It might begin as a craving or urge to use opioids, perhaps progressing to recurrent opioid use, making it difficult to fulfill life's obligations. These are just two possible symptoms of opioid use disorder.
Here's how experts describe this chronic disorder—and how to recognize its signs and symptoms.
What causes opioid use disorder?
Have you ever received a strong prescription medicine for pain? Maybe it was after getting your wisdom teeth out or when back pain flared up. Odds are it was an opioid, a highly addictive class of pain medication, which includes brand names such as OxyContin and Vicodin, says the US Centers for Disease Control and Prevention. Between their addictive nature and widespread distribution, opioids can lead to opioid use disorder.
The National Institute on Drug Abuse (NIDA) reports that an estimated 21% to 29% of people misuse opioids after a physician prescribes them for chronic pain. Between 8% and 12% of those people develop an opioid use disorder. Out of people who misuse prescription opioids, about 4% to 6% will eventually use heroin—an illegal opioid responsible for almost 40 overdose deaths a day, according to the CDC.
Elizabeth Evans, MD, a psychiatrist and addiction specialist at Columbia Doctors Midtown in New York City, says opioid use disorder "stems from the brain's repeated exposure to opioids." That results in "tolerance, physiological dependence, and a shift from drug-taking being pleasurable to drug-taking being necessary in order to prevent negative experiences like withdrawal."
But Dr. Evans stresses that opioid use disorder is not caused by a lack of willpower; nor is it a moral failing. "Some people, due to a complex combination of genetic and environmental factors, are more vulnerable to develop an opioid use disorder when exposed to opioids," she tells Health.
Identifying opioid use disorder symptoms is the first step to take if you believe you or someone you know may have developed it.
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What are the symptoms of opioid use disorder?
There are 11 potential opioid use disorder symptoms. According to the American Psychiatric Association, they include:
- Taking opioids at a higher quantity or longer than prescribed
- Regularly working to limit or stop opioid use without success
- Spending large amounts of time taking opioids or working to procure them
- Continuing to take opioids even when they bring social or interpersonal problems
- Struggling to fulfill life obligations
- Foregoing or limiting participation in certain activities due to opioid use
- Taking opioids in a physically hazardous situation
- Craving or strong want for opioids
- Taking opioids, even if they cause or increase physical or psychological problems
- Increasing tolerance throughout the use of opioids
- Feeling withdrawal after stopping use of opioids
Dr. Evans says each of these symptoms falls under one of four categories:
- Impaired control
- Impairment in social functioning
- Risky use
- Physiologic factors
Experiencing two to three symptoms indicates a mild disorder, four to five is a moderate disorder, and six or more is a severe disorder, says Dr. Evans.
Chris Gleason, executive director at Brightside Recovery in Tinley Park, Illinois, explains that the length of opioid use, tolerance level, and other life factors will determine how many and which symptoms a person experiences.
"Most of our clients who fall into the severe opiate disorder category spend a great majority of the day just trying to find opiates in order not to be sick or experience any sort of withdrawal. This becomes a full-time job for them," he tells Health.
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When is intervention for opioid use disorder needed?
Physiologic dependence alone is not enough to qualify as an opioid use disorder. "Individuals taking opioids as prescribed for pain by their doctors can develop both tolerance and withdrawal. This does not mean they have an opioid use disorder unless it is paired with other symptoms such as loss of control of use or impairment in social functioning," says Dr. Evans.
When determining whether someone requires intervention, Gleason recommends asking the following questions:
- Are they struggling to manage the amount of opioids being prescribed to them?
- Are they getting opioids off the street?
- Is their family life deteriorating?
- Are people around them concerned for their well-being?
Help is most likely needed if the answer is yes to any of these points.
In general, early intervention can be beneficial to anyone showing risks or signs of opioid use disorder. "The use of any substance in a manner, situation, amount, or frequency that can cause harm to users or to those around them would be an indicator that an intervention is warranted," says Dr. Evans. "A trained clinician can then do an assessment and help determine the most appropriate next steps."
For a doctor to diagnose opioid use disorder, the person must have experienced two or more of the 11 symptoms within a 12-month period, says Dr. Evans. From there, a doctor a can help determine the best course of treatment.
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