Opioid Use Disorder

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Opioid Use Disorder

Opioid use disorder is a misuse of opioid substances. Opioids are usually used to treat pain and with continued use of opioids, the body can develop dependence. Opioid dependence causes withdrawal symptoms, which makes it difficult to stop taking them, consequently developing an addiction. Commonly abused opioids include codeine, fentanyl, heroin, morphine, opium, methadone, oxycodone, and hydrocodone. Opioid use disorder can begin at any age, but problems with opioid use are most commonly first observed in late teens or early 20's.

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Opioid Use Disorder Defined

Opioid use disorder includes signs and symptoms that reflect compulsive, prolonged self-administration of opioid substances that are used for no legitimate medical purpose. Although opioids usually are prescribed to control pain, diminish cough, or relieve diarrhea, they also produce feelings of euphoria, tranquility, and sedation that may lead the patient to continue to take these drugs despite the development of serious related problems. Opioid use disorder, with severity specified as mild, moderate, or severe, depending on the number of diagnostic criteria that have been met. While it can range from mild to severe, even a mild disorder can escalate and lead to serious problems, so early treatment is important.

Different Types of Opioid Use Disorder:

There are not separate types of opioid use disorders, but there are levels of severity. These levels are based on which criteria is met, which is listed under symptoms.

Mild: Presence of 2-3 symptoms.

Moderate: Presence of 4-5 symptoms.

Severe: Presence of 6 or more symptoms.

Opioid Use Disorder Causes:

There can be several causes to opioid use disorder. Various factors like genetic, psychological, social and environmental factors can all impact how taking opioid affects your body and behavior. For certain people taking opioids has a different and stronger impact that can lead to opioid use disorder that it may not have on others.

Opioid Use Disorder Symptoms:

To be diagnosed with an opioid- related disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A problematic 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.

    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 need for markedly increased amounts of opioids to achieve intoxication or desired effect.
      • A markedly diminished effect with continued use of the same amount of opioid.
    11. Withdrawal, as manifested by either of the following:
      • The characteristic withdrawal syndrome for opioids.
      • Opioid (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Symptoms of opioid use disorder can include:

    • Craving
    •  Sweating
    •  Euphoria or general discontent
    •  Chronic constipation
    •  Small pupils
    •  Nausea
    •  Reduced sex drive
    • Sensitivity to pain
    •  Shallow breathing or slurred speech

If you are taking opioids solely under appropriate medical supervision, an individual does not meet this criteria. Opioid withdrawal causes brief, but severe, episodes of depression that can lead to suicide attempts and completed suicide. Accidental opioid overdose is common, and should not be mistaken for a suicide attempt. Opioid use disorder can include periods of opioid intoxication and symptoms of withdrawal.

Opioid intoxication:

To be diagnosed with opioid intoxication, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. Recent use of an opioid.

B. Clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that developed during, or shortly after, opioid use.

C. Pupillary contrition (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs or symptoms developing during, or shortly after, opioid use:

      1. Drowsiness or coma.
      2. Slurred speech.
      3. Impairment in attention or memory.

D. The signs or symptoms are not attributable to another medical conditioning are not better explained by another mental disorder, including intoxication with another substance.

Opioid withdrawal:

To be diagnosed with opioid withdrawal, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. Presence of either of the following:

      1. Cessation of (or reduction in) opioid use that has been heavy and prolonged (i,e. several weeks or longer).
      2. Administration of an opioid antagonist after period of opioid use.

B. Three (or more) of the following, developing within minutes to several days after Criterion A:

      1. Dysphoric mood.
      2. Nausea or vomiting.
      3. Muscle aches.
      4. Lacrimation or rhinorrhea.
      5. Pupillary dilation, piloerection, or sweating.
      6. Diarrhea.
      7. Yawning
      8. Fever.
      9. Insomnia.

C. The signs of symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

How to Approach a Loved One:

There is not a perfect way to approach a loved one that you assume or know is struggling with opioid use disorder. Many people with opioid use disorder hesitate to get treatment because they don't recognize they have a problem, so approaching them to tell them that they do have a problem can be difficult. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who may have an opioid use disorder, ask a professional experienced in drug addiction treatment for advice on how to approach that person. You can not force someone to seek professional care, but you can always offer your support and encouragement. Even though you may not be able to prevent your loved one from developing an opioid use disorder, you can still talk with them about treatment options. For more help on how to approach loved ones visit: https://www.mentalhealth.com/home/dx/opioiddependence.html#selfhelp.

Types of Opioid Use Disorder Treatment:

There are effective treatments for opioid use disorder. The first step in treatment is being able to recognize that you have have an opioid use problem, which can be difficult for most individuals. Many individuals reach this realization at very low point brought upon by opioid use disorder. Even with treatment, there is a probability that you may return to opioid use. This is more like occur if you spend time with people who use opioids or you're in environments where opioid use is common. A key part of recovery for opioid use disorder is continued support.

