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What is Opioid Use Disorder?
Opioid use disorder (OUD) is a medical diagnosis given to those who suffer serious impairment or distress due to the continuous use of opioids. While other definitions like opioid addiction do exist, OUD is more commonly accepted among healthcare professionals.
OUD diagnosis is based on specific criteria, ranging from unsuccessful attempts to reduce or stop opioid use to social or family problems. People with the disorder may report having trouble meeting obligations at work, school, or home. However, as OUD is an extensive disorder, healthcare specialists assess many more signs and symptoms to provide proper diagnosis and treatment.
Over 2 million people aged 12 and older were diagnosed with an opioid use disorder in the United States, comprising 0.7 percent of the population.
What are Opioids?
Opioids come in many different forms:
- Prescription medications — these drugs are often prescribed to patients to treat pain. Some of the more well-known generic names include morphine, codeine, methadone, oxycodone (oxycontin), hydrocodone, fentanyl, hydromorphone, and buprenorphine.
- Illegal drugs — heroin is a morphine-derived opioid that provides a feeling of pleasure or euphoria. Its potent chemical make-up can lead to long-term effects, such as depression or anxiety, abscesses, liver and kidney disease, and much more.
- Illicit substances — Fentanyl analogs like carfentanil are chemically similar to fentanyl, a prescribed synthetic opioid 50 to 100 times more potent than morphine. Since such analogs can produce a high more easily, they are sometimes mixed with other drugs to lower costs for drug dealers.
Another way to classify different types of opioids further is through the chemical composition of the drug:
- Natural — some plants like the opium poppy can produce nitrogen-containing chemical compounds. Examples include morphine or codeine.
- Semi-synthetic/manmade — these opioids originate from the lab but with the use of natural opiates. Heroin and oxycodone are two opioids of this kind.
- Fully synthetic — this last category of opioids are completely manmade. One of the more common names pertaining to this group is fentanyl.
How Do Opioids Work?
Opioids are powerful substances that can reduce the body’s perception of pain.
When an individual takes the drug, the opioid binds immediately to specific receptors in the brain, spinal cord, and gastrointestinal tract. This opioid-receptor interaction then triggers a series of bodily signs and symptoms that could include slowing breathing, drowsiness, nausea, and more.
Similarly, because opioid use produces a sense of euphoria or high, the risk of drug misuse, abuse, and overdose is high.
In 2018, misuse of opioids occurred in approximately 10.3 million people aged 12 or older.
Regular use of opioids causes physical dependence and tolerance. Heavy usage for a few weeks would result in opioid dependence. When a person wants to stop taking opioids suddenly, they couldn't do so because they want to avoid the dangerous symptoms of opioid withdrawal.
What is Opioid Withdrawal?
Opioid withdrawal happens when a user stops or reduces opioid intake. Here is a list of some of the common opioids that could result in withdrawal:
Symptoms of Opioid Withdrawal
Given that opioids affect the receptors of various nerve cells in the body, opioid withdrawal symptoms may occur after stopping use. Early physical and mental symptoms of withdrawal include:
- Aching muscles
- Distress or agitation
- Inability to sleep (insomnia)
Withdrawal symptoms peak at around 72 hours after last use. Severe symptoms may start to appear during this time and are more uncomfortable. These includes:
- Cold flashes with goosebumps
- Stomach cramps
- Uncontrollable leg movements
Timeline of Withdrawal Symptoms
Opiate withdrawal symptoms will lengthen or shorten in time, depending on many factors. Some factors that can influence the withdrawal timeline the most are as follows:
- The severity of the addiction
- Overall health
- Frequency of opioid use
- Type of opioid
For short-acting opioids like heroin and oxycodone, symptoms may appear within 12 hours and peak within 24 to 48 hours. Symptoms then tend to subside in 3 to 5 days.
However, for long-acting opioids like methadone, symptoms may arise within 30 hours since the opioid was last taken and not disappear until 10 days have passed.
