When you have a minor ache or pain, you may take over-the-counter medicine for relief. But for people with more severe pain, a doctor may recommend a stronger prescription medication. These stronger drugs are known as opioids. There are many types of legal opioids, such as morphine or oxycodone, but there are also illegal ones, such as heroin.

National opioid overdose epidemic

Drug overdose is the leading cause of accidental death in the United States, with opioid addiction driving the epidemic. In 2015 alone, there were 52,404 overdose deaths, with 20,101 related to prescription pain relievers and 12,990 related to heroin. Four of five new heroin users start out misusing prescription pain killers and move on to heroin because prescription drugs are more expensive and harder to find. Since 1999, opioid overdose deaths have increased 265% among men and 400% among women, with women being more likely than men to have chronic pain and be prescribed pain relievers.

Opioid use disorder: Tolerance, dependence, and addiction

Opioids interact with opioid receptors on nerve cells in the brain and nervous system to relieve pain and produce pleasurable effects. When taking opioids over a period of time, an individual may find they need more of the drug to achieve the same results. This is called tolerance. When the drug is used for an extended period, an individual may develop a dependence on it. An opioid use disorder can happen when individuals start using the drug in a way other than how it’s intended or in a way that prevents them from living without the drug.

Some people experience a euphoric response while taking opioids, which may lead to addiction. It’s also common that people misusing opioids will move on to snorting or injecting the drug to intensify their experience, which can increase risk of overdose. Others may switch from legal prescriptions to heroin due to its availability and lower price. Because of the unknown chemicals used in black-market heroin and its questionable purity, this also increases risk of overdose. As a use disorder develops and continues, it may be mild, moderate, or severe. In some cases, it may end in fatality.

Signs of a problem

Some of the symptoms of an opioid use disorder include:

• A strong desire for the drug.
• Inability to control or reduce use.
• Interference with daily activities and social functioning.
• Increasing use over time.
• Development of tolerance.
• Spending a great deal of time obtaining opioids.
• Withdrawal symptoms after use (nausea, mood, diarrhea, fever, insomnia)

How is opioid use disorder treated?

There are many types of treatments your doctor may recommend, ranging from medications to group therapy, education, or counseling. Many people with a use disorder may feel ashamed or embarrassed, but it’s important to remember that addiction can happen to anyone who uses opioids. Many factors make someone more likely to become addicted, including biology, psychology, and social and family life. Don’t let your feelings or the feelings of family get in the way of seeking treatment.

If you or someone you know is involved with opioid misuse or may have an addiction, talk to your UPMC doctor. Our many levels of treatment, from inpatient hospital care to outpatient therapy, allow people to move from one level of support to another, depending on their individual needs and rates of recovery. The Life Solutions employee assistance program is a confidential resource for assessment and referral to the appropriate mode of treatment. For information or to determine whether your company is served by Life Solutions, call 1-800-647-3327.

References:

American Society of Addiction Medicine (ASAM). www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf.

ASAM. “Public Policy Statement: Definition of Addiction.”

Center for Disease Control and Prevention. “Prescription Painkiller Overdoses: A Growing Epidemic, Especially Among Women.” Atlanta, GA: Centers for Disease Control and Prevention, 2013. www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html.

Cicero, T.J.; Ellis, M.S.; Surratt, H.L.; Kurtz, S.P. “The changing face of heroin use in the United States: A retrospective analysis of the past 50 years.” JAMA Psychiatry. 2014;71(7):821-826.

National Institute on Drug Abuse. “Drugs of Abuse: Opioids.” Bethesda, MD: National Institute on Drug Abuse, 2015. www.drugabuse.gov/drugs-abuse/opioids.

Rudd, R.A.; Seth, P.; David, F; Scholl, L. “Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015.” MMWR Morb Mortal Wkly Rep. 2016;65:1445 1452. www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm.

Substance Abuse and Mental Health Services Administration. www.samhsa.gov/disorders/substance-use.

UPMC Healthwise Library. www.upmc.com/healthlibrary/Pages/HealthwiseIndex.aspx?qid=abs2147.

UPMC Addiction Medicine. www.upmc.com/Services/behavioral-health/addiction/Pages/services.aspx.