Opioid Use Disorder

April 22, 2021 by julia@esconsulting.ca 0 comments

In 2017, there were 2,053 opioid deaths in Michigan.

Are opioids affecting your everyday life in a negative way? If you are looking for options for recovery, contact our Aegis Medical office today to explore opiate replacement therapy. No referral is necessary.

Opioids have a legitimate medical use as powerful pain relievers. However, abuse of opioids is relatively common because these drugs are widely available and cause an exaggerated sense of well-being. They include:

Heroin
Oxycodone
Morphine
Hydromorphone/Dilaudid
Fentanyl
Codeine

People can become dependent on any opioid. Tolerance can develop after a few days of continued opioid use. That is, people need more and more of a drug to feel the effects originally produced by a smaller amount. People may become more tolerant to some effects than to others.

The Effects & Symptoms Of Opioid Use Disorder

Immediate & Long-Term Effects

While opioids themselves do not cause many long-term complications other than dependence. Some people have minor side effects such as chronic constipation, excessive sweating, sleepiness, or decreased libido. However, many complications can result from sharing needles with another person and from unknowingly injecting other substances with the opioid.

Opioids dull pain and are strong sedating drugs, causing people to become drowsy and quiet.

Other, less desirable effects include: constipation, nausea and vomiting, facial flushing, itching, and confusion.

Long Term Opiod Use Withdrawal Symptoms

Symptoms can appear as early as 4 hours after opioid use stops and generally peak within 48 to 72 hours. They usually subside after about a week, although the time frame can vary considerably depending on which opioid is used.

Each opioid is eliminated from the body at a different rate, which alters how quickly withdrawal progresses and stops. Withdrawal symptoms are worse in people who have used large doses for a long time:

At first, people feel anxious and crave the drug.
Breathing becomes rapid, usually accompanied by yawning, perspiration, watery eyes, a runny nose, dilated pupils, and stomach cramps.
Later, people may become hyperactive and agitated and have a heightened sense of alertness.
Heart rate and blood pressure increase.

Other withdrawal symptoms include:

Gooseflesh
Tremors
Muscle twitching
Fever and chills
Aching muscles
Loss of appetite
Nausea and vomiting
Diarrhea

How We Can Help

Opioid Dependence Treatment Options

Detoxification

There are several approaches to detoxification:

Stopping the opioid and allowing withdrawal to run its course (cold turkey detoxification)
Substituting a similar but less potent drug, then gradually decreasing the dose and stopping the drug

In both detoxification strategies, treatment is usually needed to lessen the symptoms of withdrawal. The drug clonidine usually provides some relief.

Emergency treatment

An opioid overdose is a medical emergency that must be treated quickly to prevent death. A drug called naloxone is given by injection or by nasal spray as an antidote to the opioid, rapidly reversing all adverse effects.

People recovering from an overdose should be observed for several hours until the effects of naloxone have worn off to be sure that no adverse effects of the opioid remain. If people took an opioid with long-lasting effects (such as methadone or slow-release forms of other opioids), they are usually observed for a longer time.

Rehabilitation

Regardless of which approach is used, ongoing counseling and support is essential. Support may include specially trained doctors, nurses, counselors, opioid maintenance programs, family members, friends, and other people with the same substance use disorder (support groups).

The therapeutic community concept emerged nearly 25 years ago in response to the problems of heroin addiction. These programs help people build new lives through training, education, and redirection. The programs have helped many people, but initial dropout rates are high.

Maintenance

For people who continually return to using opioids (called chronic, relapsing opioid addiction), another approach—called maintenance—is often preferred. It involves substituting a prescribed drug at a regular dose that the user takes for a long time (months or years) rather than decreasing the dose and eventually stopping the drug.

Maintaining opioid users with regular doses of one of these drugs enables them to be socially productive because they do not have to spend time getting the illicit opioid and because the drugs used do not interfere with functioning the way that illicit drug use does.

Methadone suppresses withdrawal symptoms and the craving for the opioid without making opioid users overly drowsy or elated. However, opioid users must appear once a day at a clinic where methadone is dispensed in the amount that prevents severe withdrawal symptoms, minimizes craving, and supports daily functioning. Click here to learn more about Methadone.
Buprenorphine (Suboxone) is a mixed opioid agonist and antagonist. That means it has some of the effects of opioids (agonist) but also blocks some of the effects of opioids (antagonist). It does not require supervision in a special program, and thus doctors who are trained in its use can prescribe it in their office. Click here to learn more about Suboxone.
Naltrexone is a drug that blocks the effects of opioids (opioid antagonist). Before starting naltrexone, people must be fully detoxified from opioids, or a severe withdrawal reaction can occur. Depending on the dose, naltrexone’s effects last from 24 to 72 hours. Thus, the drug can be taken once a day or as few as 3 times a week. Because this drug has no opioid effects, this drug is most useful for opioid users who are strongly motivated to remain free of opioids and who are not severely dependent on opioids.
Sublocade is a new medication alternative for treating opioid addiction. It is an injectable form of buprenorphine that should be used as part of a complete treatment plan that includes counseling. The injection is subcutaneous (under the skin). The medication gradually breaks down (biodegrades) and releases buprenorphine for 30 days so that opioid withdrawal symptoms are effectively managed. It is recommended that Sublocade® only be offered to patients who have been receiving a consistent dose of buprenorphine and are otherwise stable in their recovery.

There is a time and place for switching between Methadone and Suboxone. It is important to understand the process takes time and should only be completed when working closely with your prescribing clinician and support team. If you are looking to switch, feel free to contact us to discuss your transition plan to help you set your expectations and set you up for success.