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What is Opioid Use Disorder (OUD)?

Opioid use disorder (OUD) occurs when someone misuses opioids and develops an addiction to them.

Opioids are highly addictive because they cause physical dependence. This is a physical condition that forms due to the chronic use of tolerance-forming drugs (like opioids). 

If you become addicted to an opioid (and then stop use abruptly), withdrawal symptoms will occur. It only takes the body a short time to adjust to the presence of opioids, and the withdrawal symptoms will be intense. They can include: 

  • Anxiety
  • Pain
  • Chills
  • Cramps
  • Diarrhea
  • Vomiting
  • Nausea
  • Insomnia
  • Restlessness
  • Dilated pupils
  • Cravings
  • Severe shaking (in severe cases, delirium tremens or DTs)

According to the US Department of Health and Human Services, more than 760,000 people have died since 1999 from a drug overdose. Two out of three of these deaths in 2018 involved an opioid.1

According to the Centers for Disease Control and Prevention, the age-adjusted rate of deaths involving synthetic opioids (other than methadone) increased by more than 1000 percent between 2013 and 2019.2

DSM-5 Diagnostic Criteria for OUD

OUD is a chronic medical condition. To diagnose OUD, doctors determine if at least two of the following 11 symptoms have occurred within the last 12 months:

  • Using larger amounts of opioids over a longer period than intended
  • Failing to cut down or control opioid use without success 
  • Investing a lot of time obtaining or using the opioid or recovering from its effects
  • Craving or having a strong desire to use opioids
  • Neglecting work, school, or home responsibilities
  • Continued opioid use despite negative social or interpersonal problems
  • Avoiding or spending less time engaged in previously enjoyed activities because of opioid use
  • Using opioids in hazardous situations
  • Continued opioid use despite physical or psychological problems linked to drug use 
  • Developing a tolerance to the drug’s effects and needing more and more to achieve the desired effect
  • Experiencing withdrawal symptoms or using opioids to avoid withdrawal symptoms

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What Causes Opioid Use Disorder? 

Genetic and environmental factors play a role in the development of opioid use disorder. These drugs are also easy to access.

Additionally, some prescription opioids tend to take effect quickly and are extremely potent. This makes them more addictive. People who mix other mind-altering substances, including alcohol, have a higher risk of developing an addiction.

In some cases, opioid addiction begins with a doctor’s prescription of the drug. 

What are the Most Addictive Opioids?

Some of the most addictive opioids include:

Fentanyl

Fentanyl is a synthetic opioid that is up to 100 times more potent than its natural counterpart, morphine. It’s very powerful and fast-acting and the effects wear off quickly, increasing the desire to use more.

Oxycodone (OxyContin)

Oxycodone is a commonly used semi-synthetic painkiller. Misuse of the drug was so widespread that the manufacturer created a new formula designed to reduce misuse in 2010. People misusing the drug take it orally or bypass the abuse-deterrent formula by injecting or snorting the drug after crushing it.

Morphine (Extended-release Version, MS Contin)

Opium is extracted from the opium poppy plant, while morphine is the primary active component of opium. It’s prescribed to treat moderate to severe pain. Doctors prescribe the extended-release version to help with chronic pain management. 

People misuse the drug by crushing the tablet and snorting or smoking it, or mixing it with liquid and injecting it. This increases the risk of addiction and overdose because the drug reaches the bloodstream all at once.

Demerol (Meperidine)

Demerol is most often used in hospital settings for pain management. It’s very potent and only intended for short-term use. People misusing the drug swallow it, snort it, or inject it.

Vicodin and Other Combination Hydrocodone Products

Hydrocodone is a combination of prescription opioids mixed with analgesics, such as aspirin or acetaminophen. 

The DEA re-classified hydrocodone medications as Schedule II in 2014, due in part to how frequently people misuse these drugs. This made hydrocodone harder to obtain for recreational use. The medication has a similar potency to heroin and is prescribed for both pain relief and as a cough suppressant.

Percocet (Combination Oxycodone Products)

Percocet contains oxycodone and acetaminophen. It’s prescribed for moderate to significant pain relief. The drug features a warning regarding addiction, misuse, and abuse on its label. 

