Opioid Overview

In 2018, an estimated 2 million people above the age of 12 had an opioid use disorder,1 a diagnostic term commonly used for people who struggle with any type of opioid addiction, whether it involves heroin or prescription pain medications. The consequences of opioid abuse and untreated opioid addiction can be devastating, but it’s never too late to encourage a loved one to seek help for their addiction.

Did you know most health insurance plans cover opioid addiction treatment?
Opioid Definition

What Are Opioids?

Opioid pills on a table

Opioids are a class of substances that work by binding to and activating opioid receptors throughout the brain and body. One of the effects of this receptor activation is a change in the perception of pain. In addition to their role as prescription painkillers, some opioids are also used to manage coughs.”2,3

Since opiates also impact certain neural processes within the reward centers of the brain, some users experience an intense, rewarding euphoria when taking them at high enough doses.2

What Drugs Are Opioids?

Opioids include illegal drugs like heroin as well as prescription painkillers, including:4

*Fentanyl, a very powerful prescription opioid, is very often manufactured illegally and sold illicitly or added to other street drugs. Illicitly-manufactured fentanyl, or IMF, is a major contributor to the opioid overdose epidemic.5,6

What Is Opioid Abuse?

Opioid abuse/misuse means using these drugs in a way other than prescribed, such as by:3,4

  • Taking opioids in higher doses or more often than prescribed.
  • Taking someone else’s prescription.
  • Combining opioids with alcohol or other drugs to amplify the subjective effects.
  • Taking opioids in ways other than prescribed (see below).

Some people who abuse opioids to get high may attempt to intensify the euphoria by taking them in ways other than as prescribed. For example, OxyContin is an extended-release opioid intended for the treatment of moderate to severe pain by steadily releasing opiates into the body after being taken orally, however people who abuse it may crush the pill to bypass the time-release mechanism and snort or inject it instead.

How Many People Abuse Opioids?

In the 2018 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that roughly 10 million Americans had misused prescription painkillers within the past year, with hydrocodone and oxycodone products at the top of that list. Prescription opioid misuse was the second most common form of illicit drug use that year, second only to marijuana.1

Effects of Abuse

Harmful Opioid Effects

Unemployed, sad man

Potentially adverse short-term effects of opioids include:4

  • Drowsiness.
  • Confusion.
  • Nausea.
  • Constipation.
  • Slowed breathing.

In overdose, the breathing may slow to extreme levels or stop completely. This may lead to a lack of oxygen to the brain (hypoxia) which may result in coma, brain damage, or death.3

Potential Effects of Opioid Addiction

The signs, symptoms, and characteristic behavioral changes associated with individual cases of opioid addiction will vary. Similarly, the precise impact that an untreated addiction has on someone’s life will depend on a number of variables, but many people will be at increased risk for several types of unfavorable outcomes.

Potential adverse consequences of opioid addiction include:7,8

  • A decline in social and interpersonal relationships.
  • Difficulty meeting schoolwork obligations.
  • Problems with job performance or loss of a job.
  • Debt from increased substance-related spending or loss of income.
  • Decreased time for previously enjoyed recreational activities.
  • Increased risk of disease contraction or other drug-related physical health issues. (e.g., HIV, tuberculosis, viral hepatitis, endocarditis, skin and soft tissue infections).
  • Intoxication-related injuries.
  • Increased risk of opioid-related respiratory depression and overdose death.

Signs of an Opioid Addiction

Many of the aforementioned consequences of compulsive or problematic opioid use are, in fact, elements of the very criteria used to make the diagnosis of an opioid use disorder, or opioid addiction. Other diagnostic criteria include:7

  • A persistent desire and/or unsuccessful efforts to decrease or otherwise control one’s opioid use.
  • Strong opioid cravings.
  • Tolerance, or a need for increasing amounts of opioid drugs to achieve a desired level of intoxication.
  • The onset of acute opioid withdrawal when use slows or stops; or, the need to continue use to prevent the onset of opioid withdrawal symptoms.
Dependence

Dependence and Addiction

Though there are additional diagnostic criteria for substance use disorders, addictions often have an element of physical dependence as a characteristic feature, which can develop when the body is chronically exposed to a drug.

In situations where opioids are taken according to a prescription, a doctor will be careful to monitor their patients for any significant dependence development and, when the time comes, gradually adjust down their dose to prevent the arrival of severe withdrawal symptoms.

Once someone starts abusing drugs—or using them nonmedically—they may no longer be taking them at the recommended dosage or via the proper route of administration. Dependence can build swiftly, unmanaged withdrawal may become a recurrent issue, and the situation may become largely out of the doctor’s control.

Though some people may be more susceptible to developing an addiction than others, addiction is ultimately an illness that can develop in nearly anyone under certain circumstances. For instance, a cycle of compulsive opioid misuse may become perpetuated when any individual reaches a point where they will experience uncomfortable withdrawal symptoms if they stop taking them. Making matters potentially worse, because tolerance has built up, they must take larger and larger doses every time if they want to merely stave off withdrawal.

