Opioid Dependence

What is opioid dependence?

Addiction is one of the most prevalent preventable diseases throughout the world. Among the varieties of addiction, opioid dependence ranks quite high in western countries such as the United States and Great Britain.

Currently, the United States is in the middle of an opioid dependence epidemic with over 200 million opioid prescriptions filled in 2013, according to the NIDA. This number has risen since and still does not include the number of illegal opiates, such as heroin, being consumed each year. As such, the United States is the largest consumer of opiates on the planet and this trend does not seem to be slowing down whatsoever.

Opioid dependence is a disease that can have catastrophic effects on an afflicted person’s health and claims the lives of tens of thousands of people each year in the U.S. alone. Additionally, this disease can severely impact the lives of the people around the afflicted person including family, friends, and business contacts.

Before delving into the details of this potentially life-threatening condition, it must be kept in mind that this is a complex disease with multiple causes, symptoms, treatment options and ways of prevention.

Symptoms of opioid dependence

The symptoms of opioid dependence can be subtle in the earliest stages of the disease but will become more and more obvious as the disease progresses. Early signs of abuse will usually manifest as drowsiness, mental confusion, lack of attention, nausea, and sometimes constipation (NIDA). As the opioid user’s dependence increases, the symptoms of withdrawal will become more apparent when symptoms of use are not present. This state of withdrawal will produce behavioral symptoms such as irritability and erratic behavior, as well as physical symptoms such as nausea and trembling.

It is important to note that opioid dependence is typically a chronic disease that will affect a person over an extended portion of his or her life. The symptoms mentioned above are strictly biological and psychological. Such symptoms will typically create a variety of additional social problems for those afflicted such as unemployment, homelessness, incarceration, etc.

Users who are deeply dependent on such substances tend to overlook or ignore many other aspects of their lives. The addiction will compel users toward risky behaviors to supply their habit including theft and prostitution. However, these outcomes can be prevented by watching for the earliest signs and understanding the causes.

In many cases, the user will either not notice or be unwilling to accept that they are developing an addiction. Consequently, it will usually be the people around the user, such as family and friends, that will become aware of the problem first. This can have profound effects on those who care for the user including mental distress and strain of the relationship. In addition to the symptoms mentioned previously, friends and family should carefully observe the user’s behavior and recognize when he or she is lying about their drug use. The vast majority of addicts remain addicts because they will rarely admit to their problem. As the addiction progresses, many users will require higher dosages in order to satiate their cravings.

Additionally, some users will begin to use the drugs intravenously in order to quell cravings faster. Such usage will present itself in the form of “track marks” which are a series of injection marks that run up the length of major veins in the limbs. Other IV users may use the same injection site repeatedly which will cause a distinct chronic wound at the site, sometimes referred to as a “heroin blister.”

Causes of opioid dependence

Biologically speaking, opioid dependence is caused by prolonged use of opioid pain medication regardless of whether it is prescribed or illegally procured. Many people who find themselves addicted to opioid substances were simply taking their prescribed medications for treatment of chronic pain; a condition that approximately 100 million people in the United States suffer from (NIDA). Other people begin using opioid medications in a recreational manner. This is typically the case with younger people aged 16-25 who find themselves addicted. In the case of those younger chronic users, they are assisted by the wide availability of prescription medications in the cabinets of their parents and relatives. But it is important to realize that simple availability and boredom are rarely the cause of chronic dependence.

In the case of heroin addiction, it is estimated that almost 93 percent of long-time addicts had underlying mental illnesses such as depression, schizophrenia, mania, and bipolar disorder (Szalavitz, M). Additionally, many addicts reported a prior history of sexual abuse and exposure to violence at young ages. As such, these conditions should be taken into consideration when the addict begins to enter treatment.

However, not all addicts have such horrible histories. Even persons with what is considered a fairly average background can become dependent on opiates. In fact, some of the causes of addiction are purely social in nature and result from destructive relationships with friends or partners. For instance, if someone were to begin a committed relationship with another person who happened to be an addict, that person also risks becoming an addict.

Additionally, peer pressure can be a factor in the original use and continued abuse of certain substances (NIDA). Teens and young adults may find themselves influenced by their peers to engage in many risky behaviors, including drug use or risky sexual behaviors.

