Opioid dependence: What you need to know

What are opioids?

Opioids, also known as narcotics, are chemicals that work in the brain and are often prescribed as powerful pain relievers. Opioids also affect emotions and can produce the experience of euphoria, or the feeling of being "high." Some opioids such as heroin are illicit, or illegal. Prescription opioids are controlled or scheduled substances, which means that the government regulates their use.1 

There are many different kinds of opioids available for prescription. Doctors often prescribe opioids to help treat pain from dental procedures, injuries (including specific work-related injuries), surgeries, or conditions such as cancer. When used correctly, prescription opioids are generally safe, but when they are used without a doctor’s prescription or in ways other than what the doctor prescribed, they can be very dangerous.1

What are common prescription opioids?2

Name Brand Names
Hydrocodone bitartrate Vicodin®, Lortab®, Lorcet®, Zohydro ER
Hydromorphone Dilaudid®
Oxycodone HCl Tylox®, OxyContin®, Percodan®, Percocet®
Codeine Fiorinal® with codeine,
Robitussin® A-C, Tylenol® with codeine (Tylenol #3)
Propoxyphene* Darvon®, Darvocet®
Morphine Duramorph®, MS Contin®, Avinza®
Oxymorphone Opana®
Meperidine Demerol®
Fentanyl Actiq®, Duragesic®
This is not a comprehensive list.
*Withdrawn from US market November 2010.
All brand names cited above are the property of their respective owners. Vicodin is a registered trademark of AbbVie Inc. Lortab is a registered trademark of UCB Inc. Lorcet is a registered trademark of Forest Pharmaceuticals. Zohydro ER is a trademark of Zogenix, Inc. Dilaudid, OxyContin, and MS Contin are registered trademarks of Purdue Pharma L.P. Tylox and Duragesic are registered trademarks of Janssen Pharmaceuticals Inc. Percodan, Percocet, and Opana are registered trademarks of Endo Pharmaceuticals Inc. Fiorinal is a registered trademark of Watson Pharmaceuticals. Robitussin and Avinza are registered trademarks of Pfizer Consumer Healthcare. Tylenol is a registered trademark of McNeil Consumer Brands, Inc. Darvon and Darvocet are registered trademarks of Xanodine Pharmaceuticals Inc. Duramorph is a registered trademark of Baxter International, Inc. Demerol is a registered trademark of the Sanofi-Aventis Group. Actiq is a registered trademark of Cephalon, Inc.

The most commonly misused prescription opioids are hydrocodone and oxycodone.

How are opioids misused?

Opioids are misused when they are taken more often or in higher quantities than prescribed, or when they are used recreationally, or nonmedically. Opioids, which are usually pills, may also be crushed into powder to snort or injected with a needle. Snorting or injecting opioids causes them to enter the bloodstream and brain very quickly. Taking opioids in this way is very dangerous and increases the risk of both dependence and overdose.3,4

People who take opioids recreationally without a valid prescription may get or take opioids from a friend or family member. Others may buy them illegally from a mail-order company or on the street. Dependence can make people do things they wouldn’t ordinarily do to acquire opioids.3,4

What is opioid dependence?

Opioid dependence is a chronic disorder like diabetes or high blood pressure, and can develop as a result of either legitimate use or misuse of opioids. Frequent opioid use physically changes the brain, so that the brain starts to think that it needs opioids to function normally. That is why people with opioid dependence experience cravings and symptoms of withdrawal when the effects of opioids begin to wear off.5

Similar to other chronic disorders4:

  • There is no known cure for opioid dependence
  • Some people are more likely to develop dependence than others
  • Relapse is common and may be successfully addressed with the right treatment plan, which may include a combination of support and/or counseling and medication
  • You can still live a healthy, productive life with the right treatment plan

Who becomes opioid dependent?

Anyone can be dependent on opioids; it doesn’t mean you are a bad person or lack willpower. People become dependent on opioids in many different ways. Some people first begin misusing opioids after a doctor prescribed them for pain following a surgical procedure or accident. Other people misuse opioids recreationally, which means they take them just because they like the way they make them feel.4,5

The fact is, millions of people in the United States are considered to have opioid dependence.6 But certain people are at higher risk7:

  • Males
  • People who suffer from depression or anxiety
  • Those with a personal or family history of alcoholism or drug abuse
  • People under age 30
  • - Almost one-third of the people in the United States who are dependent on opioids are between the ages of 18 and 256
  • People who are prescribed or misuse opioids for long periods of time

How can you tell if you or someone you know has opioid dependence?

