Opioid Use Disorder: Causes, Symptoms and Treatment Options
Opioid use disorder (OUD) is a mental health condition that involves a problematic pattern of opioid misuse that causes distress and/or impairs one’s daily life. Opioids are a class of drugs that are chemicals — natural or synthetic — that interact with nerve cells and have the potential to reduce pain. Opioids can be prescribed by a doctor to treat acute or chronic pain, or they can be obtained illegally for recreational purposes. Some examples of opioids include oxycodone, morphine, codeine, fentanyl and heroin.
OUD is a chronic (lifelong) condition with serious potential consequences, including disability, overdoses, relapses and death. According to the Centers for Disease Control and Prevention (CDC), more than 800,000 Americans died from drug overdoses from 1999 to 2020, and opioids were involved in most of those deaths. OUD is a public health crisis that affects people of all ages, races, genders and socioeconomic backgrounds.
What causes opioid use disorder?
It is not yet known why some people develop OUD and others do not. There are many factors that may contribute to the development of OUD, such as:
– How opioids affect the brain: Opioids bind to receptors in the brain and spinal cord that are involved in pain perception and reward. Opioids can produce pain relief and, for some people, euphoria — a sense of heightened well-being. Experiencing euphoria after taking opioids may be a warning sign of vulnerability to OUD. Over time, the brain adapts to the presence of opioids and becomes less sensitive to them. This leads to tolerance, which means that higher doses are needed to achieve the same effect or that the same dose produces less effect over time. Tolerance can also increase the risk of overdose, as people may take more opioids than their body can handle.
– Family history and genetics: OUD may run in families, as some people may inherit genes that make them more susceptible to OUD or influence how they respond to opioids. Studies have identified several genes that are associated with OUD, such as those involved in opioid metabolism, receptor function and reward pathways. However, genes are not the only factor that determines whether someone will develop OUD or not. Environmental and lifestyle factors also play a role.
– Environmental and lifestyle factors: These include stress, trauma, peer pressure, social norms, availability of opioids, co-occurring mental health disorders and other substance use disorders. People who experience stress or trauma may use opioids to cope with negative emotions or to escape from reality. People who are exposed to opioid use by their peers or family members may be influenced by their behavior or attitudes. People who live in areas where opioids are easily accessible or where there is a high demand for them may be more likely to obtain them. People who have mental health disorders such as depression, anxiety or post-traumatic stress disorder (PTSD) may have a higher risk of developing OUD, as they may use opioids to self-medicate their symptoms. People who have other substance use disorders such as alcoholism or nicotine dependence may also have a higher risk of developing OUD, as they may have a predisposition to addiction or use opioids in combination with other substances.
What are the symptoms of opioid use disorder?
OUD is characterized by symptoms such as:
– Strong desire or craving for opioids
– Inability to control or reduce opioid use
– Continued opioid use despite interference with major obligations or social functioning
– Use of larger amounts or for longer periods than intended
– Development of withdrawal symptoms when opioid use is reduced or stopped
– Spending a lot of time obtaining, using or recovering from opioids
– Giving up or reducing important social, occupational or recreational activities because of opioid use
– Using opioids in situations where it is physically hazardous
– Continuing opioid use despite having persistent or recurrent physical or psychological problems caused or worsened by opioids
How is opioid use disorder diagnosed?
OUD is diagnosed by a health care provider based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard reference for mental health diagnosis. The DSM-5 defines OUD as a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following criteria 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 opioids, use opioids or recover from their 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.
– Opioid use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.
– Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of opioids to achieve intoxication or desired effect; (b) a markedly diminished effect with continued use of the same amount of opioids.
– Withdrawal, as manifested by either of the following: (a) the characteristic opioid withdrawal syndrome; (b) opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.
The severity of OUD is determined by the number of criteria met:
– Mild: 2–3 criteria
– Moderate: 4–5 criteria
– Severe: 6 or more criteria
How is opioid use disorder treated?
OUD is a treatable condition that requires a comprehensive and individualized approach. The main components of OUD treatment are:
– Medication-Helped treatment (MAT): This involves the use of medications that can help reduce opioid cravings, prevent withdrawal symptoms and block the effects of opioids. MAT can help people with OUD stop using opioids and stay in recovery. The most common medications used for MAT are:
– Methadone: This is a synthetic opioid that activates the same receptors as other opioids, but at a slower and steadier rate. Methadone can prevent withdrawal symptoms and reduce cravings without producing euphoria. Methadone is taken orally once a day under the supervision of a licensed clinic.
– Buprenorphine: This is a partial opioid agonist, which means that it activates the opioid receptors but to a lesser degree than other opioids. Buprenorphine can also prevent withdrawal symptoms and reduce cravings without producing euphoria. Buprenorphine is usually combined with naloxone, an opioid antagonist that blocks the effects of opioids and can reverse an overdose. Buprenorphine/naloxone is taken sublingually (under the tongue) or buccally (in the cheek) once a day or as prescribed by a doctor who has a special waiver to prescribe it.
– Naltrexone: This is an opioid antagonist that blocks the effects of opioids and can reverse an overdose. Naltrexone can prevent relapse by making opioid use ineffective and undesirable. Naltrexone is taken orally once a day or as an injection once a month by a health care provider.
– Cognitive-behavioral therapy (CBT): This is a type of psychotherapy that helps people with OUD identify and change their thoughts, feelings and behaviors related to opioid use. CBT can help people with OUD cope with stress, triggers, cravings and negative emotions. CBT can also help people with OUD develop skills to prevent relapse, such as problem-solving, goal-setting, self-monitoring and coping strategies.
– Contingency management (CM): This is a type of behavioral therapy that uses positive reinforcement to encourage desired behaviors. CM can help people with OUD adhere to their treatment plan, such as taking their medication, attending therapy sessions and staying abstinent from opioids. CM involves giving people with OUD rewards, such as vouchers, prizes or money, for meeting their treatment goals.
– Motivational interviewing (MI): This is a type of counseling that helps people with OUD explore their ambivalence about changing their opioid use and enhance their motivation to do so. MI involves using open-ended questions, reflective listening, affirmations and summaries to elicit and strengthen the person’s own reasons for change. MI can help people with OUD resolve their ambivalence and commit to their treatment plan.
– Peer support: This involves connecting people with OUD with others who have lived experience of OUD and recovery. Peer support can provide emotional, informational and practical support to people with OUD. Peer support can also help people with OUD feel less isolated, more hopeful and more empowered in their recovery journey. Peer support can be delivered through various formats, such as self-help groups, recovery coaches, mentors or sponsors.
What are the treatment options for opioid withdrawal?
Opioid withdrawal is the set of physical and psychological symptoms that occur when someone who is dependent on opioids stops or reduces their opioid use. Opioid withdrawal can be very uncomfortable and unpleasant, but it is not life-threatening. Opioid withdrawal symptoms usually start within 6 to 12 hours after the last dose and peak within 1 to 3 days. The duration and severity of opioid withdrawal depend on several factors, such as the type, dose and frequency of opioid use, the duration of opioid dependence, the person’s metabolism and health status.
Opioid withdrawal symptoms may include:
– Restlessness
– Anxiety
– Irritability
– Insomnia
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