What is an opioid use disorder (OUD)?
An opioid use disorder is defined as a problematic pattern of opioid overuse that leads to an inability to stop using despite serious impairment, distress and/or consequences.
Can a person become addicted to opioid medications prescribed by a doctor?
Yes. In fact, 80 percent of all heroin users today start with prescription opioid medications. People who overuse prescription opioids — taking them in a manner or a dose other than prescribed, or taking medications prescribed for another person — risk developing an OUD. To minimize this risk, a physician (or other prescribing health provider) should screen patients for prior or current substance use disorders and assess their family history of substance use disorders before prescribing opioid medications, and monitor patients who are prescribed such drugs. Physicians also need to educate patients about the potential risks so they will follow their physician’s instructions faithfully, safeguard their medications, and dispose of them properly.
Why do people with OUD keep using?
Nearly all people with OUDs believe at the outset that they can stop using on their own, and most try to stop without treatment. Although some people are successful, many attempts result in failure to achieve long-term recovery. Research has shown that long-term opioid use results in changes in the brain that persist long after a person stops using. These drug-induced changes in brain function can have many behavioral consequences, including an inability to exert control over the impulse to use opioids despite adverse consequences — the defining characteristic of OUD.
Understanding that addiction has such a fundamental biological component may help explain the difficulty of achieving and maintaining abstinence without treatment. Psychological stress from work, family problems, psychiatric illness, pain associated with medical problems, social cues (such as meeting individuals from one’s drug-using past), or environmental cues (such as encountering streets, objects, or even smells associated with drug overuse) can trigger intense cravings without the individual even being consciously aware of the triggering event. Any one of these factors can hinder attainment of sustained abstinence and make relapse more likely. Nevertheless, research indicates that treatment and active participation in recovery programs can benefit even people with severe OUDs.
What is OUD treatment?
Treatment is intended to help people with OUD stop compulsive drug seeking and use. It can occur in a variety of settings, take many different forms, and last for different lengths of time. Because OUD is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment is usually not sufficient. For many, treatment is a long-term process that involves multiple interventions and regular monitoring.
There are a variety of evidence-based approaches to treating addiction. Drug treatment can include behavioral therapy, such as cognitive-behavioral therapy or contingency management, medications, or a combination of both. The specific type of treatment or combination of treatments will vary depending on the individual’s needs and if they were overusing other substances in addition to opioids, which is fairly typical.
How effective is OUD treatment?
In addition to stopping opioid use, the goal of treatment is to return people to productive functioning in the family, workplace, and community. According to research that tracks individuals in treatment over extended periods, most people who get into treatment and remain active in recovery programs stop using opioids and improve their occupational, social, and psychological functioning. However, individual treatment outcomes depend on the extent and nature of the person’s OUD, the appropriateness of treatment and related services used to address those problems, and the quality of interaction between the patient and his or her treatment providers.
Like other chronic diseases, OUD can be managed successfully. Treatment and long-term recovery programs like Narcotics Anonymous enable people to counteract its powerful disruptive effects on the brain and behavior, and to regain control of their lives. The chronic nature of the disease means that relapsing is not only possible but also likely, with symptom recurrence rates similar to those for other chronic medical illnesses, such as diabetes, hypertension or asthma, which have both physiological and behavioral components.
How long does treatment usually last?
Individuals progress through treatment at various rates, so there is no predetermined length. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes. For medication-assisted treatment (MAT), 12 months is considered the minimum, and some people with OUD continue to benefit from MAT for many years.
Dropout is one of the major problems encountered by treatment programs. Therefore, motivational techniques that can keep people engaged will also improve outcomes. By viewing OUD as a chronic disease and offering continuing care and monitoring, programs can succeed, but this will often require multiple episodes of treatment and readily readmitting people who have relapsed.
How can family and friends make a difference in the life of someone needing treatment?
Family and friends can play critical roles in motivating people with OUD to enter and stay in treatment. Family therapy can also be important, especially for adolescents. Involvement of a family member or significant other in an individual’s treatment program can strengthen and extend the person’s long-term recovery.
