Are you addicted to these painkillers too? Let's talk about Opioid Use Disorder!

Today we are going to talk about a slightly sensitive, but very important topic. You may have heard that there are certain types of painkillers that you should be very careful with. These are called opioids . If you use them incorrectly, that is, if you take too much of them without medical advice, or if you take them for other purposes, you can become addicted to them without even realizing it. This is what we call Opioid Use Disorder (OUD) .

Simply put, what is Opioid Use Disorder?

Imagine that a doctor has prescribed you an opioid for some pain. But you take it in more than the prescribed amount, or for longer than the prescribed period. After a while, you can't live without the drug, you feel like you have to take it, and if you don't take it, you feel restless and have difficulty. This starts to affect your daily activities, your relationships with family, your job, and everything else. Simply put, this is when your opioid use gets out of control and causes problems in your life.

This can also occur in varying degrees. Some people may experience mild symptoms , others moderate symptoms , and some may experience severe symptoms . It can also be a lifelong condition (chronic) . Therefore, it is very important to recognize and seek treatment early.

What are these opioids?

Opioids are a group of drugs, both naturally occurring (Opiates) and chemically produced (Opioids), that help relieve pain. They work by acting on our nerve cells to reduce pain.

Doctors prescribe these for things like severe pain after an accident, pain after surgery, and sometimes for long-term pain conditions. For example:

• `Oxycodone`
• `Oxymorphone`
• `Morphine`
• `Codeine`
• `Fentanyl`

Apart from these, Heroin, which is made from Morphine, is also an illegal drug that belongs to this same category.

These opioids not only relieve pain, but also produce a feeling of happiness and relaxation (euphoria) in some people. Over time, the dose of the drug needs to be increased to get the same relief ( tolerance ). This is why the risk of addiction is high.

But remember, not everyone who takes this medication for a short period of time as prescribed by a doctor will become addicted. If you follow the instructions exactly, the risk of addiction is low.

What is the difference between addiction and dependence?

These two are a bit confusing, but it's important to understand.

Opioid dependence is when your body becomes accustomed to the drug. This means that over time, the dose you took becomes less effective (tolerance) or withdrawal symptoms such as nausea, vomiting, and body aches occur when you stop taking the drug.

Opioid Use Disorder (OUD) goes even further. Here, your pattern of drug use is causing problems in your life, but you can't control it. This can involve both physical dependence and psychological dependence. This means that the drug takes over your thoughts, feelings, and actions, and you develop a strong desire (craving) to take it.

Who gets this? How common is it?

Opioid use disorder can develop in anyone, regardless of age, race, gender, or social status.

It is estimated that between 3% and 19% of people who take prescription opioid painkillers may develop this condition. When these medications are difficult to obtain, some people turn to more readily available substances, such as heroin. This shows how dangerous this disease can be.

More than 20 million people worldwide, and more than 3 million in the United States, suffer from this condition. It has become an epidemic in some countries. These opioids are responsible for more than 100,000 deaths worldwide every year.

What are the symptoms of opioid use disorder?

According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), someone with this condition may exhibit some of these symptoms:

• Taking opioids in larger amounts than prescribed or for longer than prescribed.
• A strong desire or urge to take opioids.
• Attempts to reduce or control use but fail.
• Continuing to use the medication even though it causes problems in social or personal relationships.
• Spending a lot of time finding, using, or recovering from opioids.
• Inability to fulfill responsibilities at work, school, or home due to opioid use.
• Missing or reducing other important activities.
• Using opioids even in physically dangerous situations (e.g., while driving).
• Continuing to use opioids despite having a physical or mental problem that may be caused by the opioids themselves.
• Over time, a higher dose is needed to achieve the same effect ( tolerance ).
• Discomfort when stopping the medication (opioid withdrawal syndrome) or taking opioids or something similar to avoid those discomforts.

If you think you have one or two of these symptoms, it is very important to seek medical advice as soon as possible.

What are the withdrawal symptoms when you stop taking opioids?