Aftercare programs and/or support groups help people recovering from opioid use disorder to stop using opioids, manage relapses and cope with necessary lifestyle changes. If you feel that you'll start to use opioids again, contact your mental health professional or sponsor right away to prevent a relapse. Lifestyle changes are also crucial in recovering from opioid use disorder. Ensuring that your family and friends are aware that you are recovering from opioids and develop a support system of friends and family who can support your recovery, not impair your recovery. If you have people in your life that continue to take opioids that do not support your recovery, they may impact your course of treatment and recovery. Finally, continuing to engage in other healthy habits is necessary for treatment. This can include managing stress in a healthy way, good sleep habits, maintaining a schedule, or regular physical activity can make it easier for you to recover from opioid use disorder.

Detox and withdrawal

The first step in treatment is enrolling in a program to begin detoxification or detox. This process is medically managed, which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital.

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling is used to identify the patterns of behaviors, thoughts, triggers, etc. that may impact individuals with opioid use disorder. In therapy, individuals learn skills and establishing treatment plans that usually involve drug treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. In therapy or counseling, it may help individuals better understand their problem with opioids and support recovery from the psychological aspects of opioid use. Opioid use disorder commonly occurs along with other mental health disorders, like depression and anxiety, which can be discussed in therapy.

Family therapy: This form of therapy can provide the individual with support, as well as the family in regards to how the opioid use behaviors affect the family unit. It can provide the family with skills on how to resolve issues that arise and communicate with each other in a healthy manner. Family therapy also provides the individual with support needed for their recovery.

Self- Help Groups

There are various self-help groups that are options for individuals to attend, such as Narcotics Anonymous. Some people find that talking with others who have an opioid use problem may be a helpful part of treatment. Through self-help groups, individuals find a forum of peer support, gaining strength as they share their feelings, and experiences with others who are facing the same obstacles as themselves. Self- help groups can also be helpful because you can have a sponsor that will assist in your continued recovery.

Medications

There are medications that can assist in the treatment of opioid use disorder. It is important to be cautious when withdrawing from opioid use, especially if a person has been injecting use. It can be suggested an individual be considered for opioid agonist maintenance treatment. These medications can include Methadone, Buprenorphine, and Clonidine or lofexidine. These medications can help alleviate the symptoms of withdrawal and cravings.

Residential treatment programs

For serious opioid use disorder, enrolling in a residential treatment facility may be necessary. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. These programs will include the collaborative efforts of a team, which typically include licensed drug counselors, social workers, nurses, doctors and others with expertise and experience in treating opioid use disorder.

Other practices

While medication, psychotherapy, residential programs and other treatment options are necessary in treatment, research has found that other forms of treatment can also helpful. Partaking in practices like meditation, yoga, your religious beliefs, etc., help individuals gain greater insight into their spiritual side and this is a key element in recovery.

Differences Between Common Disorders:

There are other possible causes of that resemble opioid use disorder but would not meet criteria for this disorder. These are common disorders but the differences between them and opioid use disorder.

  • Opioid- induced mental disorders- Opioid- induced disorders occur frequently in individuals with opioid use disorder. Opioid-induced disorders may be characterized by symptoms like a depressed mood. Opioids are less likely to produce symptoms of mental disturbance than are most other drugs for abuse.
  • Other withdrawal disorders-The restlessness and anxiety associated with opioid withdrawal resemble symptoms seen in sedative- hypnotic withdrawal. On the other hand, opioid withdrawal is also accompanied by rhinorrhea, lacrimation, and pupillary dilation, which are not seen in sedative-type withdrawal. Dilated pupils are also seen in hallucinogen intoxication and stimulant intoxication. However, other signs or symptoms of opioid withdrawal, such as nausea, vomiting, diarrhea, rhinorrhea, abdominal cramps, or lacrimation, are not present.
  • Other substance intoxication-Alcohol intoxication and sedative, hypnotic, or analytic intoxication can cause a clinical picture that resembles that for opioid intoxication. The naloxone challenge will not reverse all of the sedative effects.

Resources:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.

(5th ed.) Arlington, VA: American Psychiatric Association.

O’Brien CP. Drug addiction. In: Brunton L, Chabner B, Knollman B, eds. Goodman & Gilman’s the pharmacological basis of therapeutics.

12th ed. New York: McGraw-Hill, 2011:649-666.

Opioid use disorder. (n.d.). Retrieved from:
https://bestpractice.bmj.com/topics/en-us/200

Opioid use disorder. (2018). Retrieved from:
https://www.mentalhealth.com/home/dx/opioiddependence.htm

Schuckit, M. (2016). Treatment of Opioid-Use Disorders. Retrieved from:
https://www.nejm.org/doi/full/10.1056/nejmra1604339

What is Opioid Use Disorder? (2017). Retrieved from
https://www.painnewsnetwork.org/stories/2017/10/18/what-is-opioid-use-disorder

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