8.142: Opioid Abuse (305.52)

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DSM-IV-TR criteria

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

3. recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

4. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of Intoxication, physical fights)

Or that symptoms have never met the criteria for Substance Dependence for this class of substance.

Associated features

Opioids are drugs that include both natural and synthetic substances. The mental effects of an opioid abuser include depression with few or all of its diagnostics, such as selflessness, problems sleeping, lack of interest, faulty coping skills, and even suicidal thought. The effects of opioid abuse are not easily noticeable. The only recognizable observation that could be made is the result of small-sized pupils, or inflamed nasal mucosa if snorted. Although opioid abuse is not as severe as being dependent of opioids, it does however continuously result in negative consequences of using the drug recurrently.

Child vs. adult presentation

Opioid abuse can arise in both children and adults at any age, yet is most common among young adults roughly starting at about sixteen and older. The age of first use opioid abuse is typically about sixteen years of age, though this age has been dropping over the years. From 2002 to 2007 opioid abuse among young adults (18 & older) rose by more than twelve percent. Although opioid abuse is harmful to the abuser, it can also result in mental injury or death of young children, most often between the ages of three and six.

Gender and cultural differences in presentation

Opioid abuse among men increased two percent in 2002 to 2.6 percent in 2007 but did not change significantly for females. Men are twice as likely to overdose on pain relievers than women. Males are more likely to abuse opioids than females, with the male-to-female ratio being approximately 1.5:1 for prescription opioids. There is a much higher incidence of opioid-related deaths in rural areas than urban areas.

Epidemiology

Opioids that are most commonly abused are oxycodone (79%), hydrocodone (67%), methadone (40%), morphine (29%), heroin (13%), hydromorphone (16%), fentanyl (9%) and buprenorphine(1%). Regular opium is also abused but is in some form listed previously.

Etiology

There are no definite causes of opioid abuse other than initial choice to use the drug, though this choice can be highly influenced by peer pressure. Most opioid abusers typically experience early health problems in life, behavioral problems in early childhood, low self-esteem, and lack of respect for authority figures.

Empirically supported treatments

There are roughly eight ways to go about treating opioid abuse. These treatments include counseling, medications to reverse the effects of opioids, supportive-expressive psychotherapy sessions, and self-help groups. Opioid abuse treatment is influenced by managed care and is changing rapidly.
The psychotherapy sessions try to focus on relapse prevention and cognitive therapy.
There are two major types of maintenance therapy. They are methadone and buprenorphine. Methadone has been in use for over 30 years. It acts as an antagonist and replaces the need to daily dose of different types of opioids. It reduces criminal acts and promiscuous behaviors. It is only available at specialty clinics. Buprenorphine is like methadone in reducing cravings. It is safer at higher levels which produce no side effects. It is becoming more popular for this reason. It is also more accessible because it can be used in a doctor’s office.
Opioid abuse relapse rates vary from 25%-97%, being higher for those who smoke cigarettes than those who do not. Successful treatments are determined by improvements in social functions, reduction of illicit drug use, and performance at work and school. The success of treatment often varies according to the type of opioid abused and other factors such as medical care, employment, legal situation, family, and psychological difficulties. The chances of a successful recovery from opioid abuse are much higher in those with profession degrees than those with a poor education level and lower income jobs.

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