Opioid Dependence

Opioid Dependence

What are opioids? — Opioids are a group of drugs that include heroin, morphine, and other prescription pain medicines such as oxycodone. (Oxycodone is sold under the brand names OxyContin and Percocet.) These drugs are also grouped under other terms, such as "opiates" and "narcotics."
Opioids help relieve pain. Doctors prescribe them to treat pain that doesn't respond to other medicines. At first, at high doses, they can cause feelings of being happy, calm, and sleepy. But with continued use, these feelings lessen. Taking too high a dose of these drugs can be dangerous or even cause death.
What is opioid use disorder? — "Opioid use disorder" is basically the medical term for opioid addiction. It can be mild to severe. People with opioid use disorder have 2 or more of the following problems. The more of these they have, the more severe their disorder.
They end up using more drugs than they planned to, or they use them for longer than they planned to.
They wish they could cut down on drugs, but they can't.
They spend a lot of time trying to get drugs, getting high, or recovering from being high.
They crave or have a strong desire or urge to use drugs.
Because of their drug use, they often don't do things that are expected of them, such as go to work or school, remember family events, and clean their home.
They keep using drugs even if it causes or worsens problems in their relationships or interactions with other people.
They stop or cut back on important social, work, or fun activities they used to do.
They keep using drugs even in situations where it is dangerous to do so (such as while driving).
They keep using drugs even when they know they have a physical or mental problem that was probably caused or made worse by their drug use.
They need to use more and more drugs to get the same effects they used to get with less use. Or they get less effect from using the amount that used to get them high. This is called "tolerance."
They have "withdrawal symptoms" if they stop using drugs after using them for a long time. Withdrawal symptoms can include:
•Feeling sad or depressed
•Nausea or vomiting
•Muscle aches
•Watery eyes or runny nose
•Dilated pupils, goose bumps, or sweating
•Diarrhea
•Yawning
•Fever
•Insomnia (not being able to sleep)
How is opioid use disorder treated? — Treatment involves 3 key pieces: medicines, counseling, and support groups.
Medicines – The medicines used to treat opioid addiction reduce drug cravings and can also keep you from getting high if you do use drugs (table 1). Medicines play a big part in helping people overcome addiction. When used the right way, they are safe and effective, and they do not get you high. Some people prefer to go to counseling and support groups but not take medicines. Those people are more likely than people who take medicines to start using drugs again.
Addiction counseling – People with addiction work with a counselor to better understand their addiction. They learn new ways to lead their life that do not involve drugs.
Support groups – In support groups, people with addiction share their experiences with each other. The most common of these groups is Narcotics Anonymous (also called NA). Some people like but others dislike the role of God or a "higher power" in NA. There are other groups that do not have that as a focus.
When you are first getting off opioids, you might need to be treated in a hospital to get medicines to help with withdrawal symptoms. This makes getting off drugs easier. Afterward, you can keep taking medicines to help you to stay off of drugs.
Some people cannot stop using drugs even with medicines, counseling, and support groups. People who have an especially hard time staying off drugs sometimes do well with a treatment called "contingency management." As part of this treatment, you get a reward for staying off drugs. The reward can be money or small prize, such as movie tickets. Often you must prove that you are drug-free by giving urine samples that are tested for drugs.
Other types of therapy can help for specific situations. An example is family therapy, which can be especially helpful for children or teens with addiction.
What do I need to look out for? — People with opioid use disorder can have dangerous effects from using opioids, or even die, if they use too much or mix opioids with other drugs or alcohol. The risk of this is especially high in people who stop or cut back on opioid drugs, and then increase their use again.
What are signs of an opioid overdose? — Signs of an opioid overdose are:
Extreme sleepiness
Slow breathing or no breathing at all
Very small pupils (which are the black circles in the center of your eyes)
Very slow heart beat
What can I do to prevent someone from dying of a drug overdose? — If you think someone is having a drug overdose, call for an ambulance (in the US and Canada, dial 9-1-1).
People who overdose on opioids are treated with a medicine called naloxone. It works by blocking the effects of opioids, and it can prevent death from an overdose. People without medical training can safely give naloxone to a person who overdosed while they wait for emergency help to arrive.
If you or someone in your house uses opioids or is trying to stop using them, you might want to keep naloxone at home. Naloxone is now available by prescription in the US and some other countries. It comes as a device (brand name: Evzio) that makes it possible for anyone to give the shot, or as a spray that goes in the nose (brand name: Narcan nasal spray). Ask your doctor about getting a prescription for naloxone. Methadone treatment centers might also be able to provide it.
Be prepared to deal with an overdose. Know what the signs are. If you do get naloxone to use at home, read the instructions ahead of time and always know where it's kept.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 95131 Version 10.0
Release: 28.2.2 - C28.105
© 2020 UpToDate, Inc. and/or its affiliates. All rights reserved.