Are All Opioid Detoxes the Same?
While there are many opioids, including heroin, morphine, and oxycodone, the detox process is similar for all of them. You may experience similar symptoms from the withdrawal of each drug. In many cases, the addiction severity affects the detox process more than the type of opioid.
Treatment of Opioid Use Disorder
The treatment process for opioid use disorder is as follows:
Opioid Detoxification Process
The goal of complete detoxification is to rid the body of opioids. While detox may be short-lasting, from a few days to a couple of weeks, it is the beginning step on a path to recovery and additional treatments.
Those going through withdrawal may mistakenly believe that their current pain is the same as the original pain that led to the use of opioids. This type of experience during withdrawal is known as the “rebound effect”, in which symptoms that were either absent or controlled due to medication reappear because of a lack thereof.
Opioid withdrawal is rarely life-threatening; however, it is recommended to consult a healthcare professional to structure the most suitable approach to pain or discomfort management during that period. Sudden discontinuation of the drug or “going cold turkey” could ultimately lead to relapse in opioid use and even an unintentional overdose.
Types of Opioid Detox Medications
As detoxification can cause many symptoms and pain, medical specialists may use one of the following prescribed medications to support the withdrawal period, as supported by the National Institute on Drug Abuse:
- Buprenorphine (Subutex) - this medication helps to shorten the withdrawal timeline. It neutralizes the effects of other opioids, which can reduce cravings and withdrawal symptoms.
- Methadone - another type of opioid, this drug helps to prevent other withdrawal symptoms from appearing. It also reduces any cravings arising during detox.
Methadone and buprenorphine DO NOT substitute one addiction for another. Unlike heroin or other opioids that produce an instant rush or high, methadone and buprenorphine have a more gradual effect on the brain. This means that patients can reduce their cravings to use opioids little by little.
- Naloxone - administered in various forms, Naloxone is a common drug used to prevent overdose by opioids. It may be prescribed to patients undergoing medication-assisted treatment (MAT) and/or at risk of opioid overdose.
- Clonidine - unlike some of the other prescribed medications above, Clonidine does not reduce cravings. It does, however, help to treat high blood pressure, anxiety, sweating, runny nose, and cramping.
- Naltrexone - available in a pill form or as an injectable, this drug is typically administered 7 to 10 days after opioid discontinuation. It offsets any euphoric or sedative effects that certain opiates like heroin, morphine, or codeine could cause.
For those who suffer from an opioid use disorder, a “one-size-fits-all” opioid abuse treatment does not exist. It can be extremely difficult for many to overcome this problem, many healthcare professionals recommend that detoxification is coupled with additional psychological or support services.
A more well-known therapeutic approach for OUD is medication-assisted treatment (MAT). This line of strategy aims to combine prescribed medications with behavioral counseling to address the symptoms caused by OUD and the underlying factors that may have led to the misuse of opioids.
According to Substance Abuse and Mental Health Services (SAMHSA), MAT has been proven to provide the following benefits:
- Lengthen patient survival
- Raise retention rates
- Lower illicit opiate use and other criminal activity among those suffering from an OUD
- Improve an individual’s ability to get and maintain a job
- Improve birth outcomes among pregnant women who have an OUD
Co-Occurring Mental Health Disorders and Opioid Withdrawal
People with mental, personality, and substance use disorders are at heightened risk for non-medical use of prescription opioids. Each person who requires opioid detox and treatment for an opioid use disorder will receive a different treatment plan according to their needs. Those with co-occurring mental health disorders will receive treatment for their condition.
Whether you suffer from co-occurring mental health disorders or not, staff members of a facility will create a customized drug abuse treatment plan to fit your unique needs.
If you believe that you or a loved one suffers from an opioid use disorder or may be at risk of developing an OUD, please reach out to your nearest healthcare specialist to determine the best therapeutic approach.