Opioid use disorder is a chronic and treatable mental health condition that involves a problematic pattern of opioid misuse. Effective treatment is possible and typically involves medication and cognitive and behavioral therapy. It’s important to seek help as soon as possible if you think you’re developing a dependence on opioids.
Opioid use disorder (OUD) is a mental health condition in which a problematic pattern of opioid misuse causes distress and/or impairs your daily life.
OUD exists on a spectrum and may be mild, moderate or severe. It typically involves an overpowering drive to use opioids despite consequences, increased opioid tolerance and/or withdrawal symptoms when you stop taking opioids.
Opioid use disorder is a chronic (lifelong) condition with serious potential consequences, including disability, overdoses, relapses and death.
Opiates and opioids are narcotics. Narcotics are a class of drugs that are chemicals — natural or synthetic — that interact with nerve cells and have the potential to reduce pain. Opiates occur in nature, though they can still be very dangerous in their purified and concentrated forms. Opioids are almost always made by using chemistry.
Prescription narcotics are meant to treat acute pain (such as recovering from an injury or post-surgery) and can sometimes help chronic pain. Some examples of prescription opioids and opiates include:
Heroin is another opiate that’s a derivative of morphine. It’s exclusively used for recreational purposes.
Opioids and opiates can become addictive because they not only dull pain, but can also produce a sense of euphoria in some people. This, combined with tolerance build (needing to increase doses to produce the same effect) can lead to opioid use disorder.
Not everyone who takes prescription narcotics develops a use disorder, especially when you take them short-term, such as recovering from surgery in a hospital. When you carefully follow prescription instructions, the chances of developing a dependence decrease.
Opioid dependence simply refers to the development of tolerance or withdrawal. Tolerance is needing higher doses to produce the same effect or getting less benefit from the same dose over time. Withdrawal is experiencing nausea, diarrhea, a runny nose or other problems when you stop taking opioids.
Opioid use disorder is a pattern of opioid use that causes life problems or distress. The person finds it difficult to adjust or eliminate their use in response to problems caused by the drug.
Opioid use disorder may involve physical dependence and psychological dependence. People are psychologically dependent when a drug is so central to their thoughts, emotions and activities that the need to continue its use becomes a craving or compulsion despite negative consequences.
Opioid use disorder affects people of all ages, races, sexes and socioeconomic levels.
Approximately 3% to 19% of people who take prescription opioid medications develop OUD. People misusing opioids may try to switch from prescription drugs to heroin when it’s easier to get. This indicates that the disease is getting more dangerous.
About 45% of people who use heroin started with misuse of prescription opioids. Some people develop OUD by starting with heroin use.
Opioid use disorder is common. It affects over 20 million people worldwide and over 3 million people in the United States. Opioid use disorder is an epidemic in the U.S.
Opioids are responsible for over 120,000 deaths worldwide every year.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the signs of opioid use disorder include:
Seeking medical care as soon as you have signs and symptoms of OUD is essential.
If you have a physical dependence on opioids, you may experience the following withdrawal symptoms if you stop taking them:
Several complex factors contribute to the development of opioid use disorder, including:
The likelihood of developing dependence following opioid use is high compared with most other drugs. Opioids have high addiction potential because they activate powerful reward centers in your brain.
Opioids trigger your brain to release endorphins. This neurotransmitter both decreases your perception of pain and creates feelings of euphoria. Once the opioid has worn off, so do these sensations. You may have a strong desire to continue using opioids to continue the feeling.
Opioids can lead to physical dependence within a short time — as little as four to eight weeks. People who use opioids for a long period of time can actually experience worse chronic pain because of the long-term toxic effects of opioids on pain signaling in their bodies.
In addition, once someone has physical dependence to opioids, the severe withdrawal symptoms create significant motivation to continue using opioids.
Access to opioids is a particularly significant environmental risk factor. The availability and volume of prescription opioids, especially in North America, Western Europe and Australia, make them easier to access.
Other factors that increase the extent of exposure and the opportunity for opioid use include:
Heroin is often easier to get than opioids that are meant to be prescriptions. This can also contribute to the development of OUD. Lately, powders and pressed pills that are illegally sold as heroin, cocaine, crystal meth or even prescription opioids pills actually contain doses of fentanyl that are very dangerous and often deadly.
Researchers estimate that genetic factors are responsible for 40% to 60% of the vulnerability to any substance use disorder. If you have a first-degree relative (biological sibling or parent) with OUD, you’re more likely to develop it as well.
Several studies have found that about half of people who experience a mental health condition during their lives will also experience a substance use disorder and vice versa.
