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Opioid Addiction: Signs and Addiction Treatment

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Opioids are substances that are known for their pain-relieving effects. They include both legal, and some illegal substances that may have the potential for misuse, which can potentially lead to dependence and/or addiction.1

If you or someone you know is struggling with opioid addiction, know that you’re not alone. Opioid addiction and overdose are serious public health problems in the United States. In 2019, 10.1 million people reported misusing opioids in the past year, with 9.7 million of those people misusing prescription opioids.2

Whether you use opioids as prescribed, or misuse opioids, it’s important to understand the dangers that may be associated with them. This may help prevent potential adverse health effects, addiction, overdose, or even death. Keep reading to learn more about:

  • Opioid addiction.
  • Causes of opioid addiction.
  • Opioid addiction solutions.
  • Options for opioid addiction treatment.

What Are Opioids?

Opioids are a class of drugs that includes illegal substances like heroin and prescription drugs like oxycodone and morphine. Because of their analgesic or pain-killing properties, prescription opioids are widely used to manage many types of painful conditions.4

Naturally occurring opiate substances such as morphine, codeine, and thebaine are derived from the poppy plant. Semi-synthetic opioids like heroin, hydrocodone, and oxycodone are created in labs from these natural opioids. Fully synthetic opioids like fentanyl and methadone are manmade in laboratories.5

Certain prescription opioids are considered essential medicines by the World Health Organization (WHO). This is because they are deemed necessary for pain management and for their use in palliative care, anesthesia, and treating opioid dependence. Opioid analgesic medications on the WHO’s Model List of Essential Medicines include: 6

  • Codeine.
  • Fentanyl.
  • Hydromorphone.
  • Methadone.
  • Morphine.
  • Oxycodone.

What is Opioid Addiction?

Opioid addiction is a chronic and often-relapsing disease. The clinical diagnosis for opioid addiction is known as an opioid use disorder (OUD).4 Though a number of factors are thought to contribute to substance use disorders like OUD, their development may be associated with repeated opioid misuse or using them in a way other than how they were prescribed. OUD is characterized by a loss of control over opioid use, chronic opioid-seeking behaviors, and continuing to use the drug despite the potentially negative consequences it can have on someone’s life.4

Opioids effect the brain by binding to and activating opioid receptors.9 Opioid receptor activation is key to the painkilling properties of these drugs, but it also is accompanied by increased dopamine activity in the brain. Dopamine is a brain signaling molecule that, when released in large amounts, can create a rewarding sense of euphoria. This effect can make a person want to repeat the experience that led to the increased dopamine activity to begin with. Such reinforcement of continued use can lay the groundwork for opioid addiction development.4

Since they have similar mechanisms of action to drugs like heroin, even opioids that are prescribed by a doctor have the potential to be highly addictive. Though opioids can be safe and effective as painkillers when used as prescribed for short periods of time, the risks of negative consequences and/or misuse can begin to build when they are used for longer periods, or in higher amounts.

People may misuse opioids by taking medications that aren’t prescribed to them, taking the medication in ways other than originally intended, or by taking it to get high.4 Some of the potential health risks of opioid misuse include:10

  • Risk of addiction.
  • Death due to overdose.
  • Wide spread, systemic effects on various physiological processes and throughout several organ systems, including respiratory, gastrointestinal, musculoskeletal, cardiovascular, immune, endocrine, and central nervous systems.
  • Risk of fractures due to falls (a particular concern in older adults).

Signs of Opioid Misuse

It’s not always obvious when a person is misusing or addicted to opioids. Though an opioid use disorderwoman-feeling-nausea-alcohol-addiction diagnosis is best left to treatment professionals, opioid misuse may be associated with certain physical, psychological, and/or behavioral signs that concerned loved ones might recognize in their friends or family.

The physical effects of opioid addiction can include:11

  • Frequently appearing sedated, drowsy, or sleepy.
  • Changes in sleep habits.
  • Weight loss or appetite changes.
  • Changes in personal hygiene or grooming patterns.
  • Low or no libido.
  • Seeming to have frequent colds or flu-like symptoms (i.e., intermittent withdrawal symptoms).

The behavioral and psychological signs of opioid addiction may include:11

  • Seeking prescriptions or visiting multiple doctors.
  • Reporting lost or stolen medication.
  • Making frequent mistakes at work or school.
  • Wanting to cut down or stop opioid use but being unable to do so.
  • An increase in reported pain levels although the person’s condition doesn’t seem to be worse than before.
  • A lack of interest in relationships or activities.
  • Isolation from family or friends.
  • Change in exercise habits.
  • Stealing from family, friends, or businesses.
  • New financial or legal difficulties.

People with significant of levels physiological opioid dependence may experience opioid addiction withdrawal symptoms if they try to quit or slow their use, sometimes within a few hours after their last dose. Opioid withdrawal symptoms are often so unpleasant and uncomfortable that it makes it quite challenging for people to stop using the drug. Acute opioid withdrawal symptoms can include:4

  • Fluctuations in mood.
  • Gastrointestinal upset, like vomiting or diarrhea.
  • Body aches and pains.
  • Sleep difficulties.
  • Cold flashes and goosebumps.
  • Fever, sweating, and watery eyes.
  • Sudden, uncontrollable leg movements.
  • Strong and intense cravings to use opioids.

Dangers of Opioid Misuse

Even when used as directed, opioids are associated with physiological tolerance and dependence—though the likelihood of developing both effects may be increased in instances of misuse. Both tolerance (in prompting increased levels of use) and dependence (continued use to avoid withdrawal) can fuel the cycle of addiction. Opioid misuse can also increase the potential for an opioid overdose.4

Opioids are associated with certain adverse side effects, the likelihood of which may increase when these drugs are misused. Short-term side effects can include:4

  • Over-sedation or sleepiness.
  • Feeling confused or disoriented.
  • Nausea and vomiting.
  • Constipation.
  • Slowed breathing. In overdose situations, respiratory arrest or completely stopped breathing may result. This can result in hypoxia, a dangerous condition that can cause brain damage, coma, or death due to a lack of oxygen.

