Opioid Use Disorder

A diagnosis of OUD is made when a person who regularly uses opioids has experienced at least two of the following signs and symptoms within the past 12-month period:

• Physical dependence: Developing tolerance to opioids, meaning that larger quantities are required to attain the desired effect of the drug

• Experiencing withdrawal symptoms if stopping opioid use, or using opioids to alleviate symptoms of withdrawal

• Taking opioids in greater quantities or for longer than planned

• Inability to quit or reduce use of opioids despite wanting to do so

• Devoting a lot of time to acquiring, using, or recovering from opioids

• Feeling compelled to use opioids

• Use which repeatedly interferes with completing duties at home, work, or school

• Continuing use of opioids even when they cause problems interacting with others

• Skipping important occasions and events at work, school, or in personal life

• Repeatedly taking opioids in circumstances that could cause physical harm (e.g., while operating a motor vehicle)

• Continuing use of opioids even when they cause or exacerbate mental or physical problems

• The more of the above symptoms individuals experience, the greater the severity of their OUD:

Sometimes individuals are prescribed opioids for pain. When they use them as prescribed, the physical dependence criteria are not factored into the number of signs and symptoms. Sometimes however, those who are prescribed opioids develop OUD. Even people who use opioids only as prescribed by a physician can develop OUD. Over time, they may begin to misuse opioids, taking them for reasons other than for which they were originally prescribed. They may try to obtain prescriptions from a doctor, but because there may be difficulty obtaining a prescription for opioids, they may also try to get them from friends or family members, or in some cases, they may turn to illicit, injectable (and cheaper) opioids like heroin or fentanyl.

• Access to and availability of opioids

• Previous exposure to substance use (e.g., having friends or family who use substances)

• Current or past substance use disorder

• Family history of substance use disorder

• Having mental health conditions such as depression or post-traumatic stress disorder

• History of abuse during childhood

• History of conduct disorder as a child or adolescent

The use of opioids raises the risk of injury or death from accidents, while the use of injectable opioids increases risk for blood borne infectious diseases including HIV, hepatitis B, hepatitis C, and bacterial endocarditis, a potentially dangerous infection of the inner lining of the heart and its valves.

Overdose is a significant risk of opioid use. In addition to relieving pain and producing euphoria, opioids stimulate a range of other physiological responses. For example, taking a large dose of opioids can slow or even stop breathing, which can lead to death.

Opioids can cause constipation and nausea and can suppress the immune system. They can also increase or decrease the levels of various hormones, which can lead to reduced libido and, in women, infrequent or even entirely absent menstruation.

• GI System: recurrent or chronic constipation, in serious cases, bowel obstruction can result, a potentially fatal complication. Other concerns include nausea, vomiting, stomach cramps, and bloating. Opioid users who have GI symptoms tend to have many more ER visits, hospital admissions, and longer hospital. Chronic constipation has been shown to increase an opioid user’s risk of psychological distress and depression.

• Opioid Abuse and the Respiratory System: Opioids can cause several respiratory problems, including slowed or irregular breathing; in overdose, they can lead to dangerously slowed breathing or complete respiratory arrest. The lack of adequate oxygen to the brain resulting from an opioid overdose can lead to coma, brain damage, or death.

• Cardiovascular System: The American Heart Association journal Circulation found that opioid use is a risk factor for heart rhythm abnormalities such as atrial fibrillation, a condition that can lead to serious adverse cardiac events, such as stroke, heart failure, and death. Research has also shown a potential connection between prescription opioid use and an increased risk of coronary
heart disease and cardiovascular disease in women. When injected, blood borne bacterial infections that result from unsanitary intravenous needle use can lead to endocarditis, an infection of the inner lining of the heart that can be fatal when left untreated.

• Reproductive Health: Long-term opioid use may negatively impact the reproductive systems of both men and women. Some studies show that for women, opioid use may be associated with decreased fertility as well as an increased risk of pregnancy loss and other pregnancy complications such as placental abruption, and preterm birth. For men, long-term opioid use may affect testosterone production and decrease the quality and quantity of the sperm. Babies born to mothers who use opioids during pregnancy may suffer from neonatal abstinence syndrome (opioid withdrawal after birth). They are also at risk of having longer post-birth hospital stays,
being re-hospitalized within the first month of life, being born with birth defects, and having developmental delays.