Where do 12-step or self-help programs fit into OUD treatment?
Self-help groups can complement and extend the effects of professional treatment. The most prominent self-help groups are those affiliated with Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), both of which are based on the 12-step model of recovery. Most OUD treatment programs encourage patients to participate in self-help group therapy during and after formal treatment. These groups can be particularly helpful during recovery, offering an added layer of community-level social support to help people achieve and maintain recovery and other healthy lifestyle behaviors over the course of a lifetime.
How can the workplace play a role in OUD treatment?
Many workplaces sponsor Employee Assistance Programs (EAPs) that offer short-term counseling and/or assistance in linking employees with OUD to local treatment centers and peer support / recovery groups. In addition, work environments that support people in long-term recovery have been shown not only to promote a continued drug-free lifestyle but also to improve job skills, punctuality, and other behaviors necessary for active employment throughout life.
What role can the criminal justice system play in addressing OUD?
The majority of offenders involved with the criminal justice system as a consequence of OUD are not in prison but are under community supervision. In those cases, treatment may be recommended or mandated as a condition of probation. Research has demonstrated that individuals who enter treatment under legal pressure have outcomes as favorable as those who enter treatment voluntarily.
The criminal justice system refers drug offenders into treatment through a variety of mechanisms, such as diverting nonviolent offenders to treatment; stipulating treatment as a condition of incarceration, probation, or pretrial release; and convening specialized courts, or drug courts, that handle drug offense cases. These courts mandate and arrange for treatment as an alternative to incarceration, actively monitor progress in treatment, and arrange for other services for drug-involved offenders.
Is there a difference between physical dependence and OUD?
Yes. OUD is characterized by compulsive use despite harmful consequences; an inability to stop using opioids; failure to meet work, social, or family obligations; and tolerance and withdrawal. Physical dependence, on the other hand, can occur with the chronic use of many drugs, including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute a use disorder, but it often accompanies it. This distinction can be difficult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of OUD.
How do other mental health disorders coexist with substance use disorder and affect treatment?
OUD is a disease of the brain that frequently occurs with other mental disorders. In fact, as many as 6 in 10 people with substance use disorders also suffer from another mental illness. For these people, one condition becomes more difficult to treat successfully as an additional condition is intertwined. Thus, people entering treatment either for a substance use disorder or another mental disorder should be assessed for the co-occurrence of the other condition. Research indicates that treating both (or multiple) illnesses simultaneously in an integrated fashion is generally the best treatment approach for these people.
Is the use of medications like methadone and buprenorphine simply replacing one OUD with another?
No. Buprenorphine and methadone are prescribed or administered under monitored, controlled conditions and are safe and effective for treating OUD when used as directed. They are administered orally or sublingually (i.e., under the tongue) in specified doses, and their effects differ from those of heroin and other overused opioids.
Heroin, for example, is often injected, snorted, or smoked, causing an almost immediate “rush” or brief period of intense euphoria, that wears off quickly and ends in a “crash.” The individual then experiences an intense craving to use the drug again to stop the crash and reinstate the euphoria.
The cycle of euphoria, crash, and craving — sometimes repeated several times a day — is a hallmark of OUD and results in severe behavioral disruption. These characteristics result from heroin’s rapid onset and short duration of action in the brain.
In contrast, methadone and buprenorphine have gradual onsets of action and produce stable levels of the drug in the brain. As a result, patients maintained on these medications do not experience a rush, while they also markedly reduce their desire to use opioids.
If an individual treated with these medications tries to use an opioid such as heroin, the euphoric effects are usually dampened or suppressed. Patients undergoing maintenance treatment do not experience the physiological or behavioral abnormalities from rapid fluctuations in drug levels associated with heroin use. Maintenance treatments save lives. They help to stabilize people with OUD, allowing treatment of their medical, psychological, and other problems so they can become contributing members of families and society.
SOURCE: National Institutes of Health