What is OUD?
Opioid Use Disorder (OUD), also known as opioid addiction, is a medical condition characterized by the compulsive and problematic use of opioids. It is a chronic disorder that affects the brain and behavior, leading to significant impairment in a person’s daily life. OUD can develop from the misuse of prescription opioids or the use of illegal opioids like heroin. It can occur to people using prescription opioids or illicit ‘street’ opioids. Between 3% to 19% of people using opioids will develop addiction and it affects more than 2 million people in the US.
Addiction is recognized as a chronic, relapsing disorder. This doesn’t mean that a person struggling with it will never achieve recovery or have a meaningful, long life. It means that their brains may have long-term changes that place the person at risk for having problems controlling their use of drugs if they are re-exposed later. Understanding that helps people make better choices about the medicines they use in the future and helps them avoid other potentially addictive substances. With the proper treatment, people with OUD can return to their normal lifestyle.
The Cause of OUD
Opioid addiction is a complex issue that involves the biology of our brains. Opioids are substances that can relieve pain and make us feel good. They can be found in prescription medications like morphine and oxycodone or illegal drugs like heroin. People may become addicted to opioids for different reasons. Some people receive opioids for pain and develop addiction to them due to prolonged exposure. Other people may use opioid recreationally to experience a pleasurable sensation also known as ‘euphoria’. In other circumstances, people may choose to use opioids in order to self-treat mental health symptoms such as depression, anxiety or post-traumatic stress disorder. No matter what the initial reasons for opioid use are, the development of addiction involves similar changes to the brain pathways related to reward, motivation, control and other circuits.
Changes in the brain pleasure pathways
However, with repeated use of opioids, our brain starts to adapt. They become less sensitive to the effects of opioids, so we need higher doses to achieve the same level of pain relief or pleasure. This is called tolerance.
Over time, the brain becomes dependent on opioids to feel good, and this is where addiction comes into play. The brain’s reward system, which is responsible for reinforcing pleasurable behaviors, becomes hijacked by opioids. It craves more and more opioids to experience the same level of pleasure, leading to a cycle of addiction that can be difficult to break. In addition, the part of our brain that helps us execute control and make good decisions starts to shut down. New connections formed between different parts of the brain allow for more efficient processing of drug-related behaviors and the brain enters a state of heightened anxiety. The body and brain, now dependent on opioids, develop withdrawal symptoms when the drug is no longer available.
Over time, our bodies move from a state of controlled use where positive reinforcement is the goal of using opioids, to compulsive use driven by negative reinforcement where a person uses drugs to avoid the withdrawal symptoms, severe cravings and anxiety.
Withdrawals and Cravings
When we suddenly stop using opioids or reduce their dosage following prolonged exposure, we may experience a set of uncomfortable symptoms known as withdrawal. Withdrawal symptoms occur when the body and brain’s chemistry gets disrupted, causing various physical and emotional reactions. These may include:
- Flu-like symptoms: Individuals may experience body aches, sweating, chills, and a runny nose, similar to symptoms of the flu.
- Gastrointestinal issues: Nausea, vomiting, diarrhea, and stomach cramps are common during withdrawal.
- Increased heart rate and blood pressure: Opioid withdrawal can lead to an elevated heart rate and blood pressure, causing feelings of restlessness and anxiety.
- Muscle and joint pain: Aches and pains in the muscles and joints are frequently reported during withdrawal.
- Insomnia: Difficulty falling asleep or staying asleep is a common symptom, leading to fatigue and irritability.
- Anxiety and restlessness: Feelings of unease, nervousness, and agitation are common during this period.
- Depression: Some individuals may experience feelings of sadness, hopelessness, and a lack of interest in activities they once enjoyed.
- Irritability and mood swings: Opioid withdrawal can lead to irritability, mood swings, and increased sensitivity to stress.
- Cravings: Strong desires for opioids can be experienced during withdrawal, making it challenging to resist the urge to use again.
- Difficulty concentrating: Many individuals report difficulties with focus, memory, and decision-making during this time.
Withdrawal symptoms can vary in intensity and duration depending on factors such as the type of opioid used, the duration of use, and the individual’s overall health. Seeking medical help and support from healthcare professionals is crucial during this time to manage withdrawal symptoms and increase the chances of a successful recovery.
Risk Factors for Developing OUD
Some people with risk factors for OUD never become addicted and others without risk factors do. In short, it is impossible to predict who could become addicted. Still, these risk factors provide valuable information about who is likely to become addicted to opioids. Researchers have identified that people who develop OUD commonly:
- Use high-potency opioids like fentanyl (Actiq, Fentora, Sublimaze or illegally produced fentanyl) and oxycodone (OxyContin, Roxicodone).
- Take high doses of opioids.
- Inject, snort or use other methods that quickly deliver opioids to the central nervous system.
- Take opioids for long periods of time.
- Are between ages 18 to 45.
- Have a genetic susceptibility for addiction.
- Have a personal or family history of substance abuse disorder, including legal, prescribed and illegal substances.
- Have a mental health disorder like depression, anxiety, bipolar disorder, schizophrenia or other disorders.
- Live with other people who use opioids.
- Use other drugs in addition to opioids.
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