If you are physically dependent on opioids, stopping them suddenly can cause these problems:

• Pain all over the body
• Chills, fever
• Stomach ache
• Dilated pupils
• Restlessness, agitation
• Anxiety
• Nausea, vomiting
• Craving
• Increased heart rate and blood pressure
• Sweating
• Insomnia

How does someone become addicted to this condition?

There are several reasons for this. It's a bit complicated.

• Opioids affect brain chemistry: Opioids stimulate the centers in our brain that control things like pleasure and reward. When they are taken, a neurotransmitter called `endorphins` is released. This reduces pain and makes you feel happy. When the drug's effects wear off, that happiness also disappears. Then you feel like taking the drug again to feel that happiness. Physical dependence can develop even in as little as 4 to 8 weeks.
• Exposure to opioids and their availability: Exposure is increased through prescriptions for painkillers, use by family members or friends, and sometimes through illicit drugs. Sometimes, heroin is easier to find than legal drugs. Today, many drugs sold as heroin, cocaine, and some pills can contain high levels of the dangerous opioid fentanyl. These can be life-threatening.
• Genetic and biological factors: Research suggests that 40% to 60% of the risk of developing addiction to any drug is due to genetic factors. If someone in your immediate family (parents, siblings) has the condition, you are more likely to develop it too.
• Mental health and other medical conditions: Studies have found that about half of people with mental illnesses are at risk of developing drug addiction, and about half of people with drug addiction are at risk of developing mental illnesses. For example, conditions like depression , anxiety disorders , ADHD, bipolar disorder, and PTSD can affect this. Also, people with physical illnesses like chronic pain can also be at risk of developing opioid use disorder.
• Adverse Childhood Experiences (ACEs): Poor parent-child relationships, domestic violence, child abuse, and parental incarceration are also factors that increase the risk of drug use.

How do you recognize this?

There is no single test to diagnose this. A doctor will carefully review your medical history and your opioid use patterns. They may also use things like drug tests, prescription drug monitoring records, and more.

Opioid use disorder (OUD) is diagnosed if at least two of the previously mentioned DSM-5 symptoms are present .

• If 2-3 characteristics: Mild OUD
• If there are 4-5 symptoms: Moderate OUD
• 6 or more symptoms: Severe OUD

What are the treatments?

Fortunately, there are effective treatments for this condition. However, treatment options can vary from person to person. Since this is a long-term condition, continued treatment is important for recovery and relapse prevention.

There are several treatment methods:

• Outpatient counseling
• Intensive outpatient treatment
• Short-term residential treatment
• Long-term therapeutic communities, such as drug-free communities

The most effective of these is a combination of medication and counseling (Medication-Assisted Treatment - MAT).

Psychotherapy for OUD

Cognitive Behavioral Therapy (CBT) is a major psychotherapy method used for this purpose. Here, a psychiatrist or counselor talks in depth about your thoughts and feelings. They help you understand how your thoughts affect your actions. Through this, they help you change unhealthy thoughts and behaviors and create healthy thought patterns and habits.

Self-help programs for OUD

Participating in self-help groups like `Narcotics Anonymous` is also a great support for treatment. Through these, one can understand one's condition, share experiences with others, and help oneself improve.

Medications for OUD

There are some medications that can help treat this condition by changing brain chemistry. These can reduce cravings, reduce withdrawal symptoms, and block the euphoric effects of opioids.

There are three main types of drugs approved by the US Food and Drug Administration (`FDA`):

• `Methadone` : This reduces withdrawal symptoms and cravings. It can only be obtained from specialized clinics.
• Buprenorphine : This blocks the effects of opioids, reducing withdrawal symptoms and cravings. It can be taken as a pill or as a monthly injection.
• `Naltrexone` : This blocks the pleasure you get from opioids. It can be taken as a pill or as a monthly injection.

Are there any complications in the treatment?

Unfortunately, a person with OUD has the highest risk of death within the first four weeks of starting treatment and within the first four weeks of relapse after stopping treatment.

