What Is Opioid Use Disorder?
What is opioid use disorder? What are the signs and symptoms of opioid use disorder, what causes it and what drugs are considered opioids? These are all common questions, especially since the United States is in the midst of what’s described as the Opioid Epidemic, related to the soaring number of drug overdoses from opioids.
What Are Opioids?
Before explaining what opioid use disorder is and the signs and symptoms of opioid use disorder, what are opioids?
Opioids are a class of drugs that include prescription drugs as well as the illegal drug heroin.
- Opioids are central nervous system depressants. When used, opioids including both prescription drugs and heroin, bind to certain receptor sites found throughout the brain and central nervous system.
- These drugs slow the activity of the central nervous system as a result.
- The central nervous system controls functions including breathing and heart rate. Too high a dose of opioids can lead to a fatal overdose.
- Opioids also carry the risk of addiction and dependence, especially if they’re misused.
Opioids in prescription form are given to patients to alleviate pain. Prescription opioids vary in strength and how addictive they are. Some of the most commonly used and abused prescription opioids are:
- Codeine: Codeine is a prescription opioid that can be given to patients as a tablet, capsule or liquid. Street names for codeine include Captain Cody, Lean, Sizzurp, and Purple Drank.
- Fentanyl: This is one of the most dangerous and deadly prescription opioids. Fentanyl is found in brand-name prescription drugs such as Actiq, Duragesic and Sublimaze. When someone abuses fentanyl it can be injected, snorted or smoked.
- Hydrocodone: This is a prescription opioid that’s in brand-name drugs such as Vicodin and Norco.
- Hydromorphone: Found in the brand-name drug Dilaudid, this drug is frequently injected.
- Methadone: Methadone is intended as a medication to help people stop using other opioids, but it has an abuse potential as well.
- Oxycodone: This tends to be one of the most readily accessible prescription opioids. Oxycodone is in OxyContin, Percodan, Percocet and other brand-name prescription painkillers.
What is Heroin?
Heroin is also characterized as an opioid. Heroin is derived from morphine, which is found in the opium poppy.
Heroin can be sniffed, snorted, smoked and most commonly injected. With heroin, it crosses into the brain quickly and creates a powerful, rapid and euphoric high. Research shows the use and abuse of prescription opioids can be a gateway to heroin.
Short-term heroin effects can include nausea, vomiting, itchiness and nodding off.
Defining Opioid Use Disorder
Opioid use disorder is a term that refers to a pattern of opioid use that’s problematic. This means someone’s use of opioids causes impairment or distress. Opioid use disorder is similar in terms of signs and symptoms to other substance use disorders.
An opioid use disorder can include both psychological addiction and physical dependence.
These are two separate concepts, and one can occur without the other but they are usually seen together.
What is Opioid Addiction?
People tend to use the terms addiction and dependence interchangeably, but when someone is addicted to opioids, it’s primarily psychological. Opioid addiction occurs in the brain, due to the activation of the brain’s reward cycle that occurs when it’s exposed to opioids.
Opioid addiction means someone is compulsively using these substances. While they may have initially chosen to use opioids or even been prescribed to use them, once an addiction forms their use is no longer in their control. This lack of control explains part of why opioid addiction is a disease and not a choice.
What Is Opioid Dependence?
Opioid dependence can occur even if someone isn’t addicted. Dependence means that the brain and body depend on the presence of opioids to function in what’s a new sense of normal.
If someone is dependent on opioids and they stop using them suddenly, they’ll go through withdrawal. This can happen even if a person is prescription opioid painkillers and uses them exactly as instructed by their doctor.
What Happens During Opioid Withdrawal?
If someone is dependent on opioids and they stop suddenly, withdrawal symptoms can vary from mild to severe. Withdrawal is the body’s response to trying to readjust to a sense of normal functionality without drugs.
Early symptoms of opioid withdrawal can include:
- Muscle aches and pains
- Teary eyes
- Insomnia and sleep disturbances
- Runny nose
Later symptoms of opioid withdrawal can include:
- Abdominal cramps
- Dilated pupils
There are different ways to reduce or alleviate opioid withdrawal symptoms. If someone is taking opioids as prescribed, their health care provider might advise them to taper off slowly. This means gradually reducing the dose of opioids used over time rather than cold turkey.
If someone is abusing opioids or using heroin, they may require professional treatment as they go through withdrawal because it can be very difficult.
