Opioid use disorder

What is opioid use disorder (OUD)?

Opioids are a class of drugs that are incredibly addictive and can result in physical dependence within as little as 4 to 8 weeks. Physical dependence on opioids is characterized by a tolerance for opioids and withdrawal symptoms when they are not taken. The development of opioid use disorder (OUD) is complex, but some contributing factors include physical dependence on opioids and the pain relief and feelings of pleasure associated with using these drugs. OUD occurs when someone becomes psychologically and physically dependent on opioids and it has started to make their everyday lives dysfunctional. It is incredibly important to use prescribed opioids only as healthcare providers advise and to consult with them if any of the signs of OUD become present.

What are opioids?

Opioids are a class of drugs that bind to mu opioid receptors in the brain to reduce pain and induce a feeling of pleasure. They include prescribed pain killers and illegal drugs (like heroin). Opioids were originally derived from the resin of the poppy plant (termed “opiates“ – like heroin and morphine). Synthetic and semi-synthetic versions have since been developed.

Prescription opioids (painkillers) include:

At lower doses, such as the doses prescribed after surgery, opioids make people feel sleepy and reduces the perception of pain. Higher doses of opioids can result in respiratory failure and death. Under the care of their physician, many people use opioids to treat pain, such as in:

Both prescribed and illegal opioids can be misused and result in an opioid addiction. For example, fentanyl is 100 times more powerful than morphine and 50 times stronger than heroin, but can be prescribed by a physician to manage severe pain. Opioids can also be found on the black market, often lacing other drugs like cocaine and/or heroin. Even within a single class of opioid, there are both legal and illegal variations which have the potential for misuse.

Development of opioid use disorder

Opioids are very effective pain-relievers, but also provide an acute feeling of pleasure. Chemically, opioids promote the release of endorphins, which suppress the feeling of pain and are a “feel-good” neurotransmitter. They are also a reinforcing drug, which means that the act of taking opioids becomes associated with the pleasurable feelings from the endorphins. The brain encourages the person to take it again, as it relieved pain – be it physical or psychological. Each time opioids are taken, dopamine (the “reward” transmitter, which also creates a feeling of pleasure) is released, furthering the pleasure associated with taking the drug.

Chasing this feeling of pleasure or pain relief may lead opioid misuse, dependency and the development of opioid use disorder (OUD). It is incredibly important to use prescribed opioids only as healthcare providers advise. Unlike some substance use disorders, physical dependence to opioids can happen within as little as 4 to 8 weeks.

 Questions to Ask When Being Prescribed Opioids

Opioids can be taken responsibly as an effective painkiller. Opioids can help manage extreme pain, such as after surgery or during cancer treatments. Using opioids for a couple of days is unlikely to result in an opioid use disorder, but you should always feel free to share any concerns about taking opioids with your physician. Some questions that John’s Hopkins Medicine suggests asking are:

Causes and Risk Factors

Continued use of opioids increases the risk of physical dependence and the development of opioid use disorder (OUD). However, like all chronic diseases and mental disorders, there is no one thing that causes OUD. Opioid use disorder is complex and has multiple risk factors, some internal and others external:

Internal risk factors include:

External risk factors include:

It is unknown why some people will develop an opioid use disorder, while others will not. Physical dependence on opioids develops very quickly and coping with withdrawal can be incredibly difficult.  The symptoms faced during withdrawal can lead to a return to using opioids, which can be incredibly dangerous. Socioeconomic, biological and experiential risk factors, many outside the control of the individual, can greatly influence the likelihood of forming an addiction to opioids. The development of opioid use disorder is complex and unique to each individual, with no one factor to blame.

Diagnosis of opioid use disorder

The Diagnostic and Statistical Manual 5 (DSM-5) characterizes opioid use disorder as when (within the previous 12 months) the individual has been unable to abstain from the drug and shows behavior changes surrounding using or obtaining opioids that has caused dysfunction in their everyday lives. To make a diagnosis, a health professional will determine if at least 2 of the 11 signs of opioid use disorder (as defined by the DSM-5) have been present in the last 12 months.

The 11 factors include:

Treatment options for opioid use disorder

Every person who seeks treatment for opioid use disorder has had different life experiences and will have a unique recovery journey. As your journey evolves, you and your healthcare professionals will discuss and decide which treatment options are best for you. For more information on the treatment options available for Opioid Use Disorder, you can find more information here.

Cost of treatment for opioid addiction

Treatment costs for opioid addiction will vary based on each person’s clinical needs and their insurance coverage or ability to pay out of pocket. Lakeview Health works with most major health insurance providers and our team does everything they can to ensure the insurance verification process is simple and stress-free.

If the patient does not have insurance coverage, the admissions team can work on a payment plan. Providing treatment is the main priority.

