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