What are Opioids?
In the United States the rise and increase incidence of the opioid crisis has brought this issue to the mainstream media and various communities across the nation. Opioids are considered to be a class of drugs or agents that include heroin, synthetic opioids such as fentanyl, and pain relievers such as oxycodone, hydrocodone, and morphine. In most cases pain relievers are considered to be safe if taken for a limited timeframe, but due to their ability to also elicit euphoria there is a chance of abuse and misuse.
The misuse of opioids can lead to increased dependence, addiction, overdose events, and possibly death if not immediately addressed. With long term or chronic use of opioids an individual can develop an opioid use disorder (OUD) which can have a notable impact on a person’s quality of life. It is reported that over 16 million people around the world and 3 million people in the United States are opioid dependent or meet the criteria for an opioid use disorder. The presence of opioid use disorder has become an epidemic in the United States given the approximately 47,000 deaths that occur each year, so it is important that once a diagnosis is made, immediate treatment is initiated.
Signs and Symptoms of Opioid Use Disorder
An opioid use disorder is recognized as opioid use that can be difficult for an individual to reduce or cease use for a number of reasons. When there are concerns that a person may have OUD, it is important to be aware of the various symptoms that can develop in order to make a proper diagnosis.
Examples of behavioral symptoms of OUD can include:
- Inability to reduce doses
- Avoidance of typical social activities or hobbies
- Falling behind at school or work
- Seeking out many prescriptions for opioids from different providers
Along with the presence of behavioral symptoms, there are also notable physical symptoms that can include:
- Opioid cravings
- Slurred speech
- Increase presence of tolerance
Lastly, there can also be psychological signs of OUD that can include:
- Reduction in motivation
- Changes in sleep pattern
- Feelings of depression or anxiety
- Increased bouts of irritability
All of the signs and symptoms can prove to be significant when it comes to making a definitive diagnosis of OUD in any person. While it can prove to be a complex condition, there are treatment options that are available to provide effective management.
Pharmacotherapy for Opioid Use Disorder
As a result of the public health concern surrounding opioid use disorder it is important that effective treatment interventions are in place to help reduce OUD and its negative outcomes. The initiations of opioid replacement, maintenance, or substitution therapy are designed to replace the opioid with a longer acting agent that produces less euphoric effects. The most commonly prescribed drugs for OUD are buprenorphine (mu opioid partial agonist) and methadone (mu opioid agonist) which are to be administered under medical supervision. These two agents are considered to be the gold standard. Another agent is the long acting opioid antagonist naltrexone which works to block the effects of opioid and assists with maintaining absences from opioids.
The three agents that are approved by the Food and Drug Administration (FDA) for the treatment of opioid addiction are buprenorphine, methadone, and naltrexone which have shown to be safe and effective when used in combination with counseling and psychosocial support. While not currently FDA approved, clonidine can be used as adjunctive therapy to treat the signs and symptoms associated with opioid withdrawal, which is used off-label. These agents are designed to provide therapeutic relief in order to assist individuals with changing behaviors and improve their conditions
Counseling/Psychotherapy for OUD
While pharmacotherapy can be applied when it comes to OUD they can be used in combination with counseling or psychotherapy. Individuals who are diagnosed with OUD are encouraged to participate in therapeutic approaches such as cognitive behavioral therapy, self-help programs, or Narcotics Anonymous programs. These interventions are designed to aid with behavioral modification, provide support, and provide individuals with the resources to maintain self-control. The application of counseling for opioid use disorder is as important as the management of the withdrawal symptoms or addressing the cravings. The benefits that can be associated with counseling can include the identification of negative thoughts and behaviors in order to being the process of change, healing and rebuilding relationships that may have been negatively impacted by opioid use, learning new coping skills and techniques to address stressful life situations, and forming a trusting relationship with the counselor in order to freely discuss past traumas, family issues, and life challenges. Counseling should be considered a required element of OUD because it has the ability to improve the chances of therapeutic success.
The presence of OUD has the potential to negatively impact various domains of a person’s life to create a significant burden, if steps are not taken to address the issue. The introduction of effective treatment interventions are necessary to reduce the negative behaviors, thoughts, feelings, emotions, that can be tied to its chronic use. The use of pharmacotherapy along with psychotherapy has been shown to provide positive outcomes but ultimately these interventions are only effective if a person is agreeable to its adoption.
To learn more about opioid use disorder (OUD) and strategies, click on the fact sheet below. It is through a collaborative effort that a counselor and client can work to address the symptoms OUD which can negatively impact quality of life.
Ayanga, D., Shorter, D., & Kosten, T. R. (2016). Update on pharmacotherapy for treatment of opioid use disorder. Expert Opinion on Pharmacotherapy, 17(17), 2307–2318. https://doi.org/10.1080/14656566.2016.1244529
BAART Programs. (2022). The importance of counseling in opioid addiction recovery. https://baartprograms.com/the-...
Dydyk,A. Jain,N., & Gupta, M. (2022). Opioid use disorder. In: StatPearls. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553166/
National Institute on Drug Abuse. (2022). Opioids. https://nida.nih.gov/research-topics/opioids
Rice, C. & Arthur, S. (2021). What are the signs and symptoms of opioid use disorder? PsychCentral? https://psychcentral.com/addictions/opioid-use-disorder-symptoms