Long-term effects of opioid use can include:14

  • An increased risk of addiction.
  • A cumulatively increased risk of overdose.
  • An increased likelihood of significant dependence and increasingly severe opioid withdrawal.
  • Risk of neonatal abstinence syndrome if pregnant.

Combining Opioids with Other Substances

Some of the inherent risks of opioid use can be made worse when they are used at the same time as other substances, like alcohol or other drugs. Some older adults may be particularly at risk because they commonly take several prescription medications, have more chronic health problems, and may metabolize drugs more slowly or less efficiently.4

Using benzodiazepines and opioids together can be especially risky and can result in serious interactions. According to the National Institute on Drug Abuse, more than 30% of overdoses involving opioids also involved benzodiazepines.16 Similarly, drinking while taking opioids can be very dangerous because of the increased risk of slowed heartbeat and breathing, which can lead to coma or death.14

Opioid overdose is a serious risk associated with any type of opioid misuse—both street drugs like heroin and illicitly-manufactured fentanyl, as well as prescription painkillers. In the U.S., over 70% of the 71,000 overdose-related deaths in 2019 involved opioids.17 People may face an increased risk of opioid overdose when they take higher than recommended doses of prescription opioids. In some cases, if they resume using any type of opioid after a period of abstinence they may also be at risk of overdose.18


Opioid Addiction Treatment

If you are wondering how to treat opioid addiction and are considering opioid addiction rehab, it’s important that treatment be tailored to a person’s specific needs and focuses on treating the whole person. Treatment for opioid addiction has the potential to be very effective and may help prevent relapse.

Even if the withdrawal period is successfully endured, merely quitting these drugs often does little to help people manage chronic, compulsive opioid misuse. Instead, more comprehensive and longer-term care that can include a combination of treatment types may be more effective at helping a person maintain recovery.19

The precise approach to treatment for opioid addiction can vary depending on individual factors, including how long a person used the drug and whether they have co-occurring mental or physical health conditions. Recovering from relapse-prone addictions like opioid addiction can be a lifelong process that requires ongoing support.20 For opioid addiction, people often start with detox and progress through additional treatment efforts, such as inpatient or outpatient opioid addiction rehab facilities, support groups, and various types of aftercare following the initial treatment period.


Detox

Detox is often the first step in the recovery process. It involves a set of interventions designed to help a person safely and comfortably withdraw from the substance and become medically stable before entering other forms of treatment.

Detox can take place in an inpatient or outpatient setting, depending on what’s most appropriate for an individual’s recovery needs. A supervised, medical detox is commonly utilized for people undergoing opioid withdrawal due to challenges presented by the often markedly unpleasant withdrawal symptoms.21

Medications used during detox can minimize or prevent withdrawal symptoms. They may also help prevent relapse and increase the chances of a person staying in treatment. Some of the common medications that are used to treat opioid withdrawal include:22

  • Lofexidine. The FDA recently approved this medication to help reduce certain types of opioid withdrawal symptoms.
  • Methadone. When used as directed to stabilize someone during detox, it should not elicit a rewarding euphoria of its own.
  • Buprenorphine. This medication acts similarly to methadone as an induction or stabilizing detox medication to reduce cravings and withdrawal symptoms, yet has a limit to its opioid effects to increase its safety profile and deter abuse of its own.

Detox should not be viewed as a substitute for more comprehensive addiction treatment. Alone, it may do little to impact long-term drug abuse, and for this reason, additional treatment measures may be especially beneficial for supporting lasting recovery.26


Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) involves a combination of medication and behavioral therapies to support recovery from opioid addiction. It is very effective at treating opioid use disorder because medications can help people to stop using the drug, help prevent relapse, help restore normal brain function, and decrease cravings. Behavioral therapies may help people modify the thoughts and behaviors that led to or contributed to their opioid addiction.19

The following medications can be effective when treating OUDs:23

  • Buprenorphine
  • Methadone
  • Extended-release naltrexone

MAT has been shown to decrease opioid use and reduce opioid-related deaths, criminal activity, and the spread of infectious disease. It has also been shown to help people stay in treatment and increase their ability to function in society.23


Therapy

Therapy can be an important component of the recovery process. There are different approaches to therapy that take place in various settings to address specific concerns and needs.

For example, a person may participate in individual therapy to help address issues that may have led to the development of their addiction. In group therapy, people can address shared issues with others, gain support, and learn new skills. Depending on a person’s situation, they can also participate in family or couples therapy to help address relationship issues. Therapy is typically offered in both inpatient and outpatient settings.

Regardless of the setting, many evidence-based therapies are used to treat opioid addiction. These therapies can include:19

  • Cognitive-behavioral therapy. A person can learn to make beneficial changes to problematic thoughts and behaviors, learn new coping skills, and discover ways to help prevent relapse.
  • Contingency management. This is a form of therapy designed to encourage a person to continue not using a substance and encourage ongoing recovery progress by providing incentives for positive behavioral outcomes (such as receiving vouchers in exchange for rewards if a person provides negative drug tests).
  • Motivational interviewing/enhancement. This is a style of therapy designed to help people resolve any lingering ambivalence about treatment and recovery.

If you or someone you care about is struggling with addiction, know that help is available. American Addiction Centers (AAC) offers a free, 24/7 helpline at 1-877-714-3292. Call today to speak to an admissions navigator who can provide information about your opioid addiction treatment options and verify your benefits.


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Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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