What is Opioid Use Disorder?
Opioid Use Disorder (OUD) is when someone regularly uses opioids, leading to significant distress or trouble in their life. Opioids are strong pain relievers like heroin, morphine, codeine, fentanyl, and oxycodone. Signs of OUD may include a strong desire to use opioids, getting used to the drug’s high effects, and feeling really sick when you quit taking them. It’s observed in over 16 million people worldwide and more than 2.1 million in the United States. Shockingly, as many people regularly use opioids as those diagnosed with obsessive-compulsive disorder, psoriatic arthritis, and epilepsy in the United States. Opioids are related to over 120,000 deaths globally every year.
The number of people who have OUD and those dying from it is increasing. Therefore, it’s important to understand its complexity. Like other chronic conditions that come and go, OUD tends to flare up and then lessen, but the person is always at risk of returning to the drug. Stress, financial instability, and relationship problems can increase the risk of going back to the drug. It’s often challenging for patients to stick to their treatment regimen due to severe signs and symptoms.
The Mainstreaming Addiction Treatment (MAT) Act is a law passed to deal with the rising opioid problem. This Act allows health care providers who have a license to prescribe controlled substances to prescribe a medicine named buprenorphine for OUD, just as they would for other necessary medications. This Act aims to encourage a standard way of treating OUD and integrate substance use disorder treatment across different health care settings.
By December 2022, the MAT Act has removed a certain condition, the DATA-Waiver, earlier needed to prescribe medicines for treating OUD. Now, all DEA-registered health care providers can prescribe buprenorphine for OUD in their practice if allowed by their state law. Those who had a DATA Waiver will get a new DEA registration certificate showing the change. The law no longer limits the number of OUD patients a health care provider can treat with buprenorphine. Pharmacists can provide buprenorphine prescriptions using the physician’s DEA number. However, it is still important for health care providers to adhere to any state restrictions while treating patients with OUD. This can be confirmed on the website SAMHSA.gov.
What Causes Opioid Use Disorder?
Opioid dependence and addiction happen because of a mix of many different factors, including biological, environmental, and genetic influences, as well as personal life experiences. Most of the times, opioids are prescribed for medical reasons, but they can also be obtained illegally. If used for a while, many patients may find themselves needing the drug, a condition known as opioid dependence.
This dependence can show up in two ways: physical dependence, where the body craves the drug, and psychological dependence, where the mind strongly desires it. If someone dependent on opioids stops taking them suddenly, they’ll start to experience withdrawal symptoms. To avoid this, many people continue to use opioids, whether through legal or illegal methods. Over time, this continued use can lead to addiction and uncontrolled use of opioids, also known as Opioid Use Disorder (OUD).
OUD can happen to anyone, regardless of their level of education or financial status. Those especially at risk include people with fewer neurotransmitters like dopamine, or those whose close family members have struggled with substance abuse. Experiencing an environment where opioid use is common also increases the risk of developing OUD. This includes people who have friends using opioids or those who’ve been exposed to opioid painkillers for a previous injury. People with untreated mental health issues like depression, anxiety, post-traumatic stress disorder or history of childhood trauma are also more likely to develop OUD.
Risk Factors and Frequency for Opioid Use Disorder
Opioid Use Disorder (OUD) is a severe health issue affecting over 16 million people globally and 3 million people in the US. Regrettably, this issue causes over 120,000 deaths worldwide, and 47,000 deaths specifically in the US, each year. In fact, in the US, more people have lost their lives due to opioids than any other drug. Today, although the recreational usage of opioids has decreased since reaching its peak in 2010, almost half of the patients on long-term opioid treatment still meet the criteria for OUD.
- Over 16 million people globally and 3 million people in the US have OUD.
- OUD results in over 120,000 global and 47,000 US deaths yearly.
- Opioids have caused more deaths in the US than any other drug.
- Recreational opioid use has decreased since 2010, but it’s still a problem.
- About half of the patients on long-term opioid treatment have OUD.
It’s important to note that the extent of opioid use and dependency differs according to age and gender. Men are more likely to use opioids and become dependent on them. This is why the majority of opioid-related overdoses occur among men. However, doctors prescribe opioids more frequently to women for pain relief. Moreover, the risk of death due to opioids is highest among people aged between 40 and 50, while heroin overdoses occur mainly in the age group of 20 to 30 years.
- Men are more likely to use and become dependent on opioids, leading to the majority of overdoses.
- Doctors prescribe opioids more often to women for pain relief.