Certain medications for opioid withdrawal may be used including methadone, buprenorphine or clonidine.
How Does Opioid Use Disorder Occur?
Opioids are very addictive substances. When someone uses an opioid of any kind, it binds to opioid receptor site. That reduces pain, which is why opioids are commonly prescribed pain relievers. At the same time, this opens a person to the risk of opioid use disorder.
The following are the steps that usually lead to opioid use disorder:
- First someone takes opioids, as prescribed or otherwise which activate opioid receptor sites
- When opioid receptor sites are activated, it triggers a flood of dopamine into the brain, which is a feel-good brain neurotransmitter. Dopamine is what causes people to feel high when they use opioids and other psychoactive substances.
- When dopamine floods into the brain at a high level as it does with opioids, it can trigger the brain’s reward response
- The reward response in the brain occurs naturally when we do certain activities such as eating or sex
- When the reward response is triggered by opioids, it then leads to compulsive use of the substance. The brain wants you to keep seeking out what created the positive feelings of using opioids.
- Once this happens, the use of opioids is no longer in your control.
There are some things to realize as far as opioid use disorder, however. First, not everyone who uses opioids will become addicted or develop an opioid use disorder.
Some people are at a greater risk of developing an opioid use disorder. For example, someone with a family history of substance abuse may be more likely to become addicted.
Also, the higher the dose of opioids someone uses, the more likely they will become addicted. If you take opioids as prescribed and follow your doctor’s instructions, you’re at a lower risk of developing an opioid use disorder, although it’s still possible.
With heroin, an opioid use disorder is likely to develop very quickly because of the potency of the drug and how quickly it takes effect.
What Are the Symptoms of An Opioid Use Disorder?
If someone uses opioids and has at least two of the symptoms below that occur within a 12-month period, they might be diagnosed as having an opioid use disorder.
The symptoms of an opioid use disorder include:
- Taking more opioids or a higher dose than intended
- Feeling like you want to stop using opioids or cut down on how much you use, but not being successful in doing so
- Spending a significant amount of time getting opioids, taking them, or recovering from their effects
- Cravings for opioids occur
- Declining performance at school or work because of opioid use
- Using opioids even when there are negative effects on relationships or socially
- Giving up other interests or activities due to the use of opioids
- Using opioids even when there are harmful physical side effects or unsafe situations occur
- Knowing that opioids are causing problems physically or psychologically but continuing to use them
- Develop a tolerance and needing larger amounts to get the same effects
- Experiencing withdrawal symptoms when not using opioids
Opioid Use Disorder and the DSM-5
The Diagnostic and Statistical Manual of Mental Disorders, DSM-5, is the guide used to diagnose mental health and psychological disorders. The DSM is published by the American Psychiatric Association.
In the current 5th edition, two disorders are combined which are Opioid Dependence and Opioid Abuse. Now these are classified as Opioid Use Disorder.
According to the guidelines in the DSM-5, when a diagnosis of an opioid use disorder is made, it should include the specific opioid the person is using since the term opioid is one that covers so many substances.
Does Everyone Who Uses Opioids Have An Opioid Use Disorder?
The term opioid use disorder is one that refers to problematic opioid use. Not everyone who uses opioids has an opioid use disorder.
People are often prescribed opioids to treat pain, for long and short time periods and during that time they don’t meet the criteria for an opioid use disorder.
Also, if someone takes opioids for a period of time and develop a physical dependence with withdrawal symptoms, this isn’t necessarily problematic. This is a physical response to taking opioids, and as was touched on, is different from a psychological addiction.
In rare cases, even people who use heroin may not meet the requirements to be diagnosed as having an opioid use disorder because they control their use, although this is fairly uncommon.
How Do Doctors Screen for Opioid Use Disorder?
There are ways doctors screen to make an opioid use disorder, as is the case with many other medical conditions. One way to screen patients for a potential opioid use disorder is called the CAGE questionnaire.
The questions that are part of the CAGE assessment for opioid use disorder include:
- C—This stands for cut down. Has the person tried to cut down on their use of opioids, but weren’t able to.
- A—Stands for annoyed. Are friends and family annoyed with the person’s use of opioids?
- G—Stands for guilty, as in does the person ever feel guilty about their use of opioids.
- E—This stands for eye-opener meaning does the person every use opioids as what’s called an “eye-opener” in the morning.
