Opioid Use Disorder (OUD)

Key Takeaways

• Opioid use disorder (OUD) develops from both natural and synthetic opioids, with long-term use leading to addiction, tolerance, and dependence.
• Opioid addiction stems from the brain’s altered dopamine production, making users crave the artificial pleasure opioids induce.
• Prescription opioid misuse is a key driver of the opioid crisis, with many people transitioning to illegal drugs like heroin due to accessibility and cost.
• Common opioids abused include Vicodin, Oxycodone, heroin, morphine, fentanyl, and codeine, all of which pose high addiction risks.
• Short- and long-term health effects of opioid use include euphoria, constipation, respiratory issues, cognitive decline, and increased risk of overdose.
• Withdrawal symptoms from opioids can be severe and include nausea, muscle cramps, anxiety, and life-threatening conditions requiring medical intervention.
• Treatment options for OUD include inpatient or outpatient care, detoxification, medication-assisted treatment (MAT), therapy, and support groups.
• Personalized treatment is essential for OUD recovery, as relapse is common, and medication combined with counseling improves long-term outcomes.

Opiates and opioids have essential medical uses, mainly for pain relief. However, their long-term use can lead to addiction and other serious issues. Opiate drugs affect the brain and nerves similarly, with opiates being natural and opioids being man-made. “Opioids” is the term that covers both natural and synthetic forms.

While opioids are initially given to ease severe pain, using them for a long time can lead to misuse, addiction, tolerance, and physical dependence. Common opioids include prescription painkillers like oxycodone, Dilaudid, hydrocodone, and fentanyl, as well as the illegal drug heroin. Opioid addiction is a major cause of overdose deaths in the United States. In 2021, there were 80,411 opioid overdose deaths in the United States, and there were 2,670 drug overdose deaths in Indiana. While opioid addiction can’t be cured, it can be managed through drug addiction rehabilitation.

How Opiate Addiction Develops

Opiates are highly addictive. When taken, they enter the brain through the bloodstream and create a rush of artificial endorphins and dopamine. These chemicals are responsible for feelings of reward and pleasure, leading to a euphoric rush. Because this high is different from natural pleasure, people may want to use opiates again. 

However, with repeated use, the brain struggles to produce dopamine and endorphins naturally. This means that a person can only feel good when using opiates. Because they desire this good feeling and can’t get it naturally, they may crave opiates. This is one of the main reasons opiates are so addictive.

Developing opiate addiction involves several steps:

• Tolerance: Needing larger doses of opiates to feel the same high.
• Physical dependence: Going through withdrawal if the drug isn’t used.
• Psychological addiction: Experiencing mental cravings and engaging in addictive behaviors.

Tolerance and physical dependence can happen separately but often go together as opiates’ effects grow.

Can You Get Addicted to Opiates if You Use Them as Prescribed?

Research shows that overprescribing plays a big role in causing opioid addiction. Many cases involve doctors prescribing more opioids than needed, resulting in too many pills. This abundance increases the chance of taking them for longer than necessary, which raises the risk of addiction. Surprisingly, even pain medication prescribed for short-term pain can lead to long-term use. About 6% of people keep using opiates 90 days after surgery. Also, up to 26% of those given opioids for ongoing non-cancer pain can become dependent on them.

Which Opiates Are Most Addictive?

Heroin is one of the most addictive drugs globally because it quickly triggers a feel-good chemical surge in the brain’s reward system. Many people who get addicted to heroin start with prescription opioids. These are often used for legitimate reasons, like pain relief after surgery. However, some people may switch to heroin because it’s cheaper and easier to get.

Codeine is another addictive opiate, usually prescribed for pain and coughing. While less known than other opiates, some forms of codeine are considered less addictive than drugs like heroin, fentanyl or oxycodone.

It’s essential to understand that all opiates can lead to addiction. If you’re taking an opiate, make sure to use it exactly as your doctor prescribes.

Which Opiates Are Most Commonly Abused?

• Vicodin (hydrocodone/acetaminophen): One of the most frequently abused opiates prescribed for severe pain. Vicodin contains hydrocodone, the most abused opioid in the U.S., and is the most misused prescription drug in the country.
• Oxycodone: Found in Oxycontin, oxycodone is the second-most commonly abused opioid, used for severe pain.
• Heroin: An illegal, synthetic form of morphine, heroin is highly addictive and often abused after transitioning from prescription opioids.
• Morphine: Frequently abused, it’s derived from poppy plants and used medically, administered orally or intravenously.
• Codeine: Similar to morphine, codeine is another frequently abused opiate, often used for pain relief.
• Fentanyl: Increasingly abused, fentanyl acts rapidly as a sedative and pain reliever, with effects similar to heroin.
• Hydrocodone: Used as a pain reliever and cough suppressant, hydrocodone can also be subject to abuse.

