Opioid use disorder

What’s Opioid use disorder

Opioids produce feelings of euphoria which increase the odds that people will continue using them despite negative consequences. Opioid use disorder (OUD) is a chronic disorder, with serious potential consequences including disability, relapses and death. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5-TR) describes opioid use disorder as a problematic pattern of opioid use leading to problems or distress, with at least two of the following occurring within a 12-month period:

• 1. Taking larger amounts or taking drugs over a longer period than intended.
• 2. Persistent desire or unsuccessful efforts to cut down or control opioid use.
• 3. Spending a great deal of time obtaining or using the opioid or recovering from its effects.
• 4. Craving, or a strong desire or urge to use opioids.
• 5. Problems fulfilling obligations at work, school or home.
• 6. Continued opioid use despite having recurring social or interpersonal problems.
• 7. Giving up or reducing activities because of opioid use.
• 8. Using opioids in physically hazardous situations such as driving while under the influence of opiates.
• 9. Continued opioid use despite ongoing physical or psychological problem likely to have been caused or worsened by opioids.
• 10. Tolerance (i.e., need for increased amounts or diminished effect with continued use of the same amount).
• 11. Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

Opioid withdrawal

While opioid use disorder is similar to other substance use disorders in many respects, it has several unique features. Opioids can lead to physical dependence within a short time, as little as 4-8 weeks.3 In other words, the body will become used to opioids so that it has difficulty functioning without opioids. With chronic use, abruptly stopping use of opioids leads to withdrawal symptoms, including generalized pain, chills, cramps, diarrhea, dilated pupils, restlessness, anxiety, nausea, vomiting, insomnia, and very intense cravings. However, people do not die from opioid withdrawal. Because these symptoms are severe it creates significant motivation to continue using opioids to prevent withdrawal. 3% to 19% of people who take prescription pain medications develop an addiction to them.5 People misusing opioids may try to switch from prescription pain killers to heroin when it is more easily available. About 45% of people who use heroin started with an addiction to prescription opioids.

Treatment of Opioid Use disorder:

Effective treatments are available; however, only about one in four people with opioid use disorder receive specialty treatment. Considered the “gold-standard” of treatment, medications for opioid use disorder (MOUD), are an evidence-based treatment for individuals with an opioid use disorder.6 Counseling and behavioral therapies may be an important part of treatment alongside medications; however, they are effective by themselves.7 Medications are also used to relieve cravings, relieve withdrawal symptoms and block the euphoric effects of opioids. These medications do not “cure” the disorder, but rather improve safety and prevent withdrawal symptoms which can lead to relapse or continued drug use.

Three U.S. Food and Drug Administration (FDA)-approved medications are commonly used to treat opioid use disorder:

• Methadone– Prevents withdrawal symptoms and reduces cravings in people with OUD. It does not cause a euphoric feeling once patients become tolerant to its effects. It is available only in specially regulated clinics.

• Buprenorphine (Suboxone)– Partially blocks the effects of other opioids, displaces current opioids in the body, and reduces or eliminates withdrawal symptoms and cravings.
  o  Buprenorphine-Naloxone (Suboxone) - As stated above, buprenorphine partially blocks the effects of opioids. Suboxone combines buprenorphine with naloxone (see below) to prevent accidental or intentional use to get high.
  o  Buprenorphine extended-release (Sublocade) – a once-a-month injection of buprenorphine that is available to individuals that have shown tolerance to oral buprenorphine.

Treatment typically involves cognitive behavioral approaches, such as encouraging motivation to change and education about treatment and relapse prevention. It often includes participation in mutual-aid organizations, such as Narcotics Anonymous. MOUD have been shown to help people stay in treatment, and to reduce opioid use, opioid overdoses and risks associated with opioid use disorder, including HIV and HCV. 8

Different levels of treatment may be needed by different individuals or at different times, including outpatient counseling, intensive outpatient treatment, inpatient treatment, or long-term therapeutic communities. Opioid use disorder often requires continuing care to be effective. Evidence-based care for opioid use disorder involves several components, including:

• Personalized diagnosis and treatment planning tailored to the individual and family.
• Long-term management – Addiction is a chronic condition with the potential for both recovery and recurrence. Long-term outpatient care and support is important.
• Access to FDA-approved medications.
• Effective behavioral interventions delivered by trained professionals.
• Coordinated care for addiction and other conditions.
• Recovery support services, such as mutual aid groups, peer support specialists, and community services.