Opioid-Related Disorders

Definition

Opioids are chemicals that bind to specific receptors in the brain and body associated with pain, reward, and addictive behaviors. Opioid medications are most commonly used to relieve the type of pain that cannot be treated with less powerful drugs. Common opioids include heroin and other narcotic medications, such as oxycodone, buprenorphine, morphine, codeine, methadone, and fentanyl. Opioid-related disorders are associated with overuse, misuse, and addictive qualities of these medications, and they include opioid-use disorder, opioid intoxication, and opioid withdrawal. 

Symptoms

Opioid intoxication is diagnosed when recent exposure to an opioid causes significant problematic behavioral or psychological changes. Psychological symptoms include initial euphoria followed by apathy, a strong sense of unease, unintentional and purposeless movement (hand wringing, pacing, uncontrolled tongue movement), slowing-down of thought and movement, and impaired judgment. Other symptoms include constriction or dilation of the pupils, drowsiness or coma, slurred speech, and impairment in attention or memory. Strong cravings for opioids, an inability to function without opioids in spite of physical, emotional and financial side effects, and loss of control over their use are signs of an addiction.

The symptoms of opioid withdrawal are opposite to the effect of opioids. People experiencing withdrawal may display anxiety, restlessness, irritability, increased sensitivity to pain, and have an “achy feeling” that is often found in the back and legs. Other symptoms include a strong sense of unease, nausea or vomiting, muscle aches, excessive tearfulness, and runny nose.

The speed and severity of opioid withdrawal depends on the type of opioid used. People who use heroin begin to have withdrawal symptoms within six to 12 hours after their last dose, while people who take longer-acting drugs such as methadone may experience withdrawal symptoms two to four days after their last dose.

Causes

Opioid-use disorder may be diagnosed when a person shows compulsive, prolonged use of opioids for no legitimate medical purpose or in larger doses than are needed for medical treatment. A person with opioid-use disorder might purchase opioids on the illegal market or may falsify or exaggerate medical problems to receive prescription opioids from a physician. Healthcare professionals who have opioid use disorder might write prescriptions for themselves or take opioids from pharmacy supplies. Heavy or prolonged use causes the body to become physically dependent on opioids, which in turn causes symptoms of withdrawal that are so distressful that it becomes difficult to stop taking them. When that dependence and inability to quit interferes with the quality of a person's life, it is considered an addiction.

Treatments

Medication Assisted Treatment (MAT) is a combination of behavioral counseling and medications that has been shown to be effective in reducing opioid use, opioid-related deaths, and other problems associated with opioid-related disorders. Studies have shown that those with opioid-related disorders who also use treatment medications, such as methadone, buprenorphine or naltrexone, are more likely to remain in therapy and have more success discontinuing the use of opioids. These treatment medications reduce cravings and symptoms of withdrawal, and also help rebalance brain circuitry while an addicted person is trying to recover. Behavioral interventions, including recovery programs (such as harm reduction) and support groups (such as AA) can help diminish cravings and other symptoms of withdrawal and improve the likelihood of reducing substance use.

References

Volkow ND, McLellan AT. Opioid Abuse in Chronic Pain—Misconceptions and mitigation strategies. New England Journal of Medicine. March 31, 2016.;374:1253-1263.

NIH National Institute on Drug Abuse. Treatments for Opioid Addiction. Updated November 2016. Accessed July 2017.

American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.

Last reviewed 09/22/2017