• Falls and Fractures: Opioid use may contribute to the risk of fractures. One study found that those who used opioids—especially short-acting opioids such as codeine and hydrocodone—had an increased risk of fractures as compared to those who used other non-opioid pain medications to treat pain. Higher opioid doses are associated with higher fracture risk.The negative impact that opioids can have on sensory-motor and cognitive function can make falls more likely, especially in older users. With the increased likelihood of fracture, a fall can be very dangerous in individuals taking opioids, particularly if they are taking them in high doses.

• Opioid Abuse and HIV or Other Infectious Diseases: Certain types of opioid use can raise the risk of infectious diseases such as the human immunodeficiency virus (HIV) and viral hepatitis. Injection opioid users are considered high-risk for these diseases because these infections are easily spread by the sharing of contaminated needles and other tools used for injection. Some non-injection opioid users may still be at risk of transmitting infectious diseases through unsafe sex practices.

• Long-Term Mental Effects of Opioids: Studies show that the continued misuse of opioids can increase one’s likelihood of developing an anxiety disorder and/or depression.4 Unfortunately, depression can cause an increase in physical and emotional pain, which can feed into the continuation of an addiction.4 Getting treated for depression, anxiety, or any other long-term mental effect of opioid misuse can help mitigate symptoms and prevent continued use.

The most effective treatments for opioid use disorder include the combined use of medication and behavioral treatment. These treatments are routinely provided on an outpatient basis, including primary care or at federally regulated opioid treatment programs. They can also be provided at a part- or full-time residential facility that specializes in treating substance use disorders.

Sage Prairies’ approach to opioid use disorder is evidence-based, integrated, and individualized. Our specialists and partners utilize a range of medication and behavioral methods with demonstrated efficacy for helping individuals meet their individual recovery goals. Care is often integrated with patients’ other needs to improve treatment outcomes, reduce costs, and promote better physical and
mental health.

Effective treatments for opioid use disorder generally include: alleviation of withdrawal symptoms, stopping use, and offering patients behavioral skills and knowledge to help them meet their recovery goals of abstinence from opioid use. If an individual has great difficulty stopping use, or they suffer withdrawal symptoms, Sage Prairie partners with detox of withdrawal management programs to initiate treatment.

Withdrawal management or detox is best when it takes place under medical supervision, it is termed “medically managed withdrawal.” Many people who have OUD want to control their disordered use. Many may try to abruptly discontinue use of opioids “on their own”. This sudden elimination of opioids from the body often brings many unpleasant withdrawal symptoms that can include nausea, diarrhea,
sweating, anxiety, muscle and joint pain, and runny nose, among others. These symptoms can occur within hours of their last use and can last for days to weeks. This abrupt stopping is usually so uncomfortable and triggers powerful cravings for opioids that, it results in return to use to relieve the withdrawal symptoms.

Another detoxification option, known as medically managed withdrawal, has greater likelihood of success. In medically managed withdrawal, people with OUD stop using opioids, but rather than trying to deal with withdrawal symptoms on their own, doctors provide them with medications to decrease the unpleasant symptoms of withdrawal. It’s important to realize that people who stop using opioids, whether through a medically managed detoxification or on one’s own, frequently relapse and are at increased risk of overdose since they have lost their physical tolerance to opioids. Because of this, Sage Prairie prescribers recommend that after medically managed withdrawal, people who have OUD continue long-term treatment to avert death if use, even at a lesser level, returns.

Once an individual is stabilized, they are often evaluated for therapy and counseling needs, medication needs and other individualized needs based on a recovery continuum. If they are offered therapy and counseling. The following methods are most often effective and used by Sage Prairie:

Cognitive-Behavioral Therapy (CBT)
This form of therapy is based on the principle that one’s thoughts, feelings, and behaviors can all influence one another. The goal is to help patients reduce or stop alcohol use by adjusting patterns of thinking and feeling that can lead to consumption of alcohol.

Motivational Interviewing
This therapy helps people identify and accept ambivalent feelings about drinking with the goal of strengthening a commitment to their recovery goals.

Family Counseling
For people with alcohol use disorder and their families, this form of therapy helps all involved to identify and face consequences of alcohol use in order to support reduction in or abstinence from alcohol consumption.

