Opioid Use Disorder

Opioid use disorder (OUD) is a mental health condition where an ongoing pattern of opioid use affects your health and quality of life.

Opioids are addictive substances. Healthcare providers sometimes prescribe opioids to treat moderate to severe pain. But they also cause your body to produce more dopamine, which is a “feel good” hormone that gives you the sensation of pleasure. For some people, taking opioids may cause euphoria. Euphoria is an intensely good feeling. But this feeling is short-lived and goes away when the substance wears off.

Opioid use disorder occurs when you have an overpowering drive to use opioids despite their risks. This may include an increased tolerance or withdrawal symptoms when you stop taking the substance.

Opioid use disorder is a lifelong (chronic) condition. It can have serious and life-threatening consequences. It can affect anyone. And you aren’t a bad person or flawed for having this condition. It’s treatable. Know that help is available when you’re ready.

Symptoms of opioid use disorder

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) establishes opioid use disorder diagnostic criteria. OUD symptoms and behaviors include:

• Taking larger amounts of opioids or taking them over a longer period than prescribed
• Having a strong desire or urge to use opioids
• Having unsuccessful efforts to cut down or stop opioid use
• Continuing to use opioids despite having recurring social issues due to using them
• Spending a lot of time getting or using opioids or recovering from their effects
• Having issues fulfilling responsibilities at work, school or home due to opioid use
• Giving up or reducing activities because of opioid use
• Using opioids in physically hazardous situations
• Continuing opioid use despite an ongoing physical or psychological problem that’s likely caused or worsened by opioids
• Developing a tolerance (need for an increased amount of an opioid to get the same effect)
• Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms

You don’t need to check off every single symptom on this list in order to receive an opioid use disorder diagnosis. A healthcare provider may make a diagnosis if you meet two of the criteria within a 12-month period.

It’s never too early or too late to reach out to a provider if you suspect you have a dependency on opioids.

Opioid use disorder causes

Using opioids can change how your brain’s reward system works. This happens because of the substance’s increased addiction potential.

Opioids trigger your brain to release endorphins. This neurotransmitter decreases your perception of pain and creates feelings of euphoria. Once the opioid wears off, so do these sensations. You may have a strong desire to continue using opioids to maintain the feeling.

Opioids also increase your risk of physical dependence. This is when your body adjusts to a substance. Unpleasant symptoms happen when you stop taking it. This could include a fever and chills, nausea and vomiting and intense cravings for opioids.

Dependence can happen within four to eight weeks after using an opioid. This is why healthcare providers will closely monitor you if they prescribe opioids to you. Once physical dependence sets in, severe withdrawal symptoms may motivate you to continue using the opioids.

Risk factors

Opioid use disorder affects all people, no matter their age, race, sex, education, income or type of job. Your risk of developing OUD may increase with the following:

• Access to opioids: It’s common for OUD to develop after taking prescription opioid medications. It may also develop with nonprescription substances like heroin. In some cases, you may switch between prescription and nonprescription substances based on what’s available to you.
• Adverse childhood experiences: Negative experiences that happened during childhood may lead to OUD. Common examples may include abuse, neglect, difficult relationships, domestic violence, or untreated behavioral or mental disorders.
• Chronic pain: Having certain physical health conditions, such as chronic pain, can increase your use of opioids and the development of OUD.
• Genetics: Researchers estimate that genetic factors may increase your risk of 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.
• Mental health conditions: OUD may happen alongside a mental health disorder. Both conditions are treatable. Common types of mental health conditions include bipolar disorder, borderline personality disorder, depression, anxiety and post-traumatic stress disorder.

Complications

Opioid use disorder may lead to overdose (taking too much of an opioid than what your body can handle). This is a deadly complication that affects your breathing if it isn’t treated in time.

Other complications of OUD may include:

• Blood-borne virus infections (hepatitis B, hepatitis C and HIV)
• Legal trouble (spending time in jail or a prison sentence)
• Relationship, work, school and financial challenges

While treatment is a lifesaving effort for OUD, you may be at the highest risk of death in the first four weeks of treatment and in the four weeks after treatment due to the risk of relapse. Relapse is returning to a substance after a period of stopping.

Your risk of death increases because it’s easy to miscalculate and use doses that you previously would have been able to tolerate. But these doses may lead to overdose due to loss of tolerance from a break in opioid use.

How doctors diagnose opioid use disorder

A single test can’t diagnose opioid use disorder. Instead, a provider will review your medical history and behaviors surrounding opioid use. They may order drug tests and prescription drug monitoring program reports.

Your provider will verify your symptoms and behaviors with those listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to make an official diagnosis.

Your provider may also evaluate the severity of OUD when you receive a diagnosis.

How is opioid use disorder treated?

Opioid use disorder treatment varies based on your needs. It may include:

• Medications for opioid use disorder (MOUD)
• Psychotherapy
• Self-help programs

Treatment is highly individualized. You may need different types or combinations of treatment at different times.

Medications for opioid use disorder (MOUD)

Certain medications may modify your brain chemistry to manage opioid use disorder. The U.S. Food and Drug Administration (FDA) has approved these three medications to treat OUD:

• Methadone: It prevents withdrawal symptoms and reduces cravings.
• Buprenorphine: It blocks the effects of opioids, reduces withdrawal symptoms and reduces cravings.
• Naltrexone: It blocks the effects of opioids, preventing the feeling of euphoria.

There are risks to each of these medications. Talk to your provider to make sure you have the support you need while you’re on a MOUD.

Psychotherapy

There are many types of psychotherapy (talk therapy) available to help manage opioid use disorder. A common type is cognitive behavioral therapy.

Cognitive behavioral therapy (CBT) is a structured, goal-oriented type of therapy. 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. You can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

CBT encourages positive change by teaching you about treatments and how to prevent relapse.

Self-help programs

Participating in self-help programs, such as Narcotics Anonymous (NarcAnon), may play a significant role in OUD treatment.

These programs help support changes to your behaviors. They also teach you how to regulate your emotions. You’ll learn to help yourself and you’ll get support from others with experience in what you’re going through.

The benefits of self-help programs include:

• Understanding your condition
• Sharing your challenges with others who have a similar challenge
• Working on personal improvement and recovery skills

Group therapy supports people with OUD in learning healthier coping skills and reducing relapse risks.

When should I see my healthcare provider?

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 loved one may be misusing opioids, start a conversation with them. Make sure you listen and let them know you’re concerned and willing to help. If you’re not sure how to start this conversation, a provider may be able to give you some advice.

You may also want to reach out to the free and confidential, 24/7 treatment referral and information service by calling 1.800.662.HELP (4357) or by texting your five-digit ZIP code to 435748. In the U.S., this is the Substance Abuse and Mental Health Services Administration National Helpline. It’s available in English and Spanish.

What can I expect if I have an opioid use disorder?

If untreated, the outlook (prognosis) for opioid use disorder is often poor and can be deadly. But treatment is available and recovery is possible.

OUD is a lifelong condition. It requires continuing care to be effective.

While recovery is within reach, so is the chance of relapsing. But don’t let that discourage you from getting the help you need. Your care team will work closely with you to create a treatment plan that’s flexible to meet you where you are. If your goals change, so will your treatment plan throughout your life.

If you or a loved one is at risk of overdose, you may consider carrying naloxone on you at all times. This medication quickly blocks the effects of opioids. It can potentially save lives. Training is available to show you how to use naloxone safely. It’s often available without a prescription from local pharmacies.