Opioids are substances that relieve pain and include fentanyl, heroin, codeine, morphine, hydrocodone, and oxycodone.
Typically, individuals with opioid use disorder begin their opoid use through obtaining prescription opioids either legally or illegally. This disorder may occur as the result of self-medicating. Prescription opioids are often misused after individuals obtain them for pain managment after surgery or trauma from an accident.
Opioid Use Disorder Signs And Symptoms
There are many opioid use disorder symptoms and signs than an individual may be engaging in opioid abuse. Substance use disorders are made up of both addiction and dependence. Addiction to substances is the most severe form of a substance use disorder.
Dependence on opioids can manifest in the following ways:
- psychological dependence
- physical dependence
- both psychological and physical dependence
Individuals may have multiple opioid prescriptions, increased drug seeking behavior, and an increased tolerance and use of opioids over time. Further, individuals may begin to experience social and legal issues due to their opioid use.
For example, an individual may spend all of their time and money on obtaining and buying opioids. This then leads them to become socially isolated and unable to pay their bills. Other opioid use disorder symptoms include medical complications due to opioid use, which can include abcesses or hospitalizations due to overdose.
Finally, individuals who engage in opioid abuse typically experience opioid withdrawal symptoms.
The symptoms and signs of opioid intoxication can include the following:
- euphoria
- increased desire to sleep
- hypothermia
- nodding of the head
- decreased pain perception
- confusion
- constipation
- miosis
- hypotension
- bradycardia
- hypokenises (i.e., slowing of movement)
- slurred speech
Symptoms of overdose from opioids may include the following:
- decrease in heart rate
- small pupils
- decrease in body temperature
- pulmonary edema (i.e., accumulation of fluid in the lungs)
- decreased level of breathing and oxygen levels
- unconsciousness
- shock
- death
Withdrawal from Opioids
Individuals who consistently take opioids on a regular basis will begin to feel withdrawal symptoms approximately five hours after their last use.
For certain opioids like methadone, withdrawal may not begin for up to two days. The length of time and type of symptoms experienced depend on the amount and type of opioid that is being used. For example, individuals who use heroin will experience the most severe symptoms after two days of no use and their withdrawal peroid can last for up to approximately two weeks.
The symptoms of withdrawal are different for each individual and can include the following:
- Muscle pain
- agitation
- increased yawning
- difficulty sleeping
- anxiety
- runny nose
- increase in tear production
- increased sweating
- goose bumps
- diarrhea
- increased blood pressure
- increased heart rate
- sneezing
- dilated pupils
- abdominal pain and cramping
- increased cravings for opioids
- shaking
Opioid Use Disorder Diagnosis
A diagnosis of OUD is defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). In order for an individual to be diagnosed with OUD, they must experience significant impairment in their social, work, and family life.
Further, two or more of the following criteria must be present within a year to be diagnosed with an Opioid Use Disorder:
- individual is unable to decrease or control the amount of opioids they use
- individual takes more opioids than they intend
- individual has an increase of opioid cravings
- individual has increased difficulty fulfilling their duties related to work or school
- individual has a decrease in their level of social engagement and recreational activities
- individual has a continued use of opioids which leads to interpersonal and social consequences
- individual continues to use opioids regardless of the danger it may incur
- individual continues to use opioids even after their use leads to psychological or physical detriment (e.g., anxiety, constipation, or depression)
- increased tolerance, withdrawal
The severity of OUD can be classified as either mild, moderate, or severe. The severity of an individual’s OUD is indicated by the number of criteria that are present at the time of diagnosis.
Opioid Use Disorder Treatment
Opioid use disorder treatment usually occurs in a long-term process in order to reduce the number of risks an individual may face during their recovery. The risks can include:
- relapse
- criminal behavior
- psychological issues
- health issues
Long-term treatment and care can reduce all of these risks for individuals diagnosed with OUD.
Some treatments look to reduce the level of drug use and eventually lead to abstinence from opioids. Other treatments may replace opioids with a prescription of methadone or buprenorphine in order to stabilize the individual and help them maintain their recovery status.
Treatment will vary for every individual and certain treatments may work better than others for different people. The highest risk of drug-related death occurs within the first four weeks of treatment and the four weeks that follow treatment. These are vulnerable periods for individuals who are being treated for OUD. Many individuals may leave their treatment programs during these time periods.
Therapy is recommended for individuals diagnosed with OUD in order to maintain long-term sobriety. Cognitive behavioral therapy is a form of therapy that seeks to develop an individual’s coping strategies and change their behavior, cognition, and emotions regarding their OUD. CBT has been successful in treating OUD, but must be used in combination with medication management.
Another common treatment for Opioid Use Disorder is drug replacement therapy. Therapy may also be used in combination with opioid replacement therapy. This type of therapy involves replacing an opioid, like heroin, with a less euphoric and longer acting opioid.
Drugs that are commonly prescribed for opioid replacement therapy include buprenorphine or methadone. These drugs are taken under intense medical supervision with individuals typically visiting a clinic each day to receive their medication dose for the day. This eliminates the risk that an individual will abuse the drug prescribed to replace the opioid they abused in the past. The overall goal of opioid replacement therapy is to provide stability and reduce the symptoms of withdrawal from opioids and cravings.
Twelve-step programs are another form of treatment an individual with OUD disorder may decide to engage in. Twelve-step programs are typically attended after withdrawal symptoms have ceased. These programs are intended to be a method for long-term prevention of relapse and maintaining a long-term recovery from opioid use.
Twelve-step programs help individuals create change in their behavior by increasing their level of support from a community of peers and attending self-help programming. The overall model of a twelve-step program enforces the idea that individuals who are addicted to substances must surrender to their addiction and recognize that they have a problem.
Twelve-step programs also increase individual self-control and restraint in order to help promote confidence in their capability to maintain a long-term recovery from opioid use.
