Opioid Use Disorder

An individual with opioid use disorder (OUD) may experience various symptoms, depending on the severity of the disorder and their pattern of use. Symptoms may include physical and psychological challenges, so it may be valuable to seek early intervention³ and treatment if certain signs arise.

Healthcare providers may diagnose OUD based on specific criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The severity of the disorder can depend on how many of the following signs or symptoms a person experiences: 

• Recurrent social or interpersonal problems related to opioid use
• Neglect of necessary or daily activities due to opioid use
• Use of opioids in risky situations
• Continued use of opioids despite the risk or occurrence of adverse effects
• Increased tolerance to opioids
• Withdrawal symptoms when discontinuing the drug
• Use of opioids or related substances to avoid withdrawal
• Use of opioids to emotionally numb or self-medicate 

Tolerance and withdrawal 

One of the initial telltale signs of OUD is the development of tolerance, which means that the individual must consume more significant amounts of the drug to achieve the desired effects. Dependence often follows tolerance. As a result, stopping or reducing the drug intake can lead to withdrawal symptoms. Opioid withdrawal symptoms may include:

• Nausea and vomiting
• Diarrhea
• Irregular heartbeat
• Muscle aches and cramps
• Sweating, shivering, and fever
• Insomnia and restlessness
• Anxiety and irritability
• Mood swings and emotional instability
• Difficulty concentrating and memory problems

Behavioral symptoms 

Behavioral changes that involve seeking opioid prescriptions may also develop as the disorder progresses. These changes might include:

• Frequent doctor visits for unexplained health conditions and requests for opioid prescriptions
• "Doctor shopping,” or visiting multiple doctors to obtain more prescriptions
• Using opioids despite adverse effects on work, school, or personal relationships
• Neglecting personal responsibilities and withdrawing from social activities

The presence of one or more symptoms does not necessarily imply that someone has OUD. However, if any of these signs or symptoms persist or worsen, it may be appropriate to receive care and support. Early intervention can make a difference in improving the chances of recovery. 

As OUD can be a complex condition, a combination of risk factors and causes may come into play. A healthcare provider may try to identify underlying causes and risk factors to prevent complications and provide the most appropriate treatment.

The leading cause of OUD is exposure to opioids. There are several ways someone might first encounter these drugs. For example, a healthcare provider might prescribe opioids to help a client manage pain after surgery or an injury. Contrarily, some people might start using opioids recreationally, drawn by the intense euphoria the drugs can cause. They might begin to rely on the effects of opioids, which can also lead to addiction.

Individuals with certain psychiatric disorders may also be at increased risk of misusing medications. According to the Substance Abuse and Mental Health Services Administration, several types of mental illness are associated with substance use disorders, including anxiety, depressive, and conduct disorders.

Risk factors 

Other risk factors for OUD may include:

• Family history of addiction or substance use disorder 
• Personal history of substance use or mental health disorders
• Increased availability and access to opioids
• Peer pressure or a social environment that normalizes substance misuse
• Traumatic experiences or high-stress life events

Ways to prevent OUD may involve recognizing these risk factors and encouraging safe prescribing practices for opioid medications. Someone at risk of OUD may benefit from communicating with a healthcare provider and educating themselves on the risks and alternatives to opioid pain relief.

Various treatments are available for opioid use disorder. Treatment goals for an affected person may include regaining control over their lives and maintaining sobriety. For individuals with severe opioid use disorder, inpatient rehab is a structured way to receive detoxification, medication management, and therapy. An inpatient setting can often provide 24-hour supervision and intensive care. 

Medication

Medication-assisted treatment (MAT) is an evidence-based approach that combines medication and therapy to treat opioid use disorder effectively. A combination of treatments for people who use opioids may reduce cravings, prevent relapse, and support long-term recovery. The following three medications are often used: 

• Methadone: Methadone is a long-acting synthetic opioid that reduces drug cravings and withdrawal symptoms. It helps individuals remain stable during treatment by activating the same brain receptors as opioids without producing a euphoric high.
• Buprenorphine: Buprenorphine is a partial opioid agonist that may treat withdrawal symptoms and cravings. It has a lower risk of overdose compared to methadone, making it a safer option for some individuals.
• Naltrexone: Naltrexone is an opioid antagonist that blocks the effects of opioids, preventing the euphoria and physical dependence associated with their use. It can be taken as an oral tablet or an injectable.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The above information is not a replacement for medical advice or diagnosis. 