If someone answers yes to any questions, they may need further assessment for a potential opioid use disorder.
Opioid Risk Tool
There’s also something called the Opioid Risk Tool. The Opioid Risk Tool creates a calculation of the factors that put someone at a higher risk of having an opioid use disorder or a substance use disorder.
Some of the factors that are part of the calculation include a family or personal history of substance use, childhood abuse or trauma, and a history of psychological disorders.
How Is An Opioid Use Disorder Treated?
If someone has an opioid use disorder they will require treatment. There are a lot of different ways opioid use disorder including addiction and dependence can be treated including medication, therapy or a combination.
Medications for Opioid Addiction and Opioid Use Disorder
There are a variety of medications approved by the FDA to help with the treatment of opioid use disorder, opioid addiction and dependence. Some of these drugs are controversial, however, because they can be habit-forming themselves and are known as opioid replacements rather than true treatments. In fact, this is known as opioid replacement therapy.
Some of the medications that may be used to help someone struggling with opioids include:
- Methadone is opioid replacement therapy. It is itself a weak-acting opioid, and it can help people stop using other stronger forms of opioids. Methadone is a tightly controlled substance and it has to be monitored under a methadone program.
- Buprenorphine is a partial opioid receptor agonist. Buprenorphine has what’s known as ceiling effect, which reduces the likelihood of an overdose. After a certain amount is used, the effects no longer increase.
- Buprenorphine and naloxone are also combined with one another in a medication called Suboxone. Other brand names for this combination include Zubsolv and Bunavail.
- Naltrexone is an opioid receptor antagonist, meaning it blocks the effects of opioids if someone uses it. If someone were to try and use opioids while on naltrexone, it could lead to rapid withdrawal symptoms and it would block them from feeling high.
Therapy-Based Treatments for Opioid Addiction and Opioid Use Disorder
Even with medication, most people who have an opioid use disorder benefit from therapy as well. They can receive therapy in different settings including a rehab center.
Cognitive behavioral therapy or CBT is one of the forms of therapy most used to treat substance use disorders. With CBT, patients learn how to change their thinking and behaviors and gain more effective coping mechanisms. With regard to opioid use disorder specifically, CBT usually works best when paired with medication.
Some people also participate in 12-step programs either in place of other forms of therapy or in addition to rehab or therapy. Narcotics Anonymous (NA) is one such 12-step program.
Opioid Facts and Statistics
Opioids and opioid use disorder have led to the rise of what’s called the opioid epidemic or the opioid overdose crisis.
Each day more than 130 people die in the U.S. after overdosing on opioids. The following are statistics related to opioid use disorder and the opioid epidemic according to the National Institute on Drug Abuse and the Centers for Disease Control:
- Opioid overdoses went up 30 percent from July 2016 to September 2017
- The Midwest region saw an increase of 70 percent in opioid overdoses from July 2016 to September 2017
- Anywhere from 21 to 29 percent of patients who take opioids as prescribed for chronic pain misuse them
- Of the patients who misuse opioids for chronic pain, between 8 and 12 percent develop an opioid use disorder
Summing Up—The Reality of Opioid Use Disorder
Opioid use disorder is a troubling and growing problem. At the same time, opioid use disorder is also something that’s preventable, and if it does occur, it’s treatable. Education can be an empowering way to help yourself or someone you love if an opioid use disorder may be an issue.
It’s important to understand that if you believe you could have opioid use disorder, you should speak to a healthcare professional. Addiction treatment is available, and treatment programs can help you stop your use of any opioid drug you may have a problem with.
You may be exploring opioid use disorder not necessarily for your own drug addictions, but because you’d like to learn more to help a loved one, and this information will be relevant for you as well.
CDC. “Module 5: Assessing and Addressing Opioid Use Disorder (OUD).” Accessed February 20, 2019.
Hartney, Elizabeth Ph.D. “ What Is Opioid Use Disorder in the New DSM-5?” Verywell Mind. March 31, 2018. Accessed February 20, 2018.
Wikipedia. “Opioid Use Disorder.” Accessed February 20 2019.
NIH National Institute on Drug Abuse. “Commonly Abused Drugs Charts.” July 2018. Accessed February 20, 2019.
NIH National Institute on Drug Abuse. “What Is Heroin.” June 2018. Accessed February 20, 2019.
Medline Plus. “Opiate and Opioid Withdrawal.” Accessed February 20, 2019.