Lakeview Health accepts most major insurance carriers including:  

Detoxification and withdrawal

Treatment for opioid addiction begins with detox. One of the benefits of going to an inpatient program, like at Lakeview Health, is the medical detox center, which includes 24/7 access to the emotional support and medical interventions needed to safely detox from opioids.

Detoxification and withdrawal

Treatment for opioid addiction begins with detox. One of the benefits of going to an inpatient program, like at Lakeview Health, is the medical detox center, which includes 24/7 access to the emotional support and medical interventions needed to safely detox from opioids.

Withdrawal symptoms

When opioid receptors stop getting stimulated (the drug is not taken), areas of the brain release noradrenalin. The body goes into autonomic hyperarousal (the fight, flight, freeze or fawn response) and will stay there. This response is the main cause of many opioid withdrawal symptoms.

Long-term opioid use affects most of the body’s systems, so the symptoms of withdrawal will too. Symptoms can start within 12 hours of the last dose and usually last a few days or up to 2 weeks.

Early symptoms may include:

Later symptoms may include:

Although the symptoms of withdrawal are not typically life-threatening, their unpleasantness should not be underestimated. These symptoms are severe. People experiencing opioid withdrawal may feel hopeless, suicidal or start using opioids again to self-medicate and reduce withdrawal symptoms – risking an overdose.

Understanding medication-assisted treatment (MAT) for OUD

Once the body has built a physical dependence to opioids, it gains an increased tolerance for the drug. This means that the body needs increasingly more of the drug to get the same effects or even just to avoid withdrawal.

Opioid tolerance rapidly decreases once detox begins. MAT may include providing drugs to cope with the negative side effects of withdrawal which focuses on reducing the risk of death by overdose. Three of the most common medicines used to treat opioid withdrawal act in slightly different ways:

Methadone – an opioid receptor agonist – occupies the same receptors as opioids in the brain, but at a slower rate.  This activates these neurons, like opioids would’ve previously, so it removes withdrawal symptoms and cravings for opioids. Unlike opioids it does not give opioid users the feelings of euphoria associated with the drug.

Buprenorphine – an opioid receptor partial agonist – also binds to the opioid receptors, but activates them less strongly. Like methadone, this eliminates withdrawal symptoms and cravings but does not produce euphoric effects.

Naltrexone – an opioid receptor antagonist – like methadone and buprenorphine, binds to opioid rectors. Unlike the other two medications, it blocks these receptors but doesn’t activate them. It removes the feeling of euphoria, but does not reduce withdrawal symptoms or cravings.

Methadone and buprenorphine have been shown to improve treatment outcomes. Despite being a class of opioids themselves, in opioid dependent people, they will not produce the feelings of euphoria associated with previous drug use. Their primary use is to help people with OUD to attend treatment programs, work and rebuild functional lives.

The National Institute on Drug Abuse stresses that these medications are not a case of one drug being replaced by another. The World Health Organization (WHO) recommends that these medications be used as a part of opioid dependence or addiction treatment plans.

Psychological and holistic treatments for opioid use disorder

Lakeview Health’s treatment plans are personalized to meet each person’s unique needs and goals. During an initial assessment, the team will learn more about a person’s experience with opioids, any co-occurring mental and physical health issues and any treatment programs visited previously.

Going through detox is an important first step towards recovery and will be combined with psychological and holistic therapies for lasting results.  These therapies facilitate personal growth and help to improve communication and relationship skills. They aim to motivate participation in treatment, teach new coping skills, and provide strategies to prevent relapse.

Therapies and services at Lakeview Health include:

Trauma-informed therapy

Cognitive-behavioural therapy (CBT)

Group therapy

Experiential therapy

Learn more about the specific therapeutic and holistic treatments offered by Lakeview Health here:

Dual diagnosis

Co-occurring mental disorders may contribute to, co-exist with or be caused by substance use disorders. Pain, mental illness and opioid use disorder have a complex relationship and it is very difficult to disentangle them. It is crucial that they are diagnosed and treated at a rehabilitation center that integrates all of these into a personalized treatment plan, such as at Lakeview Health. Treatment should take into account the entirety of an individual, not just their opioid use disorder.

More than half of all opioid prescriptions in the US are filled by the (approximately) 16 percent of the population with a mental health disorder. Not only are people with a mental illness more likely to be prescribed opioids for pain, they are also more at risk for overdose and other opioid-related adverse outcomes. Those with a dual diagnosis are especially vulnerable and require a treatment facility that will treat both conditions concurrently.

Each disorder may require specific coping strategies and long-term medical management. Exploring these options with Lakeview Health’s treatment team can make a massive difference in your overall recovery journey and help to prevent relapse in the future.

