Opioid dependence

Contents 1 What is it? 2 Symptoms 3 Causes 4 Who gets it? 5 How is it diagnosed? 6 Treatment 7 What is the long-term prognosis? 8 External Links 9 References

What is it?

An individual is considered opioid dependent when the following 2 criteria are met:

1. Repeated opioid use is needed in order to feel good or avoid feeling bad, and

2. The opioid use continues despite adverse consequences. For instance, opioid dependent individuals will feel the need to keep using opioids even if continued use harms their health, their job, their interpersonal relationships, their finances and/or their families.

Symptoms

If a patient is opioid dependent they expereince opioid withdrawal syndrome when they are unable to injest an opioid. These symptoms include the following.

• dilated pupils
• hypertension
• stomach and muscle cramps
• rhinorrhea (runny nose)
• piloerection (goose flesh/bumps)
• diarrhea
• yawning
• anxiety
• restlessness
• hot/cold flushes
• Although opioid withdrawal is not a fatal condition (as alcohol withdrawal can be), the person who is suffering from opioid withdrawal will often report that they "feel like" they are going to die and/or that they "would rather" die than experience opioid withdrawal.

Causes

• Addiction to any substance is a chronic, relapsing, progessive and sometimes fatal disease. The disease of opioid dependence can be caused by several factors, among them genetic, psychosocial and spiritual.
• Opioids like prescription pain medications, heroin, or methadone attach to opioid receptors in the brain which stimulate the release of dopamine, thereby producing pleasurable feelings. When the opioid detaches from the receptor, individuals will suffer withdrawal symptoms and cravings. While drug use begins with a choice, frequent use can alter the brain chemistry. The receptors are re-set to expect a level of opioid injestion. Long-term changes in the brain often occur with repeated use and abuse of opioids; this is the reason why some people will experience cravings years after they have discontinued their opioid use.

Who gets it?

Opioid dependence does not discriminate between gender, race, ethnicity or socioeconomic status. With the increased use in prescription pain medication, the heroin using population continues to age while prescription painkillers have recently replaced marijuana as the first drug of use among the adolescent population. Many people use drugs to self-medicate symptoms of depression and anxiety and so adolescents who do suffer from mood disorders may be at high risk for becoming addicted to prescription pain medication especially since it is readily available, easy to use and easy to hide.

How is it diagnosed?

Common characteristics of opioid dependence include ~Tolerance to opioids, i.e. the need to take more drug to achieve the same effect and/or getting less effect from the same amount of drug ~ Withdrawal symptoms ~ Taking more opioids than planned and for longer periods of time, i.e. continuing to use prescribed pain medications even after pain has subsided ~Persistent desire and/or unsuccessful attempts to quit ~ Spending a lot of time and effort to obtain, use and recover from opioid use ~ Giving up or reducing activities that were once enjoyable ~ Continued use despite adverse consequences

Different tests can be utilized to diagnose addiciton, for example the DAST questionnaire, the CAGE questionnaire, Alcoholics Anonymous's 20 questions test.

Treatment

Individuals suffering from opioid dependence have several treatment options, two of which includ opioid replacement therapy.

1. Buprenorphine treatment. Buprenorphine (brand name: Suboxone or Subutex) is a form of opioid replacement therapy which allows patients to either detox off of the opioid they are abusing or they might need to be on buprenorphine maintenance therapy.

• Medical Withdrawal or Detox: If a person has had a short term habit of opioid abuse, they would probably qualify for opioid detox with the use of Subxone. This treatment would use Suboxone as a bridge, taking the patient from being opioid dependent to opioid free over a matter of days, weeks or months time.

• Maintenance therapy: If a person has been using opioids for a significant period of time (a year or more) they may need to be kept on Suboxone for up to nine months or longer for effective treatment to occur. Because the opioid receptors have been dysregulated as a result of continued, long-term opioid use, they are at high risk for relapse if they are only treated with Suboxone for a short perioid of time.

2. Methadone treatment.

• As a harm reduction model of treatment, methadone maintenance is a form of opioid replacement therapy that has helped many heroin users quit or significantly reduce their use of heroin.

3. Abstinence. Many addicts can find relief from their addiction through attending self-help groups such as Narcotics Anonymous, Alcoholics Anonymous or Smart Recovery.

It is worth noting that for the opioid dependent patient, it is often found to be better to combine stabilizing the opioid receptors with either Suboxone or methadone in addition to joining AA or NA.

What is the long-term prognosis?

75% of patients on buprenorphine maintenance therapy remain in treatment.

External Links

• www.opioiddependence.com
• www.turntohelp.com
• www.turntohelp.com
• www.suboxone.com
• www.suboxone.com

References

Copyright � 2006 Reckitt Benckiser Pharmaceuticals, Inc