Opioid Addiction Treatment, Signs and Symptoms of Abuse, Overdose and Withdrawal
What is opioid addiction?
Opioid addiction is a chronic (long-lasting) disease that can cause major health, economic and social problems. Opioids are a class of drugs that act in the nervous system to produce feelings of pain relief and pleasure. Some opioids are legally prescribed by healthcare providers to manage chronic and severe pain.
Many prescription opioids are misused or diverted to others. Individuals who become addicted may prioritize getting and using these drugs over other activities in their lives, often negatively impacting their professional and personal relationships. It is unknown why some people are more likely to become addicted than others.
According to the National Institute if Health (NIH) , opioids change the chemistry of the brain and lead to drug tolerance, which means that over time the dose needs to be increased to achieve the same effect. Taking opioids over a long period of time produces dependence, such that when people stop taking the drug, they have physical and psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety).
Commonly prescribed opioids include:
Some other opioids, such as heroin, are illegal drugs of abuse.
Opioid addiction is characterized by a powerful, compulsive urge to use opioid drugs, even when they are no longer required medically. Opioids have a high potential for causing addiction in some people, even when the medications are prescribed appropriately and taken as directed.
What is opioid dependence?
Dependence is not the same thing as addiction; although everyone who takes opioids for an extended period will become dependent, only a small percentage also experience the compulsive, continuing need for the drug that characterizes addiction.
Opioid addiction can cause life-threatening health problems, including the risk of overdose. Opioid overdose occurs when high doses of opioids cause breathing to slow or stop, leading to unconsciousness and death if the overdose is not treated immediately. Both legal and illegal opioids carry a risk of overdose if a person takes too much of the drug, or if opioids are combined with other drugs (particularly tranquilizers called benzodiazepines).
Statistics on Opioid Addiction
Opioid use disorder and opioid addiction remain at epidemic levels in the US and worldwide. According to the National Center for Biotechnology Information (NCBI) , three million US citizens and 16 million individuals worldwide have had or currently suffer from opioid addiction. In addition, more than 500,000 in the United States are dependent on heroin. In 2017, opioid overdose was declared a national emergency in the United States.
The increase in opioid addiction can be partially attributed to overprescribing of opioid medications. Four million people admit to the nonmedical use of prescription opioids. Perhaps more concerning, 400,000 people had used heroin in the past month based on data from 2015 through 2016. Roughly 80% of new heroin users in the United States report pills as their initiation to opioid use and subsequent opioid addiction.
Signs and Symptoms of Opioid Addiction
Symptoms of substance use disorders, including opioid use disorders, can be physical, psychological, or behavioral. In many cases, it can be difficult to ascertain whether someone is struggling with addiction. Potential warning signs of opioid addiction include:
- Loss of coordination
- Shallow or slow breathing rate
- Intense nausea or vomiting
- Slurred speech
Psychological and Behavioral
- Anxiety attacks
- Drastic mood swings
- Lowered motivation
- Poor decision making
- Abandoning responsibilities
- Financial hardship
- Changes in sleeping patterns
- Spending less time with family and loved ones
What causes opioid addiction?
Opioid drugs alter the brain by creating artificial endorphins. Besides blocking pain, these endorphins make the user feel good. Unfortunately, too much opioid use can cause the brain to rely on these artificial endorphins. Once your brain does this, it can even stop producing its own endorphins. The longer someone uses opioids, the more likely this is to happen. They also will need more opioids over time because of drug tolerance.
Drug tolerance is when the body, over time, gets used to the effects of a drug. As this happens, the person may need to take a higher dose of the drug to get the same effect. For example, when someone takes opioids over time, they need a higher dose to get the same pain relief.
If a person stops using an opioid for some time, their tolerance will fade. If they need to begin retaking it, they most likely will not need their former higher dose. That can be too much for the body to take. If they stop taking a medication and then resume, talk to your doctor about dosage.
The causes of opioid addiction are complex. This condition results from a combination of environmental, genetic, and lifestyle factors, some of which have not been identified. Many of the genes that are thought to play a role in opioid addiction are involved in the endogenous opioid system, the body’s internal system regulating pain, reward, and addictive behaviors.
Opioid addiction is a complex disorder, and nongenetic factors also play a critical role.
