Patient education: Opioid use disorder (The Basics)

What are opioids? — 

This is a group of pain medicines. It includes some prescription pain medicines such as morphine, fentanyl, and oxycodone. The illegal drug heroin is also an opioid.

Doctors prescribe opioids to treat pain that doesn't respond to other medicines. At first, at high doses, they can cause feelings of being happy, calm, and sleepy. But with continued use, these feelings lessen. Taking too much opioids can be dangerous or even cause death.

What is opioid use disorder? — 

This is opioid addiction. It can be mild to severe. People with opioid use disorder have 2 or more of the following problems. The more of these they have, the more severe their disorder.

●They use more drugs than they planned to, or they use them for longer than they planned to.

●They wish they could use drugs less often, but they can't.

●They spend a lot of time trying to get drugs, getting high, or recovering from being high.

●They crave or have a strong desire or urge to use drugs.

●Because of their drug use, they often don't do things that are expected of them, such as go to work or school, remember family events, and clean their home.

●They keep using drugs even if it causes or worsens problems in their relationships or interactions with other people.

●They stop doing important social, work, or fun activities they used to do or do these less often.

●They keep using drugs even in situations where it is dangerous (like while driving).

●They keep using drugs even when they know they have a physical or mental problem that was probably caused or made worse by their drug use.

●They need to use more and more drugs to get the same effects they used to get with less use. Or they get less effect from using the amount that used to get them high. This is called "tolerance."

●They have "withdrawal symptoms" if they stop using drugs after using them for a long time. Withdrawal symptoms can include:

•Feeling sad or depressed

•Nausea or vomiting

•Muscle aches

•Watery eyes or runny nose

•Dilated pupils, goose bumps, or sweating

•Diarrhea

•Yawning

•Fever

•Insomnia (not being able to sleep)

How is opioid use disorder treated? — 

Treatment involves:

●Medicines – The medicines used to treat opioid addiction reduce drug cravings and can also keep you from getting high if you do use drugs (table 1). Medicines are very important in helping people overcome addiction. When used the right way, they are safe and effective, and they do not get you high. Some people prefer to go to counseling and support groups but not take medicines. Those people are more likely than people who take medicines to start using drugs again.

●Addiction counseling – People work with a counselor to better understand their addiction. They learn new ways to live and cope with problems without drugs.

●Support groups – People with addiction share their experiences with each other. The most common of these groups is Narcotics Anonymous ("NA"). Some people like the role of God or a "higher power" in NA. But others don't. There are other groups that do not have that as a focus.

When you are first getting off opioids, you might need to be treated in a hospital to get medicines to help with withdrawal symptoms. This makes getting off drugs easier. Afterward, you can keep taking medicines to help you stay off drugs.

Some people cannot stop using drugs even with medicines, counseling, and support groups. People who have an especially hard time staying off drugs sometimes do well with a treatment called "contingency management." As part of this treatment, you get a reward for staying off drugs. The reward can be money or a small prize, such as movie tickets. Often, you must prove you are drug free by giving urine samples that are then tested for evidence of drugs.

Other types of therapy can help for specific situations. An example is family therapy, which can be especially helpful for children or teens with addiction.

What should I look out for? — 

People with opioid use disorder can have dangerous effects from using opioids, or even die, if they use too much or mix opioids with other drugs or alcohol. The risk of this is especially high in people who stop opioid drugs or use them less often, and then increase their use again.

What are signs of an opioid overdose? — 

Signs are:

●Extreme sleepiness

●Slow breathing, or no breathing at all

●Very small pupils (the black circles in the center of the eyes)

●Very slow heartbeat

How can I prevent someone from dying of a drug overdose? — 

If you think someone is having a drug overdose, call for an ambulance (in the US and Canada, call 9-1-1).

People who overdose are treated with a medicine that blocks and reverses the effects of opioids. The most commonly used medicine for this is "naloxone." It quickly reverses the opioid overdose and can prevent death. People without medical training can safely give naloxone to a person who overdosed while they wait for emergency help to arrive.

If you or someone in your home uses opioids or is trying to stop using them, you might want to keep naloxone at home. It comes as a shot, or as a spray that goes in the nose (sample brand name: Narcan nasal spray). Some brands of the nasal spray are available without a prescription. Some substance use treatment centers, safe injection sites, or emergency departments might also be able to provide naloxone.

Be prepared to deal with an overdose. Know what the signs are. If you do get naloxone to use at home, read the instructions ahead of time and always know where it's kept.

More on this topic

Patient education: Taking opioids safely (The Basics)
Patient education: Opioid overdose (The Basics)
Patient education: How to give naloxone (The Basics)
Patient education: Prescription drug misuse (The Basics)
Patient education: Substance use disorder (The Basics)
Patient education: Managing acute pain at home (The Basics)