Opioid dependence can be characterized by the 4 Cs8:

ravings

or an intense desire to keep taking the opioid

ompulsive use

of opioids

ontinued

use despite the consequences

Loss of

ontrol

over opioid use

Many people with opioid dependence will go to great lengths to try and hide it. However, the following behaviors and emotions may be signs of opioid dependence9:

  • Mood swings, depression, anger, irritability
  • Marital or relationship problems
  • Social isolation, loss of friendships
  • Missing school or work
  • Poor performance at school or work
  • Financial problems, such as recent debt

People with opioid dependence may have withdrawal symptoms when they stop taking opioids, even for a short period of time.4,8,10,11

Only a doctor can accurately diagnose opioid dependence. If you think you or someone you know has a problem with
opioids, you should talk to a doctor.

Opioid dependence is more common than you think

Opioid dependence by the numbers

Over

15 million

people around the world
have opioid dependence12

In the United States, about

5.1 million

people currently misuse prescription opioids,
leaving them at risk to become dependent
on opioids6

Currently, about

2 million

people in the United States
have opioid dependence6

Taking opioids more often or in higher quantities than prescribed, or using opioids for nonmedical recreational purposes.

The effects of opioid dependence4,13-17

Socially

  • Opioid dependence can have a negative impact on families and whole communities
  • Leads to more crime and the spread of disease
  • Costs the country billions of dollars

Personally

  • Opioid dependence can severely strain personal relationships with friends or family and with people at school or at work
  • May lead friends, family, coworkers, or classmates to recommend treatment

On well-being

  • Nearly half a million emergency room visits were due to dependence on prescription opioids in 2011, a 154% increase from 2004
  • US deaths from prescription opioid overdose now exceed those from cocaine and heroin combined
  • People with opioid dependence may also share needles or make bad decisions about who they have sex with. Because of this, they are more likely to acquire HIV, hepatitis, or sexually transmitted diseases

Financially

  • The cost of opioid dependence is enormous
    • $56 billion per year in total US costs
    • Healthcare costs account for $25 billion
    • Average healthcare cost per person is 8 times higher compared to people who do not have opioid dependence
  • Each time a person relapses, incremental costs accrue

Relapse is common and not a failure

Relapse is a part of this chronic disorder, just like symptom breakthrough is with other chronic conditions. Relapse happens when someone with opioid dependence who had stopped taking opioids begins taking opioids again.5

Long-term use of opioids causes physical changes in the brain that make people with opioid dependence feel like they need opioids in order to function properly. Because of this, people are at risk of having cravings or encountering triggers that can lead to relapse even if it has been a long time since they stopped taking opioids.5

A lot of things can trigger cravings which, if acted upon, can lead to a relapse5:

  • Stress at work or home
  • Relationship problems
  • Emotional pain or difficult situations
  • Pain from an injury or medical procedure
  • Certain people from your past

When people relapse, they sometimes feel they have failed. But that isn’t always the case. Everyone has different needs, and a relapse can simply mean that a person isn’t getting the support and/or counseling he or she needs or that they may need to try a different medication. Sometimes finding the right combination of support and/or counseling and medication can make the difference needed for a successful recovery.5

The good news: opioid dependence can be treated

The importance of a comprehensive treatment plan

Opioid dependence is a chronic condition in need of long-term management, but there is no single treatment that is right for everyone. Before treatment begins, or following a relapse, people with opioid dependence should work with their doctors, counselors, and any others involved with their treatment to develop a plan based on their individual treatment goals. An effective treatment plan should include support and/or counseling that is designed to meet that person’s specific needs and may also include medication.

How medications for opioid dependence are used

  • Detoxification (commonly referred to as “detox”): Medication is used for a short period of time just to help people get through the withdrawal period
  • Maintenance treatment: A successful form of treatment that involves a sustained treatment period, during which medication is taken every day

Support and counseling

In addition to their doctor, some people lean on their friends and family during their recovery process while others prefer the confidentiality of a therapist or counselor. Some like to share their experiences while others seek help privately. Either way, counseling and support should be a key part of any treatment plan.