Overlapping factors such as genetic vulnerabilities, issues with similar areas of your brain and environmental influences cause both substance use disorders, such as OUD, and other mental health conditions.
Research shows that mental illness may contribute to substance use disorders, and substance use disorders can contribute to the development of mental illness.
Having any of the following mental health conditions can contribute to the development of OUD:
Having certain physical health conditions, such as chronic pain, can increase people’s use of opioids and the eventual development of OUD.
Adverse childhood experiences (ACEs) are strongly related to the development of a wide range of health issues throughout a person’s lifespan, including substance use disorders.
Several family-related ACEs increase the risk of drug use during adolescence (and adulthood), including:
Other childhood factors that can increase your risk of developing OUD include:
A single test can’t diagnose opioid use disorder. Instead, healthcare providers rely on a thorough evaluation of your medical history and behaviors surrounding opioid use. They may order drug tests and evaluate prescription drug monitoring program reports.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must have at least two of the signs listed in the symptoms section to be diagnosed with OUD.
It’s important to remember that OUD exists on a spectrum of severity:
Effective treatments are available for opioid use disorder. Treatment is highly individualized — one person may need different types of treatment at different times.
Treatment for OUD often requires continuing care to be effective, as OUD is a chronic condition with the potential for both recovery and relapse.
Different types of treatment programs include:
The most effect overall form of OUD treatment is called medication-assisted treatment (MAT), meaning that medications are combined with different types of counseling for a holistic approach.
Mental health professionals, including psychologists, therapists and counselors, use it to treat or manage mental health conditions.
During CBT, a mental health professional helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.
For OUD, CBT involves encouraging motivation to change and education about treatment, as well as preventing relapse.
CBT can also help manage other co-occurring mental health conditions a person with OUD may have.
There are many other types of psychotherapies that benefit people with OUD. CBT isn’t the only option. A well-trained therapist can recommend an individualized plan for you.
Participating in self-help programs, such as Narcotics Anonymous, can also play a significant role in OUD treatment.
These programs support behavioral modification and better emotional regulation through self-help and peer support. The underlying principle of these programs is that people with OUD get well through:
Group therapy supports people with OUD in learning healthier coping skills and reducing relapse risks.
Certain medications can help modify your brain chemistry to help treat OUD. They can also relieve cravings, relieve withdrawal symptoms and block the euphoric effects of opioids.
The three medications that are U.S. Food and Drug Administration (FDA)-approved to treat OUD include:
Unfortunately, people with OUD are at the highest risk of death in the first four weeks of OUD treatment and in the four weeks after treatment ends if they relapse.
This is because it’s easy to miscalculate and use doses that they previously tolerated. But these doses lead to overdose due to loss of tolerance from a break in opioid use.
If you or a family member is seeking treatment for acute or chronic pain, talk to your healthcare provider about pain medications or therapies that aren’t opioids to avoid bringing opioids into your home.
If you’re taking prescribed opioids, it’s essential to take them with extra care to prevent dependence and OUD. Helpful tips include:
Talk to your children about how dangerous opioid drugs can be and why it's important to use them (and all other medications) only as prescribed. If you think you or your child may be using opioids nonmedically or are developing dependence, seek help as soon as possible.
Left untreated, the prognosis (outlook) for opioid use disorder is often poor.
People who have severe OUD have an increased risk of:
In addition, the mortality rate for people with OUD is 10 times higher than that of the average population.
It’s important to remember that OUD is treatable. However, only about 1 in 4 people with OUD receive professional treatment.
Medication-assisted treatment (MAT) for OUD decreases:
An opioid overdose can happen when a person takes too much of an opioid or a combination of opioids and other drugs.
Signs of an overdose include:
Immediate action is needed to help someone experiencing an opioid overdose. Naloxone (commonly known by the brand name Narcan®) is a drug that treats the overdose immediately. Naloxone can reverse the effects of an opioid overdose if it’s given to the person quickly. Medical attention is still urgently needed after the administration of naloxone.
It can be very challenging and stressful to learn that someone you love may have opioid use disorder. Here are some tips to help your loved one and yourself:
If you’re currently taking prescription opioids and are concerned you may be developing a use disorder, talk to your healthcare provider immediately.
If you think your child or a friend may be misusing opioids, get them medical help as soon as possible.
A note from Cleveland Clinic
Opioid use disorder is a complex mental health and brain condition. Opioids affect your brain, including your decision-making ability. These changes make it hard to stop taking opioids, even if you want to. If you or a loved one has opioid use disorder, talk to a healthcare provider as soon as possible. A trained provider can help guide you to the treatment you need.
Last reviewed by a Cleveland Clinic medical professional on 10/04/2022.
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