Opioid Use Disorder

Between 2002 and 2017, the total number of deaths involving fentanyl and other synthetic opioids (excluding methadone) increased by 22-fold, while the number of deaths involving heroin increased by more than 7-fold. Between July 2016 and September 2017, emergency department visits for suspected opioid overdoses increased by 30% in the United States. On Oct. 27, 2017, the opioid crisis was declared a national public health emergency.

Opioids

Opioids are substances that interact with opioid receptors on nerve cells in the body and brain to alleviate pain. They can be natural or synthetic (produced in laboratories to replicate the qualities of natural opioids). Prescription pain relievers, synthetic opioids, and heroin all fall into this category. Acute pain (such as after an injury or surgery), chronic pain, active-phase cancer treatment, palliative care, and end-of-life care are all conditions for which prescription opioids are prescribed. Many patients rely on prescription opioids to help them manage their symptoms while under the supervision of a doctor.

Opioids can cause sleepiness, mental disorientation, euphoria, nausea, and constipation in addition to reducing pain perception. They can cause respiratory depression at large doses. Oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and other prescription pain relievers are available. Fentanyl, methadone, pethidine, tramadol, and carfentanil are examples of synthetic opioids.

Fentanyl has a potency 50 times that of heroin and 100 times that of morphine. Carfentanil is a highly potent fentanyl derivative that is 10,000 times more powerful than morphine. Fentanyl, a pharmaceutical, is used to treat severe pain. Fentanyl, which is illegally synthesized, can be found in counterfeit tablets or mixed with heroin and/or cocaine. 4 "Fentanyl is the most prevalent and significant synthetic opioid threat in the United States," according to the Drug Enforcement Administration. (Apr. 2018) Recently, overdoses linked to the usage of synthetic marijuana laced with fentanyl have been documented.

Symptoms of Opioid Addiction

Opioids offer a lot of positive reinforcement, which makes it more likely that people will keep using them despite the bad repercussions. Opioid use disorder is a chronic, life-long illness with devastating implications such as impairment, relapse, and death. Opioid use disorder is defined as a problematic pattern of opioid use that leads to issues or distress, with at least two of the following events occurring over a 12-month period, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition:

Taking more medications or for longer periods of time than is recommended.

A persistent desire to reduce or regulate opioid consumption, or unsuccessful attempts to do so.

Investing a significant amount of time in obtaining, using, or recuperating from the opioid's effects.

A strong desire or drive to consume opioids is known as a craving.

Work, school, or home commitments are not being met.

Continuation of opiate use despite persistent social or interpersonal issues.

Because of opioid use, people are giving up or decreasing their activities.

Injecting opioids into a person who is in a physically dangerous circumstance.

Continued opioid use notwithstanding the presence of a physical or psychological condition that was likely exacerbated or caused by opioids.

Tolerance is a virtue (i.e., need for increased amounts or diminished effect with continued use of the same amount)

Having withdrawal symptoms (opioid withdrawal syndrome) or taking opioids (or a closely related chemical) to ease or prevent them.

In many ways, opioid use disorder is similar to other substance use disorders, but it has a few distinguishing characteristics. Opioids can cause physical dependence in as little as four to eight weeks. 2 Stopping opioid usage abruptly causes significant symptoms in chronic users, such as widespread pain, chills, cramps, diarrhea, dilated pupils, restlessness, anxiety, nausea, vomiting, insomnia, and intense cravings. Because these sensations are so intense, it's easy to feel compelled to keep using opioids to avoid withdrawal. Both hereditary and environmental factors, such as ease of availability, play a role in the likelihood of opioid use disorder, as they do with other addictions. The present opioid epidemic has been fueled by easy access to prescription opiates and heroin. 2

According to the American Medical Association (AMA), 3 to 19 percent of those who take prescription pain relievers develop a dependency on them. 3 When heroin becomes more readily available, people who abuse opioids may try to convert from prescription painkillers to heroin. According to the American Medical Association, about 45 percent of heroin users began with a prescription opioid addiction.

More than half of those who abuse opioid drugs report 3 different types of misuse. Getting them for free or stealing them from a family member or friend

Visiting various doctors in order to obtain extra prescriptions

Treatment

Although there are effective treatments available, only around one out of every four patients with opioid use disorder receives specialized therapy. Individuals with an opioid use disorder can benefit from medication-assisted treatment (MAT). It entails a combination of medicine, counseling, and behavioral therapies. Brain chemistry may play a role in both the cause and treatment of mental illness. As a result, drugs may be provided to aid in the modification of one's brain chemistry. Medications are also used to treat opioid cravings, withdrawal symptoms, and to inhibit the euphoric effects of the drugs.

Cognitive behavioral techniques are commonly used in treatment, such as boosting motivation to change and providing education about treatment and relapse prevention. Participation in self-help programs such as Narcotics Anonymous is common. MAT has been demonstrated to assist people in staying in treatment, as well as to reduce opiate usage, overdoses, and the hazards associated with opioid use disorder.

Opioid addiction is often treated with three FDA-approved medications:

• Methadone — Helps persons addicted to opioids avoid withdrawal symptoms and lessen cravings. Once patients have gotten tolerant to its effects, it does not produce a euphoric experience. It's only available in a few carefully regulated clinics.

• Buprenorphine - Reduces or eliminates withdrawal symptoms and cravings while blocking the effects of other opioids. In office-based settings, specially trained and competent physicians, nurse practitioners, and physician assistants (who have gotten a waiver from the Drug Enforcement Administration) administer buprenorphine treatment (detoxification or maintenance).

• Naltrexone - Prevents euphoria by blocking the effects of other opioids. It is offered in pill form or as a monthly injection from office-based doctors.
  

These medications, according to the National Institute on Drug Abuse (NIDA), do not replace one addiction with another. The drug used in treatment does not cause a person to become high; instead, it helps to minimize opioid cravings and withdrawal symptoms. It aids in the rebalancing of brain circuits that have been disrupted by addiction.

Different types of treatment, such as outpatient counseling, intensive outpatient treatment, inpatient treatment, or long-term therapeutic communities, may be required by different people at different times. To be effective, opioid use disorder frequently necessitates ongoing treatment. There are various components to evidence-based care for opioid use disorder, including:

Individualized diagnostic and treatment plans based on the needs of the patient and his or her family

Long-term treatment — Addiction is a chronic illness that can lead to both recovery and relapse. The importance of long-term outpatient treatment cannot be overstated.

Medication that has been approved by the FDA is available.

Professionally implemented behavioral therapies that are effective

Addiction and other medical disorders are treated in a coordinated manner.

Mutual aid groups, peer support specialists, and community services are examples of recovery support services.

Prescriptions are filed at various pharmacies so that no one notices how many drugs they receive each month.

• Morphine abuse

• Norco addiction

• Hydrocodone abuse