assisted Treatment (MAT) - FDA-approved medications like buprenorphine, methadone and naltrexone help relieve drug cravings, block the euphoric effects of opioids, and normalize body functions. They work best when combined with behavioral therapy.
- Behavioral Therapy - Includes cognitive-behavioral therapy, motivational incentives, contingency management, and family/group therapy to develop coping strategies and support recovery.
- Residential and Outpatient Treatment Programs - Structured programs offering MAT, counseling, life skills training, recovery support groups and relapse prevention strategies.
- Peer Recovery Support - Support from those in long-term recovery helps enhance treatment outcomes and prevent relapse through shared understanding and encouragement.
- Overdose Reversal Medications - Naloxone can temporarily reverse the effects of opioids and be administered during an overdose emergency to prevent death until emergency help arrives.
The Path to Long-Term Recovery
Recovery from opioid use disorder is a lifelong process, but it is possible with the right treatment and social support system in place. Relapse is common, but repeated treatment attempts can help people maintain recovery over time. Recovering individuals work on changing behaviors and relationships, addressing trauma and co-occurring conditions, and engaging in self-care and wellness practices like regular exercise, nutrition, sleep, and stress reduction. Finding purpose and meaning through work, education, or activities in the recovery community also enhances long-lasting recovery and overall well-being. Though challenging, sustained recovery is achievable for those suffering from opioid use disorder.
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