Opioid Addiction and Treatment Options
What Is Opioid Abuse?
All opioids have the potential for dependence and abuse. The word “abuse” includes the misuse of prescription opioid medications as well as any use of heroin, illicitly manufactured fentanyl or counterfeit painkillers, or the use of illegally obtained (i.e., diverted) prescription opioids.
Prescription opioid medications, like oxycodone, codeine, and morphine, have legitimate medical uses. Most of these prescription painkillers are Schedule II or Schedule III substances under the U.S. Controlled Substance Act, meaning they can be prescribed by physicians, yet they still have a potential for abuse and dependence.3
Illicit opioids, like heroin and many synthetic fentanyl analogues, are Schedule I substances., They have a high potential for abuse and dependence, like prescription opioids, but they have no recognized medical uses.
Any use of a Schedule I drug such as heroin is illegal and is considered substance abuse. The same is true with illegally obtained or counterfeit prescription opioids. For prescription painkillers, drug misuse (or abuse) means:4
- Using these drugs for non-medical purposes.
- Taking a prescription that belongs to someone else.
- Exceeding the recommended dose of a drug.
- Using a medication in ways other than how it is intended to be used (e.g., crushing up an oral tablet and snorting or injecting it).
- Using a medication with the intent of getting high.
According to the 2019 National Survey on Drug Use and Health, 10.1 million people 12 years old and older in the U.S. misused prescription opioids or used illicit opioids within the prior year, the overwhelming majority of which were prescription painkillers.5
What Are the Effects of Opioid Abuse?
Opioids are prescribed to relieve pain; however, people often use them to amplify their subjective pleasurable effects and reach a euphoric high. However, opioids have a long list of negative effects that can accompany the therapeutic or pleasurable ones. These adverse side effects include:6-8
- Heavy feeling in the extremities.
- Flushing of the skin.
- Dry mouth.
- Slowed heart rate.
- Slowed breathing.
People may experience some of the side effects listed above even when taking prescription painkillers as directed by a physician 7 Using opioids at high doses may worsen the side effects and will increase the risk of a life-threatening or even fatal overdose.9
Use of any opioid—prescription or illegal—increases a person’s risk of experiencing a potentially fatal overdose. In 2019 alone, 49,860 Americans died of an opioid-involved overdose.10
An opioid overdose is an emergency and requires immediate medical assistance. If available, naloxone can reverse the symptoms of an opioid overdose, providing lifesaving time until emergency medical services arrive or the person can be taken to an emergency department.12
Long-Term Adverse Effects of Opioids
Using opioids on a long-term basis may cause issues such as:6,7,13,14,15
- Lowered testosterone.
- Sexual dysfunction in both men and women.
- Severe constipation that may result in serious problems such as bowel obstruction.
- Depression or other mental health issues.
- Increased risk of adverse cardiovascular events such as heart attack.
- Falls and fractures in the elderly.
- Immune system suppression.
- Respiratory problems.
- Tolerance (needing a higher dose or more frequent doses to get the same effect over time).
- Dependence (needing the drug to avoid withdrawal symptoms).
- Development of an opioid use disorder (OUD).
Changing the route of administration of any opioid (for example, snorting or injecting it) is associated with unique risks that include:6,7,13,15
- Collapsed veins and bacterial infections of blood vessels and heart valves (from injection drug use).
- Skin abscesses (from injection drug use).
- Damage to the nose (from snorting).
- Contraction of infectious diseases (e.g, HIV or hepatitis C).
What Is Opioid Addiction?
The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) defines opioid use disorder (OUD) (often referred to as opioid addiction) as a “problematic pattern of opioid use leading to clinically significant impairment or distress.”16
Addiction is a treatable medical disease characterized by the compulsive substance use despite negative consequences.16,17 Areas of the brain related to reward and self-control are altered by repeated use of substances. These brain changes can be long-lasting and are part of the reason that relapse remains a risk long after a person gets sober.17,18
An estimated 1.6 million people age 12 and older had an opioid use disorder in 2019.5
What Are the Signs of an Opioid Addiction?
A medical professional will give a diagnosis of OUD when a patient exhibits 2 or more of the following 11 criteria within a 12-month period:16
- Taking larger amounts of an opioid or for a longer time period than intended.
- A lingering feeling of wanting to reduce or give up opioid use but not succeeding in doing so.
- Spending too much time seeking, using, or recovering from opioids.
- Craving opioids.
- Using opioids even though they have been interfering with work, academic, or home obligations.
- Using opioids even though they have been causing relationship problems.
- Giving up important or enjoyable activities or hobbies to use opioids.
