Opioid Use Disorder

Opioids can occur naturally or be made in laboratories (synthetic).  Opioids, when ingested, interact with opioid receptors that are located on neurons in both the brain and the body.  Due to the interaction between the opioid and the neurons, any pain is reduced (APA, 2018).  Opioids have both analgesic (pain relief) and Central Nervous System depressant effects (Strain, 2020).  Naturally occuring opiates (Heroin, Opium, Morphine, Codeine) and Synthetic Opiates (Oxycodone, Hydrocodone, Fentanyl, Tramadol, and Methadone) are  both classified as opioids (Strain, 2020).  Some opioids are stronger than others.  Fentanyl is 50 - 100 times more potent than other opioids (Strain, 2020).

There are medical uses for opioid use such as treatment of acute pain, cancer treatment, palliative care, and end of life care (APA, 2018).  When used at increased amounts, for an increased amount of time, for reasons other than being prescribed by a medical professional or longer than what it was prescribed to be, a person can develop an addiction to opioids.  Taking opioids in increased amounts activated the reward system in the brain which is what causes the "high" that people feel when taking opioids.  When opioids are abused, they "high-jack" the reward system in a way that normal activities of the reward system are foregone in favor of the "high" obtained with opioid use.  With continued use, a person becomes physically dependent fairly quickly and develops tolerance.  This tolerance causes higher doses to be needed in order to create the same ¨high¨ as lower doses had previously created.  Withdrawal occurs when use of the drug is either reduced or stopped (PCSS, 2017).

In 2015, 3.8 million people aged 12 and older in the United States reported past month use of prescribed pain medication with 2 million having Opioid Use Disorder or dependence diagnosable according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorder)(Strain, 2020).  Seventy two thousand people died from drug overdoses in 2017 in the United States (APA, 2018).

Risk Factors include:

• Prior history of Substance Use Disorder
• Younger age
• More severe pain
• Co-morbid mental disorders
• Genetic factors
• Environmental factors 
• Ease if access (PCSS, 2017)(Strain, 2020)

Diagnosis of Opioid Use Disorder consists of using criterion in the DSM-V.  Two or more criterion should be present within a 12-month period including:

• taking opioids longer than prescribed
• desire and/or trying to control use
• spending a lot of time obtaining, using, and recovering from use
• craving for opioid use
• failure to meet obligations due to opioid use
• persistent or recurrent social or interpersonal interactions due to opioid use
• giving up previous activities due to opioid use
• Tolerance
• Withdrawl (Strain, 2020) 

Several tests can be done to assist in diagnosing Opioid Use Disorder.  Diagnosis tools:

• Substance use history
• Physical Exam
• Drug screen
• Complete Blood Count (Strain, 2020)

Treatments include:

• Medically Assisted Treatment (MAT)
• Methadone
• Buprenorphine
• Naltrexone
• Opioid Treatment Centers
• Coordinated Care
• Recovery support system
• Behavioral interventions (PCSS, 2017)(SAMSA, 2020)

Prevention efforts:

• Naloxone - opioid reversal medication
• Individuals should lock up all medications to remove them from reach of others. (PCSS, 2017)

If you, a family member, friend or neighbor are dealing with Opioid Use Disorder:

• please seek assistance in your local area, 
• call SAMHSA´s National Hotline, 1-800-622-HELP
• Go to SAMHSA website, https://www.samhsa.gov/find-treatment

APA. (2018) Opioid Use Disorder.  American Psychiatric Association.  Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder

PCSS (2017) Opioid Use Disorder: What is Opioid Addiction? Providers Clinical Support System.  Retrieved from https://pcssnow.org/resource/opioid-use-disorder-opioid-addiction/

SAMHSA.(2020)  Medication and Counseling Treatment.  Substance Abuse and Mental Health Service Administration.  Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment

Strain, E. (2020) Opioid Use Disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment and diagnosis. UpToDate.  Retreived from https://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis

Ovarian Cancer

The female reproductive system consists of the uterus, two Fallopian Tubes, and two ovaries.  The ovaries.  The ovaries are small and produce eggs (ovum) and the hormones estrogen and progesterone (Mayo, 2020).  As with other parts of the body, cancer can develop in the ovaries.  Although deaths from ovarian cancer has declined over the past twenty years, it is still the fifth leading cause of cancer deaths in women in this county (MNT, 2020).

Because, most often, cancer starts in the outer lining of the ovary, also called the epithelium, there are few or no early symptoms.  Because of the types of symptoms that do occur, the condition is often misdiagnosed as conditions such as Pre-Menstrual Syndrome, Irritable Bowel Syndrome, or a temporary bladder problem (MNT).   Symptoms of ovarian cancer include:

• abdominal bloating or swelling
• quickly feeling full when eating
• weight loss
• pelvic discomfort
• changes in bowel habits
• frequent urination
• pelvic pain
• pelvic pressure
• unexpected vaginal bleeding
• gas
• nausea
• vomiting
• loss of appetite (Mayo)(MNT)(Medline, 2019).

Risk factors include:

• family history: having a close relative with ovarian or breast cancer
• reproductive history
• dietary factors
• use of Talcum powder 
• gene mutations
• using fertility treatment
• smoking (ACS, 2020)(MNT)(Mayo).

There are three types of ovarian cancer.  They include:

• Epithelial:  occurs in the outside layer of the ovary (90% of ovarian cancers)
• Stromal:  occurs in the ovarian tissue (7% of ovarian cancers)
• Germ cell: occurs in egg producing cells.  Are often benign, but when malignant, treatment is effective in 90% of cases. (MNT)(Mayo).

Along with history and physical exam, there are several tests that can be done to diagnose ovarian cancer including:

• imaging tests
• ultrasound
• MRI
• CT scan
• laparoscopy
• biopsy
• barium enema xray
• chest xray
• PET scan
• colonoscopy (ACA, 2018)(MNT).

Staging, how far the cancer has progressed, is determined after testing is done.

Treatments used depend on the type and stage of the cancer, the patient's age, the patient's general health, patient preference, and the accessibility and affordability of treatment (MNT).  Treatments include:

• surgery
• chemotherapy
• targeted therapy
• palliative care
• radiation therapy
• immunotherapy (Mayo)(MNT).

Genetic testing can be done to search for gene mutations that make some individuals more susceptible to certain cancers such as ovarian, breast in both men and women, prostate, pancreatic and melanoma cancers (Mayo, 2020).  The BRCA1 and BRCA2 genes are the genes where mutations can increase someone's likelihood of certain cancers.  Finding out that someone has the mutation of one or both of those genes does not mean that the individual will indeed develop cancer, however, there is an increased susceptibility.

If you have a family history of breast cancer and/or ovarian cancer, please consider speaking with your doctor and getting genetic testing done.

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ACS. (2020) Ovarian Cancer Risk Factors.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.html

Mayo Clinic. (2020) Ovarian Cancer.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941

Mayo Clinic. (2020) BRCA gene test for breast and ovarian cancer risk.  Retrieved from https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815

Medical News Today. (2020) What is Ovarian Cancer?  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/159675#symptoms

Medline Plus. (2020) Ovarian Cancer.  Medline Plus.  Retrieved from https://medlineplus.gov/ovariancancer.html