Opiates and Their Euphoric Effects

When people use opiates, they feel a powerful sense of pleasure or euphoria. This feeling can become addictive because our brains associate taking opiates with feeling good.

Opiates work by triggering the release of dopamine, a natural neurotransmitter that controls pleasure. When opiates flood the brain with dopamine, it creates a strong sense of euphoria. The rush of pleasure from opiates is much higher than what our brains can produce naturally, making it easy for us to crave more.

Over time, the brain’s pleasure centers become less responsive to opiates. This happens because the brain gets used to the increased dopamine levels, requiring larger doses of the drug to feel the same pleasure. This leads to physical tolerance and, eventually, opiate addiction.

How Opiates Affect the Nervous System

When someone uses opiates, their nervous system undergoes rapid and significant changes. Users often describe an intense surge of euphoria, especially with substances like heroin. This happens because opiates interact with the nervous system.

Opiates attach to opioid receptors on neurons responsible for releasing dopamine. This interaction leads to an intense release of dopamine, about ten times more than the natural amount. The body becomes conditioned to seek opiates repeatedly because it craves this heightened dopamine response. With continued use, the body builds a tolerance, needing higher doses of opiates to achieve the same effects.

Common Opioids and Opiates

Doctors often prescribe opioid pain medications to manage moderate to severe pain, typically after surgery or medical procedures. Some of the most commonly prescribed opioids in the United States as of 2020 include:

• Vicodin (hydrocodone/acetaminophen), with more than 30 million prescriptions
• Tramadol, with more than 17 million prescriptions
• Oxycodone, with more than 12 million prescriptions
• Percocet (oxycodone/acetaminophen), with more than 10 million prescriptions
• Morphine, with more than 4 million prescriptions
• Buprenorphine, with more than 2 million prescriptions
• Tylenol 3 (acetaminophen/codeine), with more than 2 million prescriptions

Common Signs of Opiate Addiction

When someone abuses or is addicted to opiates, they may prioritize obtaining drugs and getting high over everything else. There are several visible signs of opiate abuse that may become apparent when someone you know is using opiates.

Financial Signs of Opiate Abuse

Long-term substance abuse often leads to financial difficulties. Initially, when someone starts using opiates with a prescription, the cost may be low. However, as tolerance and addiction develop, they need more of the drug.

A person purchasing opiates may spend a significant amount of money and show signs of financial strain, such as:

• Falling behind on bills
• Borrowing money or taking out loans
• Selling or pawning belongings
• Stealing money or possessions from others

Short-Term Effects of Opiate Use

Using opiates can swiftly alter both the mind and body, leading to observable changes in behavior and health. If someone is grappling with opioid or opiate misuse, you may notice these physical and mental shifts:

Initial Physical Symptoms of Opiate Use:

• Dry mouth
• Constipation
• Feeling lightheaded
• Experiencing euphoria and elation
• Constricted pupils
• Lack of coordination
• Excessive sleepiness
• Nausea and vomiting

However, it’s crucial to recognize that the dangers of opiate use can manifest at any time, potentially escalating to severe symptoms:

Severe Symptoms Include:

• Slowed heartbeat
• Shallow or slowed breathing
• Lips, nails, or skin turning blue or purple
• Dizziness or extreme drowsiness
• Low blood pressure

If you encounter someone exhibiting these severe symptoms due to opioid use, it might indicate an overdose. In such cases, immediately dial 911 and administer naloxone if available.

Psychological Symptoms of Opiate Use:

• Confusion
• Reduced appetite
• Irritability
• Mood swings
• Depression

It’s crucial to acknowledge that opiate users face increased risks of health issues such as HIV and hepatitis, primarily when they inject opiates. Furthermore, all opiate users are at risk of experiencing an overdose, a medical emergency that can quickly become fatal if not addressed promptly.

Long-Term Health Effects of Opiate Use

Prolonged opiate abuse significantly heightens the risk of severe and sometimes irreversible harm to various parts of the body, including the brain, heart, central nervous system, and major organs. Opiate misuse can also impact pregnancy and result in adverse effects on fetuses and newborns.

It’s essential to grasp that individuals abuse opiates to experience the euphoric “high” they provide. Nevertheless, as tolerance builds, users require increasingly larger doses, leading to severe harm to the body.

Pregnancy and Opiate Use:

Pregnant women addicted to opiates not only jeopardize their own health but also put their infants at risk of addiction in utero and after birth. 