Factors that have been shown to increase the risk of opioid addiction include:
- A history of substance abuse
- Depression or other psychiatric disorders
- Childhood abuse or neglect
- Certain personality traits, including impulsivity and sensation-seeking
It is likely that a combination of health, social, economic, and lifestyle factors interact with genetic factors to determine an individual’s risk.
How is opioid addiction diagnosed?
Diagnosing opioid addiction requires a thorough evaluation, which may include obtaining the results of urine drug testing and prescription drug monitoring program (PDMP) reports, when opioid addiction is suspected.
It is also important to remember that opioid addiction exists on a continuum of severity. As a result, a scale for assigning severity exists and is based upon the number of criteria that have been met (mild, moderate, severe). This severity distinction has opioid addiction treatment implications.
According to the U.S. Center for Disease Control and Prevention (CDC)  :
- Opioid use disorder (OUD) is defined in the DSM-5 as a problematic pattern of opioid use leading to clinically significant impairment or distress
- OUD was previously classified as Opioid Abuse or Opioid Dependence in DSM-IV
- OUD has also been referred to as “opioid addiction.”
- About 2.1 million Americans had opioid use disorder in 2016
In order to confirm a diagnosis of OUD, at least two of the following should be observed within a 12-month period:
- Opioids are often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
- A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
- Craving, or a strong desire or urge to use opioids.
- Recurrent opioid use resulting in a 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 are given up or reduced because of opioid use.
- Recurrent opioid use in situations in which it is physically hazardous.
- 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.
- Exhibits tolerance.
- Exhibits withdrawal.
Tolerance is defined as either:
- 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 an opioid.
You can refer specifically to DSM-5 Criteria A and B for opioid withdrawal syndrome:
Criterion A: Either of the following:
- Cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer)
- Administration of an opioid antagonist after a period of opioid use
Three (or more) of the following, developing within minutes to several days after Criterion A:
- Dysphoric mood
- Nausea or vomiting
- Muscle aches
- Lacrimation or rhinorrhea
- Pupillary dilation
- Piloerection, or sweating
Steps to prevent opioid addiction
Opioids are safest when used for three or fewer days to manage acute pain, such as pain that follows surgery or a bone fracture. If you need opioids for acute pain, work with your doctor to take the lowest dose possible, for the shortest time needed, exactly as prescribed.
If you’re living with chronic pain, opioids are not likely to be a safe and effective long-term opioid addiction treatment option. Many other opioid addiction treatments are available, including less-addictive pain medications and nonpharmacological therapies. Aim for an opioid addiction treatment plan that makes it possible to enjoy your life without opioids, if possible.
Help prevent addiction in your family and community by safeguarding opioid medications while you use them and disposing of unused opioids properly. Contact your local law enforcement agency, your trash and recycling service, or the Drug Enforcement Administration (DEA) for information about local medication takeback programs. If no take-back program is available in your area, consult your pharmacist for guidance.
The most important step you can take to prevent opioid addiction? Recognize that no one is safe, and we all play a role in tackling the grip these drugs currently hold on our loved ones and communities.
Opioid use can lead to death due to the effects of opioids on the part of the brain which regulates breathing.
An opioid overdose can be identified by a combination of three signs and symptoms:
- pinpoint pupils
- difficulties with breathing
According to the World Health Organization (WHO) , worldwide, about 500 000 deaths are connected to drug use. More than 70% of these deaths are linked to opioids, with more than 30% of those deaths caused by overdose. According to WHO estimates, approximately 115 000 people died of opioid overdose in 2017. Opioid overdoses that do not lead to death are several times more common than fatal overdoses.
Emergency responses to opioid overdose
Death following opioid overdose is preventable if the person receives basic life support and the timely administration of the drug naloxone. Naloxone is an antidote to opioids that will reverse the effects of an opioid overdose if administered in time. Naloxone has virtually no effect in people who have not taken opioids.
According to the National Center for Biotechnology Information (NCBI) , opioid overdose should be promptly treated with naloxone to reverse the effects of the drug, particularly respiratory depression. Adequate intravenous access allows IV fluid administration and repeats naloxone dosing when indicated. Begin with an intravenous dose of 0.4 to 0.8 mg to reverse neurologic and cardiorespiratory symptoms. People who have taken large doses of very potent opioids may require larger doses. Naloxone can also be administered intranasally and intramuscularly.
