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Opioid Dependence – An Overview

Opioid Dependence – An Overview

In this article the writer provides an overview of the history of opioid dependence as well as current statistical analysis. The article provides insight into current research findings and trends. The information in this article is shared in good faith and derived from sources believed to be reliable and accurate. However, readers of this article are responsible for making their own assessments and judgement on the information provided and are advised to verify all information. The content in this article is not necessarily representative of South Pacific Private’s treatment approach. 

Opioids are substances that act on opioid receptors in both the spinal cord and brain to relax the body and relive pain. Opioids are typically used in a medical setting for pain relief (by reducing the intensity of pain-signal perception), but are sometimes abused for the ability to alter emotional states; causing euphoria through activation of the reward centres of the brain.

When a person continues to use opioids beyond what a doctor prescribes, whether to minimise pain or induce euphoric feelings it can mark the beginning stages of an opiate addiction (a chronic relapsing brain disease that is characterised by compulsive, and uncontrollable drug seeking behaviours, despite adverse consequences)[1].

North America experienced an opioid epidemic in the late 1990s, which originated from an over prescription of opioids for the relief of chronic pain1.

  • In 2012, there were 25 million American adults suffering from chronic pain on a daily basis1.
  • Beginning in the early 2000s, opioid analgesics were increasingly seen as a solution to the problem of under-treatment that had been a concern in the 1990s[2]
  • From 1991 to 2011 the number of opioid prescriptions filled at U.S. Retail pharmacies nearly tripled, increasing from 76 million to 219 million per year2.
  • Nearly half of all opioid overdose deaths in 2016 involved prescription opioids2
  • Illegally acquired heroin and synthetic opioids such as fentanyl have become the leading cause of overdose deaths2.
  • From 2000 to 2015 the rate of opioid deaths in America increased 347%, with 33,000 deaths in 2015, and over 42,000 deaths in 2016 (over 115 per day)[3].

While deaths from prescription opioid overdoses aren’t increasing as rapidly for Australia, the President of the Australian Drug Law Reform Foundation highlighted that Australia’s problems with opioids was “going down the same route, and we have been going down that route for 15 years[4]”.

  • Australia is ranked 8th out of the top 30 opioid consuming countries in the world[5]).
  • There has been over a 100% increase in oxycodone (a slow releasing opioid) prescriptions between 2010 and 20155
  • There were 1808 drug induced deaths registered in 2016. The highest number of drug deaths in 20 years5

When a person continues to use opioids beyond what a doctor prescribes it can mark the beginning stages of an opiate addiction. Tolerance develops which describes a person’s diminished response to a drug after repeated use[6], which eventually leads to dependence (a physiological adaptation to chronic exposure that causes neurons to adapt so they only function normally in the presence of the drug[7]). A cessation or decrease of a dependent drug will lead to withdrawal. Common side effects for opiate withdrawal includes the following:

Early withdrawal symptoms – 6-12 hours for short-acting opiates, or 30 hours for longer-acting ones[8].

  • Tearing up
  • Muscle aches
  • Agitation
  • Trouble initiating or maintaining sleep
  • Excessive yawning
  • Anxiety
  • Sweats
  • Fever
  • Hypertension

Late withdrawal symptoms usually peak within 72 hours and last for a week or more5.

  • Nausea and vomiting
  • Diarrhea
  • Goosebumps
  • Stomach cramps
  • Depression
  • Drug cravings

Symptoms can be extremely uncomfortable and are one of the reasons many people find it so difficult to stop using opioids.

Opioid use disorders are typically managed by long term treatment and care. Effective methods for managing withdrawal encompass both pharmacological and psychological means.

Opioid replacement therapy (ORT) aims to substitute a user’s opioid of choice with a less euphoric, and longer acting substitute[9]. Commonly used drugs for ORT include methadone and buprenorphine[10], however a recent 2018 study has shown that buprenorphine/naloxone is a preferential first line solution[11].

Behavioural therapies are aimed at helping an individual change their attitudes and behaviours towards opioid use. Common programs include cognitive behavioural therapy, multidimensional family therapy[12] and 12 step programs[13].

For support regarding clients struggling with an opioid addiction please connect with our Client Care Team on info@southpacificprivate.com.au or on 1800 063 332.

 

References / Resources:

[1] Manhapra, A & Becker, WC 2018, ‘Pain and Addiction: An Integrative Therapeutic Approach’, Med Clin North Am, vol. 102, no. 4, pp. 745-763
[2] Matthews, S 2018, ‘Opioid use disorder in the United States: Diagnosed prevalence by payer, age, sex, and state’, Milliman White Paper, viewed 5 July 2018 < http://www.milliman.com/insight/2018/Opioid-use-disorder-in-the-United-States-Diagnosed-prevalence-by-payer–age–sex–and-state/>
[3] CDC (Centre for Disease Control and Prevention) 2016, ‘Increases in Drug and Opioid-Involved Overdose Deaths – United States, 2010-2015’ viewed 2 July 2018, < https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm>
[4] Power, J 2017, ‘Prescription opioid epidemic coming to Australia’, viewed 1 July 2018, <https://www.smh.com.au/national/prescription-opioid-epidemic-coming-to-australia-20170803-gxobvt.html>
[5] ABS (Australian Bureau of Statistics) 2018, ‘Causes of Death, Australia, 2016’, viewed 2 July 2018 < https://www.smh.com.au/national/prescription-opioid-epidemic-coming-to-australia-20170803-gxobvt.html>
[6] Lynch, SS 2016, ‘Tolerance and Resistance’, viewed 1 July 2018, < https://www.msdmanuals.com/en-kr/professional/clinical-pharmacology/factors-affecting-response-to-drugs/tolerance-and-resistance>
[7] Koob, GF, Simon, EJ 2009, ‘The Neurobiology of Addiction: Where We Have Been and Where We Are Going’, J Drug Issues, vol. 39, no. 1, pp. 115-132
[8] Ries, RK, Fiellin, DA, Miller, SC, Saitz, R 2009 ‘Principles of Addiction Medicine Fourth Edition’, Lippincott Williams & Wilkins, Philadelphia.
[9] Mattick, RP, Digiusto, E, Doran, C, O’Brien, S, Shanahan, M, Kimber, J, Henderson, N, Breen, C, Shearer, J, Gates, J, Shakeshaft, A 2001, ‘National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)’, Australian Government, Department of Health and Aging, Monograph Series, no. 52.
[10] Butler, S 2017, ‘Buprenorphine-Clinically useful but often misunderstood’, Scand J Pain, vol. 4, no. 2, pp. 148-152.
[11] Bruneau, J, Ahamad, K, Goyer, ME, Pouline, G, Selby, P, Fischer, B, Wild, TC, Wood, E 2018, ‘Management of opioid use disorders: a national clinical practice guideline’, CMAJ, vol. 190, no. 9, pp. 247-257.
[12] Beck, JS 2011, ‘Cognitive behaviour therapy: basics and beyond’, The Guilford Press, New York.
[13] Melemis, SM 2015, ‘Relapse Prevention and the Five Rules of Recovery’, Yale J Biol Med, vol. 88, no. 3, pp. 325-332