- Opioid-related deaths predominantly occur among 40 to 50-year-olds.
- Heroin overdoses are most common among people aged between 20 and 30.
Signs and Symptoms of Opioid Use Disorder
Opioid Use Disorder (OUD) is diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). OUD is recognized when a person repeatedly uses opioids within a 12-month period leading to issues or distress indicated by two or more of the following symptoms:
- Continuing to use opioids despite worsening physical or psychological health
- Insistence on using opioids, even when it leads to social and interpersonal problems
- Reduced involvement in social or recreational activities
- Struggling to meet work or school responsibilities due to opioid use
- Spending a lot of time obtaining opioids or recovering from their effects
- Taking more opioids than initially intended
- Experiencing cravings for opioids
- Unable to reduce the amount of opioids consumed
- Developing a tolerance to opioids, meaning you need to take larger amounts to feel the same effect
Continued opioid use regardless of the risk, or continuous use of opioids to avoid withdrawal symptoms, is also indicative of OUD. If a person exhibits six or more of these symptoms, they are considered to have severe OUD.
The signs and symptoms of opioid use disorder include seeking drugs constantly, facing legal or social problems due to opioid use, having multiple opioid prescriptions from different doctors, increasing opioid use over time, and showing symptoms of withdrawal such as muscle aches, diarrhea, runny nose, nerve excitability, and chills when discontinuing use.
Testing for Opioid Use Disorder
If you’re being evaluated for Opioid Use Disorder (OUD), a condition where a person has a problematic pattern of opioid use leading to serious issues or distress, your doctor will need a comprehensive account of your social and mental health history. Information about past injuries, traumatic experiences, surgeries, and times you spent in the hospital might be essential. This information can help your doctor understand how you might have started using opioids.
If you’ve been using drugs in a way that involves injecting them into your body, your doctor should perform tests to check for diseases that can spread through this method of drug use, like HIV and hepatitis B and C.
Before starting treatment for OUD, your doctor will test you for the presence of opioids in your body using a urine drug screening. This test will be done regularly during your follow-up visits too. Regular testing is critical because it lets your doctor measure how well you’re sticking to your treatment plan and whether you’ve been able to avoid illicit use of opioids.
Treatment Options for Opioid Use Disorder
Treatment for Opioid Use Disorder (OUD), which is an addiction to opioids, can improve physical and mental health, lower the risk of overdose, and help prevent illegal activities and potential legal problems. There are many ways to help patients with OUD, and treatment plans often start like those used for other ongoing health problems. These plans usually include psychological support and measures to motivate the patient to change through education, rewards for meeting recovery goals, and medication.
Cognitive behavioral therapy is one method used during treatment. This type of therapy helps patients avoid returning to drug use and encourages them to attend self-help programs such as Narcotics Anonymous. Through education and self-help, patients learn to understand how opioids have impacted their lives.
Group therapy is another helpful tool for patients with OUD, as it provides a sense of community and support to help patients stay clean. Group therapy has also been shown to be cost-effective in comparison to personal therapy.
The core of any rehabilitation program is helping patients understand that change is possible. Treatment aims to minimize behaviors that encourage illegal drug use while helping patients establish new behaviors that can decrease drug-related issues. Non-opioid medication and physical therapy can be used to manage chronic pain long-term, reducing reliance on opioid drugs.
An important part of treatment for OUD involves replacing the dangerous opioid with a safer substitute under medical supervision. Known as Medication-assisted treatment (MAT) or outpatient buprenorphine office therapy (OBOT), this helps the patient experience reduced symptoms of drug withdrawal and cravings. Almost half of the patients are able to avoid additional opioids when undergoing replacement therapy.
Two common medications used in opioid replacement are methadone and buprenorphine. Methadone is usually given to patients in a clinic, and is known to reduce feelings of euphoria, curb cravings for narcotics, and lower the risk of spreading infectious diseases through the avoidance of intravenous drug use. Buprenorphine is another option, often given orally or via a patch or implant. While both of these treatments can be effective for treating OUD, factors such as the patient’s specific needs and reactions to the medications should influence which medication is used.
Treatment length varies from person to person. Some doctors try to gradually reduce the medication after a year of treatment, while others believe the treatment should be a lifetime commitment because of the risk of falling back into old habits and potentially overdosing after stopping treatment.
Another medication option for patients with OUD is naltrexone, which blocks the effects of opioids and helps to maintain sobriety by blocking receptors that opioids normally activate. Naltrexone can only be started once a patient is completely free from opioids and has gone at least seven days without withdrawal symptoms.