- Continuing to use opioids despite knowing that it causes or worsens physical or mental health problems.
- Repeatedly using opioids in situations where doing so is physically hazardous.
- Using opioids despite feeling their effects less intensely or needing more to feel the same effects (tolerance).
- Experiencing withdrawal symptoms when not taking or reducing intake of opioids. (This criterion is not considered to be met for those taking opioids solely as directed by a physician.)
The severity (mild, moderate or severe) of the disease is measured by the number of criteria a person exhibits.16
Treatment for Opioid Addiction
Opioid addiction is a chronic illness with a high relapse risk, but it is one that can be treated. Many people with OUD lead fulfilling lives in recovery. Effective treatment of opioid use disorder often employs many treatment methods across a continuum of care, which may include:17,19,20
- Medical detox. During medical detox, a patient is able to withdraw from opioids safely under the supervision of medical professionals on an inpatient or outpatient basis. Staff can monitor a patient’s health and prescribe medication to ease withdrawal symptoms as well as stave off cravings. In inpatient programs, staff can respond immediately to medical emergencies. Once the patient is past the acute withdrawal phase and is stable, they are typically transitioned to an inpatient or outpatient rehabilitation program.
- Rehabilitation treatment. While medical detox can help a person break free from physiological opioid dependence, long-term recovery often hinges on a person’s success in recognizing potential triggers, restructuring thought patterns, and staying motivated and focused on recovery. With therapeutic treatment, which can be provided in a variety of settings (e.g., inpatient, outpatient, telehealth, mutual help groups, etc.), and typically employs evidence-based behavioral health therapies, education, and other tools to empower patients with the necessary skills to remain sober.
- Medication-assisted treatment. This refers to the use of maintenance medications, such as buprenorphine, naltrexone, or methadone along with rehabilitation treatment therapies to foster a person’s long-term recovery. Medications can be used for as long as they are effective, often for months or even years.
- Aftercare or ongoing care. Recovery is a lifelong process, and ongoing support is vital. Aftercare can include steps like attending other forms of rehabilitation treatment, joining a sober living facility or a mutual help group like the 12-step program Narcotics Anonymous (NA). Professional rehab facilities often have online alumni programs that facilitate self-help mutual-help, allowing former patients to remain in contact with their peers, track their recovery progress, and attend meetings and special events.
Does Insurance Cover Opioid Addiction Treatment?
Almost all employer-based, private, and government-funded insurance policies cover substance abuse treatment since the passage of the Affordable Care Act (ACA).21 The level of coverage provided and the treatment options available will vary according to the plan itself. For example, certain plans will only provide coverage for treatment facilities considered within their network. Some plans may require high deductibles to be paid before they start covering costs, while some plans may not require a deductible at all. The level and duration of treatment covered will also depend on your plan.
Details about a specific insurance policy can usually be found in the Summary of Benefits and Coverage provided to members. Desert Hope Treatment Center and other American Addiction Centers’ (AAC) facilities feature a useful online tool to check insurance your coverage immediately.
How long does opioid withdrawal last?
Withdrawal from short-acting opioids like heroin and oxycodone typically begins between 8 to 12 hours of the last dose and often subsides within 3 to 5 days. Longer-acting opioids such as methadone have a more delayed and prolonged timeline, with symptoms 36-48 hours and lasting for several weeks or longer.19 Cravings and certain other effects may linger beyond withdrawal and are often controllable with medication-assisted treatment.
Can I detox from opioids myself?
Opioid withdrawal is almost always very unpleasant and in rare cases it can be dangerous, for example if vomiting and diarrhea lead to dehydration or electrolyte imbalance. Medical professionals in a detox program can ease the process and ensure your physical safety, while supporting your recovery attempts and helping you avoid a relapse back to opioids.19
How addictive are opioids?
Opioids are considered very addictive.6,22 Even prescription opioids have a high potential for abuse, as indicated by their DEA Schedule II status.3
Are opioids depressants?
While opioids have a relaxing effect on the body and slow breathing, they not part of the class of drugs called central nervous system (CNS) depressants. Prescription CNS depressants include benzodiazepines (e.g., Valium and Xanax), other sedative hypnotics (e.g., Ambien), and barbiturates (e.g., Luminal). Other CNS depressants include gamma hydroxybutyrate (GHB) and alcohol.23-25
What is the difference between opioids and opiates?
“Opiate” refers to drugs derived naturally (e.g., heroin, morphine, etc.), while “opioid” is a term that encompasses opiates as well as semi-synthetic or fully synthetic opioids, such as fentanyl and methadone.26