The reason for this is that they try to take the same dose they used before, but because the body's tolerance has decreased, the dose can become too high and lead to an overdose.

How can you avoid this?

• If you or someone in your family needs treatment for pain, talk to your doctor about non-opioid pain relievers or other treatments.
• If you have been prescribed opioids, take them exactly as your doctor tells you, in the amount prescribed, and at the times prescribed. Do not take extra doses. Do not break, crush, or dissolve the pills.
• If you feel dependent on the medication, or if the prescribed dose does not control your pain, never increase the dose on your own. Tell your doctor immediately.
• Never share your medicines with anyone else. Keep them in a safe place out of the reach of children.
• If you have any opioids left over from treatment, dispose of them safely. (You can ask your pharmacy.)
• Talk to your children about the dangers of opioids and the need to use them only as directed.

What happens if treatment is not given? (Prognosis)

If left untreated, the outcome of OUD is often poor. People with severe OUD are at increased risk for:

• Injuries such as falls and car accidents.
• Blood-borne diseases such as Hepatitis B (HBV), Hepatitis C (HCV), and HIV can be transmitted through sharing needles.
• Imprisonment.
• Opioid overdose.
• Death from opioid overdose.
• Suicide.

The mortality rate of people with OUD is 10 times higher than the general population.

But remember, OUD is a treatable condition. However, only 1 in 4 people with OUD receive professional treatment.

Medication-assisted treatment (MAT) reduces opioid use, overdose deaths, and the spread of infectious diseases. It increases social functioning and treatment retention.

What are the symptoms of an opioid overdose?

An overdose can occur when someone takes too much opioid, or when they take other drugs with opioids. Symptoms include:

• Unresponsiveness, loss of consciousness.
• Breathing slows down or stops.
• The black pupils in the eyes are very small (`pinpoint pupils`).
• Snoring or a sound coming from the throat.
• Cold, clammy skin.
• Blue lips or fingernails.

In such a situation, quick action is needed. The effects of an overdose can be reversed quickly by administering a drug called `Naloxone` (often known by the brand name `Narcan®`). However, even if `Naloxone` is given, immediate medical attention is required.

If someone you know has a problem like this, how can you help?

Finding out that someone you love has OUD can be a very difficult and distressing experience. Here are some things you can do to help someone like that:

• Speak up early: The sooner someone with OUD gets treatment, the better. Talk to them about your concerns and help them find treatment.
• Treat them with compassion: Listen carefully to what they have to say, even if you don't agree with it. The more you listen to them, the more they will trust you.
• Be patient: Don't expect this problem to be solved with one talk or one action. OUD is a complex, long-term condition.
• Think about yourself too: Family and friends of people with OUD may also feel stressed, depressed, sad, and lonely. Think about your own mental health too. Get help if you need it.
• Keep Naloxone (Narcan®) on hand: If your loved one overdoses, Naloxone can be life-saving. If possible, keep Naloxone on hand at all times.

When should I see a doctor?

If you are already taking opioid medication and have even the slightest suspicion that you are becoming addicted to it, talk to your doctor immediately.

If you suspect your child or a friend is abusing opioids, seek medical help as soon as possible.

Opioid use disorder is a complex mental and brain condition. Opioids affect your brain and your ability to make decisions. These changes can make it difficult to stop taking opioids, even if you want to. If you or someone you love has this condition, see a doctor as soon as possible. A trained doctor can guide you through the treatment you need.

Finally, things to remember

• Opioids are powerful painkillers, but they can be dangerously addictive if used incorrectly.
• Never use these without medical advice. Follow the prescribed dosage and duration exactly.
• If you or others notice signs of addiction, don't be ashamed or afraid, and seek medical advice immediately.
• There is treatment and recovery. So don't suffer alone, ask for help.
• Educating others is also a help in combating this problem.

I hope this information is helpful to you. If you have any further questions regarding this, please do not hesitate to speak to a doctor.

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