Opioid dependence

What are opioids?

Opioids are compounds that bind to the opioid receptors and are used as strong painkillers. They can be natural (opiates) that derive from the poppy plant eg. Morphine or synthetic and semi-synthetic which are drugs like Oxycodone, Fentanyl and Hydromorphone. They are often used by doctors to alleviate or relieve acute pain, often associated with surgeries and injuries and also in the management of cancer pain and rarely in chronic non-malignant pain. Some of the commonly used opioids include Codeine, Tramadol, Buprenorphine as well as Morphine, Fentanyl, Oxycodone and Methadone.

Caution must be taken with opioids, as a single large dose of an opioid can lead to an accidental drug overdose and death. Opioid abuse is also associated with a greater risk of self-harm and suicide.

What is opioid dependence?

Opioid dependence is defined as the uncontrollable use of drugs despite adverse consequences. Many people can take these prescription painkillers without developing dependence but some people become addicted to the euphoric feeling that comes with taking these drugs. This leads to prolonged use and overdose to experience the feeling of being “high” and the development of tolerance requires the use of larger doses to achieve pain relief.

However, prolonged high doses of opioids change the brain’s chemistry, the body adapts to the drugs and the drugs no longer give that sense of euphoria. People then become dependent on the drugs to feel normal and are dependent on the opioids without which they would get unpleasant withdrawal effects. In patients with pain problems, this could also result in poorly controlled pain.

What are the symptoms of opioid dependence and substance misuse disorder?

  • Intense cravings for opioids and excessive effort and time spent to avail of drugs
  • Taking the prescribed drugs for longer than intended or taking more drugs than recommended by the practitioner
  • Continued use of opioids despite social, personal, work-related and relationship problems caused by the abuse of opioids
  • Continued usage despite the risk of potential psychological and health-related problems

What triggers opioid dependence?

Opioid dependence could start when a person begins to take prescription painkillers. On taking opioids, a chemical reaction occurs in the brain’s reward centre, a large amount of dopamine is released and feelings of pleasure are experienced. However, with long-term use of opioids, the brain changes it’s chemistry and becomes dependent on the drugs to function normally. The patient becomes dependent on drugs feel normal and withdrawal from these drugs causes severe side effects.

What are the negative side effects of opioid abuse?

Those who misuse opioids can experience the following side effects:

  • Psychological and behavioural changes such as apathy and irritability
  • Drowsiness
  • Slurred speech
  • Dry mouth
  • Abdominal cramping

How can opioid dependence be avoided?

Opioid dependence can be avoided if patients treat their prescribed medication with caution, follow the prescribed course of medication as recommended by their doctor and don’t take any extra medication than what is required. Medical supervision and use of multimodal analgesic strategies can be helpful in supporting patients.

Those with a history of addiction in their families are at an increased risk of developing opioid dependence. Those who feel they are dependent on drugs should alert their doctor who can monitor their medication intake closely and help them to withdraw from the medication and support them with other pain management options.

What treatments are available for those who suffer from opioid dependence?

Treatment most likely includes supportive therapy, counselling and replacement therapy with appropriate medication to help people come off the medication that is causing them problems. Medication can be given via tablet form, as a patch or depot injection. Buprenorphine or Methadone, for example, can be prescribed to help with withdrawal symptoms and ease other opioid cravings.

If you are experiencing signs of drug addiction or dependence, contact your doctor or see a specialist who can help.

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