Risk factors for opioid overdose
There are a number of risk factors for opioid overdose. These include:
- Having an opioid use disorder
- Taking opioids by injection
- Resumption of opioid use after an extended period of abstinence (e.g. following detoxification, release from incarceration, cessation of opioid addiction treatment)
- Using prescription opioids without medical supervision;
- High prescribed dosage of opioids (more than 100 mg of morphine or equivalent daily).
- Using opioids in combination with alcohol and/or other substances or medicines that suppress respiratory function such as benzodiazepines, barbiturates, anesthetics or some pain medications
- Having concurrent medical conditions such as HIV, liver or lung diseases or mental health conditions.
Opioid addiction treatment
Opioid addiction is a chronic disease and should be treated the same as other chronic diseases. Like those, it should constantly be monitored and managed.
Opioid addiction treatment is different for each individual. The main purpose of opioid addiction treatment is to help the person stop using the drug. Opioid addiction treatment also can help the person avoid using it again in the future.
When someone stops using opioids, the body will react. The person will have a number of symptoms, including nausea and vomiting, abdominal pain, and anxiety. This reaction is called withdrawal and is treated in opioid addiction treatment.
Different types of medications may be useful at different stages of treatment to help clients stop abusing drugs, stay in treatment, and avoid relapse.
When clients stop using drugs, they can experience various physical and emotional symptoms, including restlessness or sleeplessness and depression, anxiety, and other mental health conditions. Certain opioid addiction treatment medications and devices reduce these symptoms, making it easier to stop drug use.
Staying in treatment
Some opioid addiction treatment medications and mobile applications are used to help the brain adapt gradually to the absence of the drug. These opioid addiction treatments act slowly to help prevent drug cravings and have a calming effect on body systems. In addition, they can help clients focus on counseling and other psychotherapies related to opioid addiction treatment .
Science has taught us that stress cues linked to drug use (such as people, places, things, and moods) and drug contact are the most common triggers for relapse. So scientists have been developing therapies to interfere with these triggers to help patients stay in recovery.
Common medications used to treat opioid addiction and withdrawal
- Methadone and Buprenorphine
- They help reduce withdrawal symptoms by targeting the same centers in the brain that opioids target. Only they do not make you feel high. Instead, they help restore balance to your brain and allow it to heal. According to the National Institutes of Health (NIH), you may safely take the medicines long-term, even for a lifetime. It would help if you did not quit them without first telling your doctor.
- It is another medicine doctors may prescribe. This medicine doesn’t help you stop taking opioids. Instead, it is to help you prevent from relapsing. Relapsing means to start taking opioids again. This medicine is different from methadone and buprenorphine because it does not help with cravings or withdrawal. Instead, according to NIH, it prevents you from feeling the high you would normally feel when you take opioids.
Behavioral therapies in treating opioid addiction
Cognitive-behavioral therapy seeks to help patients recognize, avoid, and cope with the situations in which they’re most likely to use drugs.
Contingency management uses positive reinforcement such as providing rewards or privileges for remaining drugfree, for attending and participating in counseling sessions, or for taking opioid addiction treatment medications as prescribed.
Motivational enhancement therapy uses strategies to make the most of people’s readiness to change their behavior and enter opioid addiction treatment.
Family therapy helps people (especially young people) with drug use problems and their families, address influences on drug use patterns, and improve overall family functioning.
Twelve-step facilitation (TSF) is an individual therapy typically delivered in 12 weekly sessions to prepare people to engage in 12-step mutual support programs. 12-step programs, like Narcotics Anonymous, are not medical opioid addiction treatments but provide social and complementary support to those in opioid addiction treatments. TSF follows the 12-step themes of acceptance, surrender, and active involvement in recovery.
Find the Right Opioid Addiction Treatment Plan
A trained addiction treatment professional is the best place to start developing an opioid addiction treatment plan for yourself or a loved one. They can evaluate your needs to determine if methadone or Suboxone is a good medically assisted treatment option and develop a schedule for group therapy, individual therapy, and possibly alternative therapies. Get started on the road to recovery at We Level Up NJ.