Treatment of opioid dependence

In order for a person suffering from opioid dependence to successfully complete treatment, the user must be willing to submit to treatment. Being primarily a psychological condition, an unwilling patient will rarely have good outcomes. Additionally, it is incredibly helpful if the patient enters treatment with the full support of his or her family behind them.

In terms of treatment options, there are a wide variety of types and they typically depend on the type of opioid abused and the length of the abuse. In the case of severe addictions to stronger opiates, such as heroin and Fentanyl, substitution therapy is usually prescribed. This type of treatment involves discontinuing the user’s opiate of choice and substituting it with a more controllable substance such and methadone (Szalavitz, M). Eventually, the user is able to be completely weaned off the substitute opiate and is no longer dependent.

This is the most medically accepted form of treatment but it is not without criticism. The most common criticism against this treatment is that it does not effectively break the dependence and essentially keeps the user addicted to opiates. However, this type of treatment remains the mainstay for a serious addiction to opiates despite criticisms and alternative therapies being touted (Szalavitz, M).

In regards to alternative therapies, there are a great deal out there. As appealing as they can be, it is important to look at the evidence behind each purported treatment before committing. For instance, celebrity “doctor” Dr. Drew Pinsky operated an alternative treatment program for addicts that came under suspicion after roughly 13 percent of his patients died of an overdose after completing it (Szalavitz, M). His and other programs attempt to address only psychological, emotional, and behavior issues in opioid dependence while attempting to ignore physical aspects of the condition.

Additionally, some programs are little more than fancy resorts and spas dressed up as treatment centers and marketed to wealthy clients. These centers operate websites that sell highly priced stays at luxurious resorts in the hopes of helping their clients find “balance.” In most cases, there is no acknowledgment of the physical problem of addiction, but many references to the “spiritual” problem of addiction.

In any case, if you or a loved one are suffering from opioid dependence, it is important that the treatment sought addresses the dependence directly as well as its underlying cause(s). Such treatment should involve multiple behavioral health professionals using an integrated treatment that considers all aspects of the disease. A large part of addiction is sociological as well as psychological, i.e. social connections must be broken as well. In the vast majority of cases, the opiate addict has a network of fellow addicts that help each other reinforce their behavior. It is important that treatment considers these social factors as well.

As mentioned previously, mental illnesses are typically a precursor to many addictions including opioid dependence. There is a range of mental health professionals to consult and it is not necessary to meet with a psychiatrist or psychologist initially. In many cases, simple counseling in the early stages of abuse can improve outcomes tremendously (Szalavitz, M). If you are uncomfortable scheduling with a counselor yourself or are unaware of where to start, seek out your local crisis centers such as the homeless coalition or community outreach program. They will be able to point you in the direction of essential care.

It is important to understand that addiction affects millions of people so you or your loved one are not alone. Start attending a local support group through a local community organization and leave the social circle(s) that reinforced your destructive behavior. But in whatever situation you find yourself in, seek treatment!

Prevention of opioid dependence

Similar to treatment, prevention of this condition must also be multi-faceted. It is rare that there is only one cause of opioid dependence in the individual. Prevention efforts can begin at any point but they will be most effective before opioid use begins in the individual and should be assessed on a case-by-case basis.

In the case of those who are prescribed opioid medication to treat chronic pain conditions, patients should consult their doctor regularly regarding their dosage or any adverse effects they are experiencing (NIDA). If you suspect that you are becoming addicted to your pain medication, ask your physician about lowering your dosage or discontinuing your medication altogether. Additionally, do not take a higher dosage than prescribed or combine your medication with alcohol or other medications. Alcohol will increase the effect of the medication and could increase the likelihood of overdose.

In the case of those who begin addiction with recreational use, the user must realize that these medications are damaging unless used only under certain circumstances. Due to the nature of addiction, individual users or groups of users may not be able to recognize the problem with their usage on their own. It is necessary for the potential addict to have emotional and psychological support from their friends and family to help prevent them from pursuing a destructive path in the form of dependence.

If you suspect a loved one is addicted to opiates, remind them that you are there for them and support them in ways that do not simply enable their addiction, such as freely giving them money. Emotional support is far more crucial than financial support.