Lakeview Health’s dual diagnosis program Offers:

Success rates for recovery from opioid addiction

The goal of treatment at Lakeview Health is to enable patients to safely stop using opioids by teaching new, healthy ways to cope with everyday life. Recovery from opioid addiction is possible, but OUD is a chronic disorder that has no “cure”. As the National Institute on Drug Abuse (NIDA) emphasizes: recovery is a journey. Successful treatments for opioid addiction are those that teach the individual how to manage their chronic mental disorder.

Previous studies focused on complete abstinence as the only metric for “successful” recovery. These statistics may make recovery seem unattainable. NIDA is actively working on reframing research to look beyond abstinence and consider the entire recovery journey.  Their research suggests that the rates of relapse for addiction are similar to those for other chronic illnesses – such as lapses in taking medications for diabetes, hypertension and asthma. In other words:

Benefits of inpatient treatment at a rehabilitation center

One of the most important benefits of going to inpatient rehabilitation facilities to treat opioid abuse is the wide variety of treatments offered and access to specialists in addiction treatment and recovery. Lakeview Health’s treatment programs are specifically tailored to the needs of each patient. With an integrative approach to treatment, we seek to treat and unite all aspects of a person – biological, psychological and social.

Inpatient facilities allow for this in ways that outpatient programs cannot, because patients can fully immerse themselves in treatment and focus completely on their recovery journey. People, places and things are changed immediately and you always have access to a wide range of addiction specialists. Detox and therapy happen without the potentially jarring move from one facility to the next, as all facilities are on one campus. Schedules are planned out for patients, so that they get the most out of their stay. Lakeview Health offers gender-responsive programs, as men and women often have very different reasons for abusing opioids.

Dangers of opioids as compared to other drugs

The rise in awareness around the dangers of opioids has been an important consequence of the opioid crisis in the US. Opioid overdose deaths have continued to increase over the years and, in 2016, rose to more than 42,000 deaths in the US. About 40 percent of these deaths involved prescription opioids.

The potential of extreme harm from opioids, like heroin, have been known for many years. The Independent Scientific Committee on Drugs (ICSD) developed a scale that measures the harm that different drugs could do to both the individual and society. Heroin was ranked as the drug most harmful to the individual and ranked second only to alcohol on harm to society. Overall, it was rated as the second most harmful drug. Unfortunately, the Committee only investigated heroin and not all opioids. The full extent of the harm caused by both illicit and prescribed opioids was mostly unknown until it resulted in the opioid epidemic.

The consequences of the opioid epidemic include:

The CDC reports that opioid overdose deaths between 1999-2019 have been characterized by three waves:

  1. Recorded overdose deaths from prescription opioids began increasing alarmingly after 1993. This was primarily due to the increased prescription of opioid painkillers.
  2. Overdose deaths related to heroin rapidly increased after 2010.
  3. From 2013 onwards, there has been a significant increase in overdose deaths involving illicit synthetic opioids, especially fentanyl and fetyanyl analogues. The addition of fentanyl to drugs like heroin and cocaine results in many overdose deaths. People may take their usual substance of choice at doses they know they can tolerate, but unwittingly consume an unknown amount of an opioid 50 times stronger than heroin.
The consequences of using opioids

Short-term consequences

Opioids are nervous system depressants which act to slow your breathing and reduce feelings of pain. Additionally, euphoria is often experienced when they are taken. Other side effects can include:

Long-term consequences of opioid use

The long-term effects of opioids are related to, but not limited to, the rapid rate of physical dependence to the drugs and the potential development of opioid use disorder.

Many of the consequences related to physical dependence and addiction include:

Opioids also affect other body systems, resulting in problems such as:

How to help someone with an opioid addiction

Watching a loved one with an opioid use problem can be heart-wrenching and it can be challenging to find out how best to help and support them. Education around opioid use disorder and its treatment is a great first step. Although only healthcare providers can diagnose someone with OUD, some of the common signs that someone should seek professional help include:

In terms of emergency medicine, the highest risk of death from opioids is from an overdose. Naloxone can reverse the effects of opioid overdose for 30 to 90 minutes. Even if naloxone is administered, 911 should still be called in the case of an opioid overdose. Naloxone temporarily allows a person to continue breathing and allows first responders time to get loved ones to a hospital. It can be requested from pharmacists in many states, including Florida, without a prescription. Family members and friends may want to always keep a dose on them or know where to find it in case of emergency.

The person with opioid use disorder is the only one who can make the decision to stop using and to seek treatment. It is important to learn to put healthy boundaries in place when trying to help a person with an opioid use problem. Supporting the person using opioids is often the focus of loved ones as the user can forget to take care of their own mental and physical health. It is often a good idea for those supporting someone with an opioid use problem to see their own therapist – who can assist them in creating healthy coping mechanisms and good boundaries.

If you or a loved one is looking for opioid treatment reach out to Lakeview Health’s admissions team today. Learn more by contacting us at 866 704 7692 or reaching out online.