What is Opioid Use Disorder (OUD)?
Defining OUD and DSM Criteria
Opioid use disorder is a condition that adversely affects the lives of millions of Americans. In 2016 about 2.1 million Americans were reported suffering from the disorder. The condition creates an enormous difficulty controlling opioid use, regardless of its negative consequences, sometimes confused as opiate addiction. The DSM-V defines opioid use disorder as a problematic pattern of opioid use, which leads the user to significant clinical impairment or distress.
DSM requires confirmation of OUD when at least two of the following are present within 12 months:
- Opioids are often taken in more significant amounts or over a more extended period than originally intended.
- A continuous desire, unsuccessful efforts to decrease the dosage, or at least, control opioid use.
- A great deal of concentrating on how to obtain, use, or recover from opioid effects.
- Cravings and urges to use opioids.
- Failure to fulfill primary role obligations due to opioid use.
- Continued use despite having constant problems caused or exacerbated by the effects of opioid use.
- Discontinuation or reduction of social, occupational, or recreational activities because of opioid use.
- Repeated opioid use in physically hazardous situations.
- Opioid use despite the understanding of having a persistent or recurrent physical or psychological adverse effects caused or exacerbated by opioid use.
- Presence of tolerance
- Symptoms of withdrawal in case there is a reduction or discontinuation of the drug.DSM excludes those individuals who may experience tolerance and withdrawal, which are taking opioids solely under appropriate medical supervision.
What Are Opioids?
Opioids are a class of drugs that bind to specific receptor sites, mostly in the brain. When opioid drugs bind to these receptors, a chemical activation occurs. This activation causes a sense of pain relief and a feeling of euphoria. Opioid drugs include prescription medications such as morphine and OxyContin, illicit street drugs like heroin and replacement medications such as methadone and buprenorphine. More recently, there has been a deadly influx of synthetic opioids in the United States, mainly fentanyl. Fentanyl is often added to heroin or other street drugs to intensify euphoria and numbing effects. This potent mixture of drugs is continuously responsible for thousands of accidental overdoses.
Reasons for Opioid Use
One of the leading causes of opioid use disorder has been the excess of prescriptions written by physicians for pain relief. In other words, irresponsible medical practices. Although safety measures were taken a bit late for so many less fortunate patients, new prescribing practices from the Centers for Disease Control and Prevention (CDC) are now in place. The CDC cautions when prescribing opioids and encourages prescribers to limit opioids to shorter time frames (i.e., days to weeks). There are also new prescribing limits and more comprehensive and available data regarding patients’ history.
Although, a large number of people are suffering from opioid addiction due to physical pain there are those who are masking emotional distress. People who use street drugs such as heroin or synthetic opioids are often self-medicating untreated mental health issues. The constant torment of emotional pain leads people to seek numbing devices, especially narcotics. Over time, using opioid drugs — whether legally prescribed or illegally obtained — can lead to addiction.
Opioid Use Disorder Symptoms
Opioid use disorder is an official diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM-5). It describes a condition in which a person has difficulty controlling their use of opioids. This could refer to prescription painkillers, heroin, or synthetic opioids such as fentanyl.
To meet criteria for opioid use disorder, a person must use opioids and have at least two of these symptoms within 12 months:
DSM Criterias
- Taking more opioids than intended
- Trying or wanting to control opioid use without being successful at doing so
- Spending large amounts of time obtaining, using, or recovering from opioids
- Experiencing strong cravings for opioids
- Failing to meet major role obligations, such as at work, home, or school. This might include failing to show up for important events or poor performance.
- Persisting in opioid use despite problems in relationships or social functioning caused by drug use (e.g., arguments, relationships ending)
- Reducing other enjoyed activities because of opioid use
- Using opioids even when it is physically unsafe to do so (e.g., when driving, sharing needles)
- Continuing to take opioids despite knowing that opioid use is contributing to a physical or psychological health problem
- Developing tolerance for opioids, which is characterized by not getting the same effects from a dose of the drug or needing more of the drug to achieve desired effects
- Withdrawal symptoms, which refers to symptoms that emerge when opioids are not taken. This commonly includes vomiting, diarrhea, runny nose, teary eyes, yawning, goosebumps, muscle aches, poor sleep, and anxiety.
