Opioid Abuse and Addiction

Opioids are narcotic drugs that either are natural (obtained from the opium plant) or synthetic (manmade).

Opioids bind to opioid receptors (mu, kappa, delta, and OFQ/N) on the cell membranes of neurons distributed throughout the nervous and immune systems.

Doctors prescribe opioids to reduce pain due to major injuries or surgery or health conditions, such as cancer.

Opioids have three classes:

1. Naturally occurring opioids
   • Morphine
   • Narcotine
   • Codeine
   • Thebaine
   • Papaverine
   • Narceine
2. Semi-synthetic opioids
   • Heroin
   • Oxycodone
   • Oxymorphone
   • Hydrocodone
3. Synthetic opioids
   • Buprenorphine
   • Methadone
   • Fentanyl
   • Alfentanil
   • Levorphanol
   • Meperidine
   • Propoxyphene

1. Mixing with different groups of people or changing friends
2. Spending time alone or avoiding time with family and friends
3. Losing interest in activities
4. Not bathing, changing clothes, or brushing teeth
5. Being extremely tired and sad
6. Eating more or less than usual
7. Being overly energetic, talking fast, or saying insensible things
8. Being nervous or cranky
9. Quickly changing moods
10. Sleeping at odd hours
11. Missing important appointments
12. Getting into trouble with the law
13. Attending work or school on an erratic schedule
14. Experiencing financial hardship

Some of the known risk factors of opioid abuse or addiction are:

• Poverty
• Unemployment
• Family history of substance abuse
• A history of substance abuse or psychological disorders
• Younger age
• History of criminal activity
• Previous legal problems
• Contact with high-risk people or regular visits to high-risk environments
• Issues with past employers, family members, and friends
• Risk-taking or thrill-seeking behavior
• Heavy tobacco use
• History of severe depression or anxiety
• Stressful circumstances
• Prior drug or alcohol rehabilitation

Symptoms of opioid abuse are categorized into:

• Intoxication state
  • Mild to moderate
    • Drowsiness
    • Pupillary constriction
    • Slurred speech
  • Severe overdose
    • Respiratory depression (slow, shallow breathing)
    • Stupor
    • Coma
• Withdrawal state
  • Autonomic symptoms
    • Diarrhea
    • Rhinorrhea
    • Diaphoresis
    • Lacrimation
    • Shivering
    • Nausea
    • Piloerection
  • Central nervous system arousal
    • Sleeplessness
    • Restlessness
    • Anxiety or irritability
    • Insomnia
    • Tremors
  • Pain
    • Abdominal cramping
    • Bone pains
    • Diffuse muscle aching
  • Intense craving (for the medication)

According to the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5), opioid use disorder is a problematic pattern of opioid use, leading to clinically significant impairment or distress, manifested by at least two of the following occurring within a timeframe of 12 months:

• Consuming excess amounts of opioids or over a longer period than intended
• A persistent desire for opioids or continuously engaging oneself in unsuccessful attempts to cut down or control opioid use
• Spending a lot of time in activities necessary to obtain, use, or recover from the effects of the opioid
• Intense and irresistible craving or a strong urge to use opioids
• Using opioids in ways that fail to fulfill major role obligations at work, school, or home
• Taking opioids despite recurrent social or interpersonal problems caused or exacerbated by opioids
• Completely giving up or reducing essential social, occupational, or recreational activities
• Using opioids even in physically hazardous situations
• Continuing opioids despite knowing their persistent or recurrent physical or psychological problems
• Tolerance is either a need for an increased dose of opioids to achieve the desired effect or a diminished effect with the continued use of the same amount of an opioid
• Withdrawal is experiencing characteristic opioid withdrawal syndrome or taking opioids to avoid withdrawal symptoms

According to the American Psychiatric Association guidelines, the following treatment modalities can effectively manage opioid dependence:

• Medications
  • Methadone
  • Buprenorphine
  • Buprenorphine combined with naloxone
• Psychosocial treatment
  • Behavioral therapies (community reinforcement and contingency management)
  • Counseling
  • Cognitive behavioral therapies (relapse prevention and social skills training)
  • Psychodynamic therapy or interpersonal therapy
  • Group and family therapies