Self-care

Self-care strategies may also support the recovery process for people who have used opioids. Some potentially helpful self-care strategies include:

• Exercise: Regular physical activity may improve mood, decrease stress, and improve overall health. Regular exercise may include activities like walking, swimming, and yoga.
• Healthy eating: Eating a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats may support physical and emotional health during recovery.
• Sleep: High-quality sleep may help the brain heal from the effects of opioid use. Keeping a regular sleep schedule and practicing sleep hygiene may improve sleep quality.
• Stress management techniques: Relaxation practices, such as mindfulness, deep breathing, and progressive muscle relaxation, may help individuals manage stress and prevent relapse during the recovery process.

For people struggling with OUD, various resources are available that can provide support, guidance, and treatment. Support from an online therapy platform, such as BetterHelp, may help clients cope and recover from the condition. Through an online platform, individuals can get help from home, which may reduce the stigma of reaching out for in-person support. 

Several organizations are explicitly dedicated to providing support to those recovering from OUD. Narcotics Anonymous (NA) is a global, community-based organization that offers a recovery process and peer support network. It is an open, inclusive group for anyone seeking help where they can share experiences and encouragement. SMART Recovery is another global community that provides specialized tools and offers meetings to help people overcome problems with addiction.

The Substance Abuse and Mental Health Services Administration has numerous resources available for people experiencing substance use disorder and other mental health challenges. Additionally, the Centers for Disease Control and Prevention provides an extensive amount of data and helpful information on opioid overdose.  

Local support groups may also offer a platform for people to share their experiences and learn from others going through similar situations. These groups may also provide access to professionals who specialize in treating opioid use disorders. 

For help with substance use, contact Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline at 1-800-662-HELP (4357).

Research on OUD is continuously evolving, with new findings on causes and treatments emerging. A recent study found a link between pre-existing mental health conditions and the later development of chronic high-dose (CHD) opioid use among people who are new to opioid treatment. The study found that the risk was higher in people with psychotic disorders, substance use disorders, and multiple mental health conditions. In addition, people taking multiple psychiatric medications were at the most significant risk of chronic high-dose opioid use. 

Recent research has focused on the underlying causes of OUD and potential new treatment strategies. One study examined how specific systems in the brain can influence reward and addiction, which may help researchers better understand opioid use disorder. The research also found that whether a person is male or female may play a role in the treatment of this disorder, although it doesn't necessarily mean one sex has better or worse results. 

Some promising new treatments, such as thienorphine, YQA14, and agmatine, are being developed. However, researchers are cautious about how they apply results from animal studies to human patients as they work on creating more effective medicines for OUD. 

Below are several statistics on opioid use disorder:

• In the 21st century, the prevalence of OUD has become a significant public health concern. According to data from 2019, the estimated count of adolescents and adults in the US with OUD ranged from 6.7 to 7.6 million people.
• OUD not only affects individuals and their families but also has a substantial economic cost. According to the Centers for Disease Control and Prevention, the economic burden of OUD and fatal opioid overdose was $1.02 trillion in 2017, which includes healthcare, criminal justice, and work productivity costs.
• Despite the high prevalence and serious effects of OUD, treatment access remains a significant challenge. About 6,607,845 individuals, accounting for 86.6% of those diagnosed with OUD, did not receive the necessary treatment in 2019.
• According to estimates spanning 2017 to 2022, around 66 million annual outpatient visits to the emergency department (ED) and approximately 760,000 yearly inpatient admissions in the US are attributed to people diagnosed with opioid use disorders.
• There were more than 80,000 deaths caused by opioid overdose in 2021, ten times more than in 1999, according to the Centers for Disease Control. 
• Medication prescribed to reduce withdrawal symptoms and help individuals stop using opioids is one of the most effective treatment methods, with one study showing 95% of participants did not experience an overdose or severe relapse after using these treatments.