Opioid Dependence: 7 Secrets How to Manage With It

Introduction

Opioids may be natural which are made from seed pods of the opium poppy plant (e.g. morphine, codeine); semi-synthetic (like heroin, oxycodone, hydrocodone), which are formed when natural opioids are processed in laboratories; and synthetic opioids (like fentanyl), which are made wholly in laboratories with no natural ingredients. Natural opioids are also known as opiates.

Symptoms of Opioid dependence 

1. Initial opioid use is generally associated with a degree of pleasure. However, as dependence develops, a person is compelled to take opioids to prevent feeling low and to avoid other distressing withdrawal features.
2. Repeated usage of opioids leads to an uncontrolled seeking behaviour for the opioids, leading to increased risk-taking behaviour, deterioration at work, school, and interpersonal relations with reduced interest in other pursuits in life.
3. The person uses opioids despite knowing about their dependence on them.
4. A decrease or stoppage in the use of opioids will cause withdrawal symptoms such as watering eyes, a runny nose, frequent watery stools, abdominal cramps, nausea, vomiting and cramps in the legs. 
5. Withdrawal symptoms are relieved by taking opioids.
6. Tolerance to opioids may develop, where the person will need a higher dosage, as the initial dose becomes less effective. For example, doses of opioid  pain killers may need to be increased from time to time to achieve the desired pain relief.

What factors contribute to developing Opioid Dependence 

1. Using opioids at an early age is one of the risk factor for opioid dependence; adolescence and young adulthood are vulnerable periods (1).
2. Many painkillers and cough syrups contain opioids.  Ineffective and unplanned pain management over-the-counter use of cough syrups, and disparities in healthcare across different areas can lead to recurrent use of opioids and dependence(2).
3. Previous use of other substances like tobacco and alcohol is a significant risk factor for opioid misuse and dependence (1).
4. The use of opioids among friends, family and coworkers increases the chances of opioid misuse and dependence (1).
5. A history of emotional trauma and family conflicts during early childhood and adolescence can lead to unattended emotional issues, resulting in different substance dependence, including opioids.
6. Geographical location is also a risk factor, as some areas act as transit points for illegal opioid trade. This increases access to opioids for individuals who are at high risk of abusing it due to other psychosocial issues around them (3)

How is Opioid Dependence diagnosed and treated? 

1. Dependence is diagnosed primarily through a clinical assessment, testing of biological fluids, and psychological tests.
2. Opioid dependence can be strongly predicted by the pattern of opioid use, whether it is binge use, used  as needed, or regular use.
3. The presence of aberrant behaviour by the person (double doctoring, procuring opioids from friends, family or on the street) increases the chances of dependence.
4. There may also be a history of interpersonal conflicts, frequent absences from work and school, and inability to complete tasks at work.
5. When an opioid is not taken, there will be restlessness, piloerection, sweating, muscle tenderness and diffuse body pain.
6. Urine drug tests can be used to screen for opioid use and definitive tests for opioid use are high-pressure liquid chromatography combined with mass spectrometry (4). Such tests may be helpful to diagnose dependence in persons who may not divulge a history of regular opioid use. 
7. Substitution therapy with milder opioids helps reduce the withdrawal symptoms which are then gradually tapered and stopped.

How to Manage Opioid Dependence-7 tips

1. Traits like difficulty regulating emotions, coping patterns like avoiding difficult situations and isolation need to addressed.
2. We should proactively try to stop any recreational use of opioids as dependence develops within a short span of use.  Help should be sought from mental health professionals.
3. As many pain management medicines are opioids, such medicines should be taken only as prescribed by concerned specialist doctors.  Pain management should be a multimodal approach along with psychosocial measures. 
4. Users need psychological help to come out of denial accept the presence of dependence and resolve to work on it. 
5.  Medicines are given to treat withdrawal features and cut down cravings.
6. Psychological help is needed to make users aware of different physiological changes that occur in the body due to the use of opioids and when intake is stopped. 
7. Seeking support from people around them and the community during the process helps users to come out of dependence effectively.

Conclusion

 Opioids give a high during the initial period of use; throughout continuous use, they change the brain chemistry in a way that substance becomes a normal way of coping with situations. To come out of it, we need to work on managing withdrawal, changing the default way of coping, improving interpersonal dyads, managing emotions better and learning to adapt to adverse situations effectively.

References

1. The opioid crisis: a contextual, social-ecological framework;  Mohammad S. Jalali, Michael Botticelli, Rachael C. Hwang, Howard K. Koh & R. Kathryn McHugh, Health Research Policy and Systems Volume 18 Article number: 87  (2020) 
2. Risk Factors for Opioid-Use Disorder and Overdose; Webster, Lynn R. MD; Anesthesia & Analgesia 125(5):p 1741-1748, November 2017.
3. Sociodemographic profile and pattern of opioid abuse among patients presenting to a de-addiction centre in tertiary care Hospital of Kashmir; Farhat S, Hussain SS, Rather YH, Hussain SK; J Basic Clin Pharma 2015;6:94-7.
4. Quraishi, R., Kololichalil, A., Muhammed, J.K., Sarkar, S. (2024). Laboratory Assessments in Opioid Use Disorder Treatment. In: Martin, C.R., Preedy, V.R., Patel, V.B., Rajendram, R. (eds) Handbook of the Biology and Pathology of Mental Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-32035-4_145-1