There are a number of different kinds of support and counseling available for the treatment of opioid dependence. These include behavioral therapy, group therapy, self-help groups, and personalized support programs. Personalized support programs allow people with opioid dependence to customize their experience to meet their specific needs and goals.

Maintenance medications

Maintenance medications can help reduce cravings, without making the person feel “high.” These help give people a chance to change their habits and to avoid relapse.

  • During treatment with maintenance medication, people take a dose of medication each day. Depending on the person and his or her goals for treatment, this step can last for weeks, months, or even years before tapering off is considered

The benefits of maintenance medication

Maintenance medications can help reduce cravings without making the person feel “high.” This helps free a person from thinking about opioids all the time. Because opioid dependence is a chronic disorder, it is never really cured. The maintenance step is about managing the disorder so that the person is able to regain control of his or her life.

Maintenance medication, in combination with support and/or counseling, is critical to preventing relapse. Unfortunately, many people are not able to stick with their treatment plan like they should.

Current treatments for opioid dependence offer options

Everyone is different...so why should treatment plans be the same?

Choice of medication

Medications are available that offer advantages in:

  • Taste
  • Dissolve time
  • Tablet size
  • Delivery (ie, tablet or film)
  • Cost

Personalized support

Some people lean on their friends and family during their recovery process while others prefer the confidentiality
of a therapist or counselor. Some like to share their experiences while others seek help privately.

Personalized support programs allow people with opioid dependence to customize their experience to meet
their specific needs and goals.

References:

  1. American Academy of Family Physicians (AAFP). Opioid addiction: overview. http://familydoctor.org/familydoctor/en/diseases-conditions/opioid-addiction.html. Accessed August 08, 2013.
  2. National Institute on Drug Abuse. Commonly abused prescription drugs chart. Revised October 2011. http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/commonly-abused-drugs-chart. Accessed Aug 08, 2013.
  3. National Institute on Drug Abuse. Research Report Series: Prescription drugs: abuse and addiction. NIH Publication No. 11-4881. US Department of Health and Human Services; 2001. Revised October 2011.
  4. US Department of Health and Human Services. Medication-assisted treatment for opioid addiction facts for families and friends. 2009; HHS Publication No. (SMA) 09-4443.
  5. National Institute on Drug Abuse. Principles of drug addiction treatment: a research-based guide, 3rd edition. NIH Publication No. 12-4180. http://www.drugabuse.gov/sites/default/files/podat_1.pdf. Accessed May 11, 2013.
  6. Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
  7. Sehgal N, Manchikanti L, Smith HS. Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician. 2012;15:ES67-ES92.
  8. Kahan M, Srivastava A, Wilson L, et al. Misuse of and dependence on opioids: study of chronic pain patients. Can Fam Physician. 2006;52:1081-1087.
  9. New York City Department of Health and Mental Hygiene. Buprenorphine: an office-based treatment for opioid dependence. City Health Information. 2008;27:25-32.
  10. MedlinePlus. US National Library of Medicine. Opiate withdrawal. http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm. Accessed Aug 08, 2013.
  11. Andreae-Jones SA. Opioid Medication. http://www.arachnoiditis.info/content/opioid_medication/opioid_medication.htm. Accessed May 6, 2013.
  12. World Health Organization (WHO). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. http://www.who.int/substance_abuse/publications/Opioid_dependence_guidelines.pdf. Accessed May 11, 2013.
  13. Flassing J. Buprenorphine: a more accessible treatment for opioid dependence. JAAPA. 2010;23:40-43.
  14. Birnbaum HG, White AG, Schiller M, et al. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011;12:657-667.
  15. National Institute for Health & Clinical Excellence (NICE). Drug Misuse: Opioid Detoxification. Leicester, UK: The British Psychology Society, and London, UK: Royal College of Psychiatrists; 2008:1-269.
  16. Tetrault JM, Fiellin DA. Current and potential pharmacological treatment options for maintenance therapy in opioid-dependent individuals. Drugs. 2012;72:217·228.
  17. White AG, Birnbaum HG, Mareva MN, et al. Direct costs of opioid abuse in an insured population in the United States. J Manag Care Pharm. 2005;11:469-479.