As described above, opioid use disorder involves two components: physiological dependence and signs of addiction. Physiological dependence includes tolerance and withdrawal symptoms. These occur when your body begins to need opioids to function normally. Any person may develop physiological dependence when using opioids over a long period of time. However, not everyone develops an addiction. Signs of addiction include cravings and continuing to use opioids despite negative consequences. Detoxification from opioids addresses the underlying physiological dependence, but it does not help with the opioid addiction.
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Risks of Opioid Use Disorder
Opioid use disorder has several potential negative consequences — first, the possibility of common adverse side effects such as constipation, drowsiness, nausea, or vomiting. Opioids can also interact with other medications or drugs. For example, having opioid use disorder and also taking alcohol, certain antidepressants, antibiotics, or sleeping pills can have severe consequences including death.
One of the most significant and irreversible risks of opioid addiction is an overdose. In 2017, more than 49,000 Americans died from an opioid-related overdose. Overdose deaths occur because this class of drugs has a depressant effect on the central nervous system. In other words, taking opioids causes breathing and heart rate to slow down or even stop. Consequently, when a person uses too many opioid drugs or mixes it with another depressant substance, they are at significant risk of an overdose.
Narcan (Naloxone) for Overdose
Overdoses are not always deadly, but they can be. Medications like naloxone (brand name Narcan) can reverse an overdose, potentially saving someone’s life. However, administering naloxone only stops an overdose while it is happening. It cannot address the underlying symptoms that fuel the addiction. As a result, many people who overdose once and don’t receive adequate treatment, go on to continue abusing opioids.
Treatment for Opioid Use Disorder
No one treatment cures opioid use disorder. However, multiple interventions are tremendously successful and effective in the treatment of Opioid Use Disorder.
Medication-Assisted Treatment (MAT)
Although providers often prescribe medications like buprenorphine (Sublocade, Suboxone) and methadone to treat opioid use disorder, they are not always effective. It is important to know that these are opioids themselves, and can lead to further dependence and lengthier withdrawal symptoms. Furthermore, people who experience medication side effects may need to continue to use the drugs over extended periods, and do not always address the underlying causes of addiction. In many cases, this approach replaces merely one drug (painkillers or heroin) with another.
Treatment of Opioid Use Disorders
Medical Opioid Detox
Treatment for acute withdrawal syndromes such as a medically supervised withdrawal or rapid detoxification is very successful because this type of method helps reverse opioid dependence effectively and rapidly. Furthermore, a medical detox also assists in improving the patient’s physical health, which facilitates his or her participation in psychotherapy or any mental health program they choose. It is essential to understand that being completely off opioids, helps patients better consider abstinence because they are thinking much more clearly.
Successful medical detox protocols use particular medication to control vitals while clearing the body of all opioids. Also, an inpatient medical detox allows the patient to comprehensive-around-the-clock medical supervision for greater comfort and safety.
Length and protocol of medical detoxification rely on different unique factors including:
- Age
- Health history
- Types of opioids
- Duration of use
- Method
- Emotional health and much more.
Rapid Detox Under Anesthesia (Waismann Method®) for OUD
Another form of treatment for opioid use disorder is anesthesia-assisted rapid detox. With rapid detox, the patient sleeps under sedation while a combination of medications, including antagonists, are used to induce and speed the acute withdrawal. When performed correctly and responsibly rapid detox is a safer, more humane, and compassionate approach for treating opioid abuse. The provision of 24/7 medical care ensures that people going through detox have the medical support they need to withdraw from opioids safely.
After detox is complete, recovery care is critical to provide time for physical, psychological, and emotional recovery. This additional professionally-assisted phase also gives people the opportunity to address the issues that may perpetuate addiction. For example, many people begin using opioids to self-medicate psychological or emotional pain. Once opioids are no longer available, they need new strategies to address those underlying issues. Psychotherapy can address the root causes of opioid addiction and provide new coping skills.
Rather than masking the effects of opioid use disorder by giving an alternative opioid drug, starting with an effective medical detox sets people up for a long-lasting opioid-free life.
Source
- https://www.asam.org/docs/default-source/education-docs/dsm-5-dx-oud-8-28-2017.pdf?sfvrsn=70540c2_2
- https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
- https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder
- https://www.nejm.org/doi/full/10.1056/NEJMra1604339