Prenatal Opiate Exposure Risks Include:

• Premature birth
• Low birth weight
• Neonatal abstinence syndrome, including tremors, convulsions, and respiratory distress
• Infant opiate addiction
• Newborn withdrawal
• HIV or hepatitis-positive infants

As prenatally opiate-exposed children grow, preliminary findings indicate an increased prevalence of conduct issues, emotional disturbances, slow physical development, and attention-deficit/hyperactivity disorder (ADHD). While research is ongoing, it’s crucial for pregnant mothers to avoid opiate misuse and seek help for addiction before and during pregnancy.

Factors Influencing Opiate Addiction Risk

Opiate addiction can manifest more rapidly in some individuals than in others, even when they use the drug similarly. Several risk factors can heighten the likelihood of opiate addiction:

These Factors Include:

• Long-term substance use
• Early initiation of substance use
• Poverty
• Unemployment or a troubled work history
• Family members with substance use issues
• Traumatic life experiences
• Chaotic or unsafe environments

The presence of multiple risk factors increases the likelihood of developing an opioid use disorder or addiction. However, the absence of these risk factors doesn’t guarantee immunity from opiate addiction.

Diagnosing Opiate Addiction

Mental health and addiction professionals assess individuals to determine if they are adversely affected by opiates. They evaluate whether the person meets the criteria for an opioid use disorder, a recognized psychological condition in the DSM-5, characterized by:

Criteria for Opioid Use Disorder Include:

• Prolonged use of opiates in large amounts
• Unsuccessful attempts to reduce or cease opioid use
• Substantial investment of time, energy, effort, and money in obtaining and recovering from opioid use
• Intense cravings and urges to use
• Impairments in meeting responsibilities at home, work, or school
• Sacrificing enjoyable or important activities for more time spent using opioids
• Engaging in risky situations, such as driving while under the influence
• Increased opioid dosage required to achieve the desired effect
• Discomfort or illness when opioids are unavailable

A person only needs to exhibit two of these signs and symptoms to be diagnosed with an opioid use disorder. A higher number of symptoms may indicate a more severe and problematic disorder.

Opiate Addiction Withdrawal

When someone discontinues opiate use, they may experience withdrawal symptoms, which can be physical and psychological and vary in severity. The severity depends on factors such as the type of opiate used, dosage, and duration of use.

Common Physical Withdrawal Symptoms Include:

• Nausea and vomiting
• Diarrhea
• Muscle cramps
• Chills
• Sweating
• Increased heart rate
• High blood pressure
• Pupil dilation
• Runny nose
• Tearing

Common Psychological Withdrawal Symptoms Include:

• Anxiety
• Insomnia
• Irritability
• Depression
• Fatigue
• Restlessness
• Cravings

In some cases, withdrawal symptoms can be life-threatening. If you or someone you know is experiencing withdrawal symptoms, it’s crucial to seek medical attention.

Treatment options for opiate withdrawal include medication-assisted treatment (MAT), counseling, and support groups. MAT involves medications to manage withdrawal symptoms and cravings. Counseling helps individuals understand their addiction and develop coping strategies, while support groups offer peer support during recovery.

Treatment and Help for Opiate Addiction

Treating opiate addiction should be personalized to suit each person’s unique needs. Luckily, there are various treatment options available:

Inpatient/Residential Care

For those deeply struggling with opiate addiction, inpatient or residential care might be necessary. These are intensive and highly supervised treatments where individuals live at the treatment center.

Inpatient treatment usually takes place in a rehab center or a hospital, staffed by experts around the clock.

Outpatient Services

Outpatient treatment lets individuals stay at home while receiving treatment and services at a treatment center. Different levels of outpatient care exist, ranging from several hours a week to an hour each month. The treatment team will decide the best level of care.

Detoxification

Detox, often the first step in recovery, can be done in both inpatient and outpatient settings. It helps ease the discomfort of withdrawal as opiates leave the body.

Therapy

Therapy, available at all care levels, helps patients understand themselves and their addiction better. Different therapy approaches uncover the reasons behind addiction and ways to avoid relapse.

Medication Services

Many people with opiate addiction benefit from medication-assisted treatment (MAT) to reduce withdrawal symptoms. Medications can block or trigger neurotransmitters in the brain’s opioid system.

Support Groups

Support groups like SMART Recovery or 12-step programs complement therapy and medication. They provide fellowship and understanding.

Is At-Home Opiate Detox Safe?

Attempting to manage opiate withdrawal at home with remedies like vitamins and exercise is not recommended. It’s less effective and increases the risk of relapse.