Opioid Addiction

Definition

Opioids are a class of drugs made from opium, as well as synthetic or semi-synthetic drugs that resemble these opium-based drugs. Many opioids are available by prescription. Examples include oxycodone, codeine, morphine, and fentanyl. Heroin is one of these drugs that is illegal. These drugs are often referred to as narcotics.

Addiction is marked by an out-of-control need and craving that affects relationships and social obligations, such as work and school. Some medications have a higher risk of addiction. Even with proper use they are associated with alterations in the pathways in the brain. These pathways influence sense of reward and well-being which can influence addiction.

Opioid abuse is inappropriate use of opiods. It may include snorting pills, mixing with other drugs and alcohol, or using them for the wrong reasons (such as using pain medication for sleep). Opioid abuse may only develop because of addiction or the addiction may develop after abuse of an opioid.

Causes

Opioids produce a quick, intense feeling of pleasure (euphoria), followed by a sense of well-being and calm drowsiness. When opioids are used repeatedly, your brain is likely to become dependent on them. Opioids are highly addictive.

Other factors that may play a role in opioid addiction include:

Genetic factors
Altered pathways in brain caused by the addictive drug
Peer pressure and personality traits

Chemical Release in Brain

Opioids stimulate the release of "euphoric" chemicals in the brain. Over time, more of the drug is required to produce the same release, leading to abuse.

Risk Factors

Factors that may increase your chance of opioid addiction include:

Being under 30 years old (risk of addiction decreases as age increases)
Being a man
Improper use of medication (abuse)
Family history of drug addiction
Having anxiety, depression , loneliness, and a history of alcoholism

Physical dependence may contribute to the development and continuance of addiction. Physical dependence is when your body needs a drug to function normally. Withdrawal symptoms when the medicine is stopped or reduced can be a sign of physical dependence. Withdrawal symptoms can be intense and include nausea, vomiting, and sweating. It can make cessation of drug use difficult. Physical dependence may occur with abuse or with long term proper use of medications.

Symptoms

Symptoms of opioid addiction may include:

Rapid increase in the amount of medication needed
Moving from one doctor to another for additional prescriptions
Craving the medication
Inability to stop or limit medication use
Using significant effort to acquire the medication
Medication use that interferes with activities
Compulsive use of the medication despite adverse effects

Diagnosis

Addiction can be difficult to diagnose. Prescription opioid addiction can start with someone who needs frequent pain medications for a long-term condition. This can make it difficult to distinguish the difference between addiction and medical need.

Your doctor will ask about your symptoms, your medical history, and use of opioids. A physical exam will be done.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Rehabilitation Programs

Rehabilitation programs can be inpatient or outpatient. Inpatient rehab involves staying in a controlled environment for a several weeks or up to one year, depending on nature of addiction and factors that contribute to the addiction. Before going home, some inpatients reside at half-way houses where they can slowly regain their independence. Outpatient rehab can also last up to a year, but you can live at home. Outpatients make frequent visits to clinics for treatment.

Components of both rehab involve:

Detoxification and controlled withdrawal with medication
Treatment for other psychological conditions
Counseling and support

Support Groups

Narcotics Anonymous is a twelve-step program that help support people who are recovering from addiction to opioid drugs.

Behavioral Therapy

Behavioral therapy is designed to modify people’s attitudes and behaviors related to opioid abuse. In therapy, you will learn how to avoid and cope with situations in which you are most likely to use drugs, and avoid situations that may cause relapse. Therapy sessions may include individual, group, or family counseling.

Medications

Certain medications can be used to treat opioid dependence and addiction. They may be used during detoxification to reduce withdrawal symptoms. They may also be continued through maintenance to decrease craving and reduce the risk of relapse. They are given as a part of an overall treatment approach including counseling. Common medication options include:

Methadone
Buprenorphine
Naltrexone
Buprenorphine/naloxone (Suboxone)

The choice of medication will depend on drugs involved in addiction, your medical history, and recovery commitment.

Other medications may be needed to treat underlying issues, such as depression or anxiety. These medications may help you on your way to a full and productive life as well as prevent relapse.

Prevention

The best way to prevent this condition is to never use opioids. They can be highly addictive. If you do have to take prescription drugs to treat pain, follow the directions closely and use them for the shortest amount of time needed.

RESOURCES

American Academy of Family Physicians Family Doctor http://familydoctor.org

National Institute on Drug Abuse http://www.drugabuse.gov

CANADIAN RESOURCES

Canadian Centre on Substance Abuse http://www.ccsa.ca

The Council on Drug Abuse http://drugabuse.ca

References

Drug facts: Treatment approaches to drug addiction. National Institute on Drug Abuse website. Available at: http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction. Updated September 2009. Accessed March 13, 2013.

Edlund M, Steffick D, Hudson T, Harris T, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007;129(3):355-362.

Hall W, Doran C, Degenhardt L, et al. Illicit opiate abuse. National Center for Biotechnology Information website. Available at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.7003. Published 2006. Accessed March 11, 2013.

Opiate addiction treatment programs. Addiction-Treatment website. Available at: http://www.addiction-treatment.com/research/opiate/. Accessed March 11, 2013.

Opioid abuse or dependence. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated February 15, 2013. Accessed March 11, 2013.

Opioid addiction. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/opioid-addiction.html. Updated January 2011. Accessed March 11, 2013.

Opioid withdrawal. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated July 13, 2011. Accessed March 11, 2013.

Praveen KT, Law F, O'Shea J, et al. Opioid dependence. Am Fam Physcian. 2012;86(6):565-566.

Prescription drug addiction. EBSCO Health Library website. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthlibrary. Updated December 2011. Accessed March 11, 2013.

The Science of Addiction. National Institute on Drug Abuse website. Available at: http://www.drugabuse.gov/sites/default/files/sciofaddiction.pdf. Updated August 2010. Accessed March 11, 2013.

Types of treatment programs. Principle of drug addiction treatment: A researched-based guide. National Institute on Drug Abuse website. Available at: http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs. Updated December 2012. Accessed March 11, 2013.

Revision Information

Reviewer: Brian Randall, MD
Review Date: 02/2013 -
Update Date: 03/11/2013 -

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