In conjunction with therapy, Sage Prairie uses the following medications, which the Food and Drug Administration (FDA) has approved:

Methadone
This medication blocks the effects of other opioids, controls withdrawal symptoms, and reduces cravings for opioids. Because methadone is itself an opioid with the potential for misuse and dependence, it can only be obtained at specially licensed treatment facilities.

Buprenorphine
Like methadone, this medication is an opioid, used to block the effect of other opioids, lessen withdrawal symptoms, and reduce cravings. But unlike methadone, it can be prescribed by physicians and advanced practice providers (including primary care) and obtained at a pharmacy. Buprenorphine is usually provided in combination with naloxone.

Naltrexone
This medication, which is not an opioid, works by blocking opioids from binding to certain receptors in the brain. This means that if someone taking naltrexone also takes an opioid, the opioid will not produce the desired effects, including feelings of euphoria, and that person is less likely to continue opioid use or to relapse. Naltrexone is often given as a long-lasting injectable that works for four weeks.

People with OUD may continue treatment with these medications for years and even decades.

These include 12-step groups, SMART Recovery, Al-Anon Family groups, All Recovery groups, and others. Sage Prairie also has developed a partnership with local Recovery Community Organizations to offer other peer services. These programs are designed to offer participants active help and support for one another in their recovery. 

Housing
Sage Prairie has partnered with Recovery Properties to offer patient housing. I the housing, there are only current and former Sage Prairie patients. This helps patients to develop a community, which is supportive of recovery. 

Financial Assistance
A major barrier to recovery can be access to care. Sage Prairie has partnered with navigators to assist individuals to fund treatment and access other financial services available through Federal, State and local programs and scholarships. 

Physical Health
Patients are given a healthy meal each treatment day. Patients living in housing are offered a free local gym membership to improve their physical health. 

Harm Reduction
Because ongoing use or relapse are common and not all individuals are able to engage in formal treatment, care of patients with OUD often involves an educational component designed to minimize the harm associated with their opioid use. Sage Prairie partners with their local recovery community organization to facilitate the following: Narcan Administration where patients and family are taught
about naloxone to reverse opioid overdose, safe use of syringes to reduce the risk of acquiring an infectious disease through opioid injection, fentanyl strips to detect the presence of fentanyl in substances and education about the risks of mixing certain drugs with opioids.

Natural opioids are all derived from the opium poppy, which has been cultivated for medical purposes for centuries. Archeological evidence shows that it grew in Mesopotamia, as far back as 5000 B.C., and the Sumerians were using it as an intoxicant around 4000 B.C. Not all parts of the poppy are narcotic. The flowers are beautiful, and you’ve probably eaten the tiny, black seeds in a muffin once or twice.

The opium poppy was introduced to new areas over time. The fossil record shows that it was used in Europe around 2000 B.C. Ancient Greek and Arabic doctors used it for issues as diverse as surgical pain and diarrhea. Laudanum, a tincture of opium, was developed in the 1600s and began to be used as an all-around medical treatment. In the 18th and 19th centuries, recreational use of opium spread
(and was sometimes purposely introduced to areas for profit). In 1803, morphine, an alkaloid of opium, was derived for the first time. Later that century, additional alkaloids codeine and papaverine were discovered.

Opioid addiction and overdose have reached a point that we commonly refer to it as an “opioid crisis” or “opioid epidemic.” In 2017, the US Department of Health and Human Services declared a public health emergency around the opioid crisis. The CDC recognizes three waves of opioid overdose deaths:

First wave—Prescription medications: In the 1990s, there was a great increase in clinicians prescribing opioids, and overdose deaths involving prescription opioids began rising from 1999.

Second wave—Heroin: Beginning in 2010, there was a surge in the availability of heroin and a correlating rapid increase in heroin-related overdose deaths.

Third wave—Synthetic opioids: Since 2013, overdose deaths involving synthetic opioids have been sharply increasing. These are largely due to the advent of fentanyl availability and presence in other drugs.

According to the CDC, provisional data show an estimated 107,622 drug overdose deaths in the United States during 2021, a heartbreaking record high. In 2019, an estimated 10.1 million people misused opioids (of those, 9.7 million people misused prescription pain meds and 745,000 people used heroin). An estimated 2 million Americans meet the diagnostic criteria for opioid use disorder.