Symptoms of Opioid Use Disorder 

Symptoms of opioid use disorder include:

  • Intense cravings for the drug
  • Tolerance for the drug, so larger amounts and more frequent doses are needed to achieve the same effect
  • Anxiety
  • Nervousness
  • Depression
  • Irritability
  • Fatigue
  • Sleep problems
  • Interpersonal issues
  • Neglect of personal hygiene
  • Inability to enjoy once-loved activities
  • Lack of concentration
  • Inability to manage time
  • Difficulties making and/or keeping commitments
  • Neglecting responsibilities
  • Lack of judgment
  • Reckless or dangerous behavior

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OUD in Pregnant Women

According to the CDC, the number of pregnant women with OUD more than quadrupled between 1999 and 2014. 

Misuse of opioids during pregnancy is associated with a variety of negative outcomes for both mother and baby.3

Use of opioid drugs during pregnancy increases the risk of:

  • Maternal death
  • Preterm birth
  • Stillbirth
  • Neonatal abstinence syndrome (NAS)

How to Prevent an Opioid Overdose

Recognizing an opioid overdose can be challenging. It’s always best to assume the worst and seek medical attention, even if there are legal risks. 

Signs of an opioid overdose include:

  • Constricted pupils
  • Loss of consciousness
  • Slow, shallow breathing
  • Limp body
  • Choking
  • Pale, cold, and/or blue skin

It’s possible to reverse an opioid overdose if you act quickly enough. Victims of overdose are given Naloxone, an FDA-approved “rescue drug” that counteracts the life-threatening effects of an overdose. 

In 2018, the US Surgeon General recommended that people at risk of overdose, as well as friends, family, and community members, carry Naloxone to administer if overdose is suspected. Naloxone has no risk of abuse.4 

Additionally, many states have passed Good Samaritan or 911 Drug Immunity Laws to protect people who call 911 to report a potential overdose. These laws provide immunity from arrest and prosecution for people experiencing or witnessing symptoms of a drug overdose. 

Treatment Options for Opioid Abuse & Addiction

There are several options for people suffering from opioid addiction. These include:

  • Medication-Assisted Therapy (MAT) There are three medications approved to treat opioid use disorder: buprenorphine, methadone, and naltrexone. Buprenorphine and methadone can help you manage withdrawal symptoms throughout the detoxification process. Naltrexone is less commonly used, but it blocks your opioid receptors, making it impossible to get high. Medication-assisted therapy is most effective when combined with other forms of treatment.
  • Inpatient Programs — Inpatient programs are the most intensive and effective treatment options for opioid addiction. These programs guide you through medically supervised detoxification, then behavioral therapy and other services (possibly including MAT), will be added to your treatment. They typically last 30, 60, or 90 days, however they may be longer if necessary.
  • Partial Hospitalization Programs (PHPs) PHPs are also known as intensive outpatient programs (IOPs). They are the next most intensive type of treatment for opioid addiction. They provide similar services to inpatient programs such as detoxification, behavioral therapy medical services, and custom treatments such as MAT. The difference is that in a PHP, the patient returns home to sleep. Some programs will include transportation and meals, but this varies by program. Partial hospitalization programs are helpful for both new patients and patients who have completed inpatient treatment and still need intensive recovery therapy.
  • Outpatient Programs Outpatient programs work best for people who have a high level of motivation to recover. They create treatment programs that work around your schedule. These programs can either be an effective treatment option for new patients or a part of an aftercare program for people who complete inpatient or partial hospitalization program.

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Resources

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Departments of Health and Human Services, Digital Communications Division (DCD). “Opioid Crisis Statistics.” HHS.gov, 2018.

Mattson, Christine L., et al. “Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019.MMWR. Morbidity and Mortality Weekly Report, vol. 70, no. 6, 12 Feb. 2021, pp. 202–207, 10.15585/mmwr.mm7006a4.

Centers for Disease Control and Prevention. “The Number of Women with Opioid Use Disorder at Labor and Delivery Quadrupled from 1999-2014.” www.cdc.gov, 2019.

Department of Health and Human Services, Digital Communications Division (DCD). “Better Availability of Overdose-Reversing Drugs.” HHS.gov, 2018.

Centers for Disease Control and Prevention. “Opioid Basics | CDC’s Response to the Opioid Overdose Epidemic | CDC.” www.cdc.gov, 17 June 2021.

Office of the Surgeon General, Assistant Secretary for Health. “Opioid Overdose Prevention.” HHS.gov, 3 Apr. 2018.

National Conference of State Legislatures. “Drug Overdose Immunity and Good Samaritan Laws.www.ncsl.org, 5 June, 2017.

Related Pages

Opioid Use Disorder

Addiction Treatment

Opioid Use Disorder

Rehab

Types of Drugs

Opioids

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