Withdrawal

Withdrawing from Opioids

Recovery requires a person to stop using the abused opioid in question, which often means experiencing some degree of opioid withdrawal. People who have consistently used opioid drugs eventually develop physiological dependence on them; opioid dependence increases the likelihood of a potentially uncomfortable withdrawal experience at the point that a person stops using. Going through withdrawal can be challenging and scary, but it is important to remember that medical detox can help stabilize a person in withdrawal, and make this inevitable hurdle to recovery much more comfortable and bearable.

The precise duration and intensity of withdrawal will vary among individuals and will be influenced by the type of opioid having been used; in some cases, the characteristic withdrawal symptoms may change over the course of a somewhat stepwise progression.

Though opioid withdrawal can be intensely unpleasant, it is seldom life-threatening; with the right withdrawal management care in place, many progress comfortably through this earliest stage of treatment and come out on the other side re-invigorated and ready to begin additional recovery efforts.

As part of medical treatment for opioid use disorder, physician staff may administer opioid agonist medications like methadone and buprenorphine to stabilize people in withdrawal and maintain them through longer-term recovery. Clonidine may additionally be used to manage opioid withdrawal symptoms, as well as other adjunctive pharmacotherapies for better management of symptoms such as insomnia, body aches and pains, and headache.10,11 At some point after being stabilized on an opioid agonist regimen, the choice may be made to then taper the recovering individual off the maintenance drugs in a slow, controlled manner, though many people remain on maintenance therapy for longer periods of time.

Treatment

Treating Opioid Addiction

Woman in therapy session

No single treatment option will be the right fit for everyone; however, some inclusion of pharmacotherapy (i.e., medication treatment) is widely recognized as the standard of care for long term management of opioid use disorders. As discussed, this often starts with medical detox and opioid withdrawal management. Attempts to manage the acute opioid withdrawal syndrome without medications is increasingly recognized as having the potential to result in needless suffering for those in early recovery.11

As important an element of treatment as they are, comprehensive treatment for opioid addiction does not stop with medications alone. As part of an ongoing medication-assisted treatment strategy, several behavioral treatment modalities have helped many people find continued recovery success after their withdrawal symptoms have subsided.12,13

Behavioral Therapies for Opioid Addiction

Behavioral therapeutic interventions used during addiction treatment include cognitive behavioral therapy, motivational interviewing, and contingency management. Different behavioral approaches are commonly utilized in both individual and group counseling or therapy sessions.12 One benefit of such treatment in a group setting is that recovering individuals are able to interact with others who have experienced many of the same symptoms and struggles that they have, which allows them to draw upon the collective wisdom and experiences of their peers.

Outpatient or Inpatient Rehab for Opioid Abuse

Treatment for substance use disorders may take place on an inpatient or outpatient basis, depending on patient needs.

Inpatient rehab programs may cost more than their outpatient counterparts; however, many people find the expense worth it because inpatient rehabilitation provides them with a safe environment in which they can focus on their recovery with less worry about the outside world or having to face situations that may have contributed to their drug use in the first place.

Many outpatient programs offer a similar range of therapeutic offerings with varying levels of intensity. Partial hospitalization, for example, is the most intensive level of outpatient care, requiring patients to attend many hours of therapy per day, most days of the week. Intensive outpatient programs are slightly less intensive, but still conduct treatment services for several hours a week.

Outpatient programs allow the individual in recovery to continue living at home while participating in treatment. Outpatient treatment may be most suited to those with a job and/or a lot of social support, as well as for those who have previously attended and made progress in a higher level of care.14,15

In any treatment setting—whether inpatient/residential or outpatient—patients may take part in several different types of therapy to better target why they became addicted and how they can prevent relapsing in the future.

Many effective rehabilitation programs encourage family members to aid in recovery as well, and offer family therapy sessions and other programs that incorporate loved ones. Addiction’s impact is often felt family-wide, and it’s a struggle that no one should have to fight alone if they have support systems available to them.

How to Get Opioid Addiction Treatment

Many facilities, including Greenhouse Treatment Center, offer both inpatient and outpatient programs, making it easy for you to move from one form of treatment to another as your needs dictate. When you’re beginning the process of getting help, you can call the specific facility you’re interested in to discuss their treatment offerings and ask about the admissions process.

Most programs will perform an initial assessment over the phone to determine your background and your needs and advise you of your care options. Most insurance plans are required to offer some form of coverage for rehab. Learn how to use health insurance to pay for rehab and what your plan covers by checking your insurance benefits.

How Long Is Opioid Addiction Treatment?

There is no specific length of time someone is required to attend treatment for opioid addiction. Common treatment durations include 30 days, 60 days, and 90 days. Generally speaking, for inpatient rehab and outpatient treatment, longer durations (90 days or more) are associated with better recovery outcomes.16

Patients may stay on opioid treatment medications, such as methadone or Suboxone, for years.16