Along with primary treatments, secondary or additional medications are often used to help manage services of OUD. For example, clonidine can help manage withdrawal symptoms while the dose of methadone or buprenorphine is being adjusted. Tizanidine can help reduce anxiety and muscle pain associated with opioid withdrawal. Anti-anxiety medication bupropion, anti-diarrhea drug loperamide, and anti-nausea/vomiting medication ondansetron are also sometimes used in combination with the primary treatment options.
What else can Opioid Use Disorder be?
When trying to diagnose Opioid Use Disorder (OUD), doctors have to consider a few other conditions that could potentially be the cause of the symptoms. These include:
- Faking of symptoms for some purpose (known medically as malingering)
- Abuse of other substances (like alcohol, drugs, etc.)
- Long-lasting (chronic) pain issues
- Unresolved mental health problems
Understanding and recognizing any physical and mental health illnesses is extremely important in order to accurately diagnose OUD. In many cases, OUD may be diagnosed alongside other substance abuse and mental health disorders.
What to expect with Opioid Use Disorder
Diagnosing a patient with opioid use disorder (OUD), a medical condition characterized by a problematic pattern of opioid use, allows doctors to minimize harm for patients who are on chronic opioid treatment. Doctors should provide all OUD patients with naloxone, a medication used to rapidly reverse opioid overdose. It’s important to note that patients are most likely to die from opioid-related issues during the first month of OUD treatment and the month following the end of treatment. Therefore, it’s crucial for doctors to keep in contact with the patient throughout and beyond the treatment process.
Treating OUD helps to lower the chances of long-term opioid addiction, reduce the use of illegal opioids, and decrease the death rate. In addition to these benefits, it also diminishes drug-associated crimes and the costs of handling HIV, sepsis, and other medical complications.
A notable treatment is the use of methadone, a medication used to treat opioid addiction. Studies have shown that methadone treatment can decrease the death rate by half and decrease the occurrence of hepatitis C, a liver disease, by 50%. The therapy has also been successful in reducing drug-related crimes, enhancing social relationships, and encouraging higher retention rates in rehabilitation programs.
Possible Complications When Diagnosed with Opioid Use Disorder
The most severe problem associated with Opioid Use Disorder (OUD) is addiction. This means that a person continues to use opioids even when they cause harmful effects. The addiction usually happens because the drugs overstimulate the reward system in the brain, leading to a strong urge to use the drug again. This is particularly impacted by prolonged opioid use which affects a part of the brain that controls feelings of anxiety, emotional reactions, and behaviors linked to rewards. This addiction doesn’t just affect the brain, it affects all areas of a person’s life, often leading to legal issues, loss of personal relationships, and serious health issues.
Another major problem tied to OUD is opioid withdrawal. This is when a person stops using the drug and starts to feel ill. The time it takes for withdrawal to start can differ based on the type of opioid. Withdrawal can start as early as five hours after the last heroin use, while for methadone, it might start between the second and third day after the last use. The length of withdrawal symptoms can range greatly too. Some people may only experience withdrawal symptoms for a few days, whereas others may experience them for weeks.
Lastly, a very dangerous risk associated with OUD is opioid overdose. Patients who haven’t been treated for OUD are at high risk of an overdose. However, even patients who have been treated still face a significant risk, especially between the time when they stop using the drug (detoxification) and start a maintenance therapy. The use of cognitive-behavioral therapy can reduce this risk, but unfortunately, the mortality rate for patients who use opioids long term is still very high.
Dangers of Opioid Use Disorder:
- Addiction
- Opioid withdrawal
- Opioid overdose
- Legal trouble
- Loss of personal relationships
- Serious health issues
- Extremely high mortality rate
Preventing Opioid Use Disorder
Doctors suggest using medications like methadone and buprenorphine for people suffering from opioid use disorder (OUD), a condition where a person is dependent on opioids, in order to reduce the risk of death. Another drug called naloxone is commonly used for immediate treatment if a person has taken too many opioids, which can be life-threatening. Naloxone can be given under the skin, into a muscle, directly into the vein, via the nose, or even through inhalation.
Doctors may also prescribe naloxone for patients who frequently use opioids, even if they do not have OUD. In addition, it’s really important for people with OUD to have the involvement of a specialist in addiction or pain medicine in their care. These specialists can help develop a thorough and effective treatment plan. It’s crucial to remember that overcoming any addiction, including OUD, is a tough journey that requires specialized care, support, and treatment.
