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Opioid Dependence

An opioid is a category of drug that includes heroin, morphine, codeine, oxycodone, and other substances. Opioid dependence is a condition wherein a person cannot stop using these drugs, even if he or she knows they are harmful.

The World Health Organization defines dependences according to six factors:

  1. A strong need or want to take the drug.
  2. Lack of control over the onset, levels of use, or termination of taking the drug.
  3. A withdrawal state that resembles typical withdrawal symptoms from that drug, which may be marked by taking a similar drug to relieve withdrawal symptoms.
  4. Built-up tolerance, so that the user must take more of the drug to achieve the desired physical or psychological effect.
  5. Avoiding other activities to take the drug, and finding less pleasure in activities once enjoyed; also, taking more time away from other activities to devote to the drug.
  6. Continuing to take the drug despite evidence of its harmful physical, emotional, or social effects.

The behavior of an opioid dependent resembles that of someone dependent upon any drug. Opioids rearrange brain chemicals to make the person think that the drugs are necessary to survive. This upset in brain chemistry will lead the dependent person to do anything to obtain the drugs. In real life, this could mean greatly changing one's habits and lifestyle. Opioid dependents may work to the point of exhaustion to have money for drugs, or stop spending time with family and friends that they know disapprove of the habit. They may also stop spending money on necessities, such as food and clothing, in order to have more money for opioids.

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Opioid Withdrawls

When a person becomes dependent upon opioids and then stops using them, he or she can go through some of the many symptoms of withdrawal. Physically, the user may experience sweating, chills, tremors, weakness, cramps, nausea, and other flu-like symptoms. These physical symptoms may be enough to induce more opioid usage, or the use of similar drugs to alleviate discomfort.

Some of the most serious symptoms of withdrawal can be deadly. These include cardiac arrest, stroke, seizures, and suicide attempts. The latter in the list is an example of how psychologically distraught an opioid dependent may become after a long period of use.

Psychologically, users may feel other effects of opioid withdrawal. These may include anxiety, depression, general malaise, and cravings. While physical effects will generally go away after a few days without using opioids, psychological symptoms may persist beyond the initial withdrawal period. In this way, they can be more harmful than physical symptoms.

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Opioid Dependence Treatment

As with most conditions, one type of opioid dependency treatment does not work for everyone. Some people need longer treatment plans, while some people need a different balance of physical and psychological help. It is important to remember that if an opioid user relapses after one attempt at treatment, it does not mean the case is hopeless. Rather, it may just mean that he or she needs a different approach.

The first step of treatment is often detoxification. In this step, the dependent must go for several days without consuming opioids. This usually leads to withdrawal, which is miserable for the dependent. Relapse is common during detoxification, and it is important that the person detoxifying do so in a closely monitored rehabilitation facility, or with close and watchful family and friends.

After successful detox, generally patients go one of two ways: complete abstinence, or substance replacement therapy. Abstinence is very difficult and requires a lifetime of commitment to maintain. It may require constant individual or group therapy. However, many opioid users have found success with abstinence. Success does usually require that the user remove himself or herself from any negative influencing factors, such as people and situations that may have led to former opioid use.

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The other major physical treatment is substance replacement. This involves using a similar, but far less harmful, substance to opioids in order to keep cravings at bay. For example, using methadone on a regular basis has many benefits for former opioid users. It makes abstinence from opioids easier by reducing narcotic cravings and reducing the chances of a relapse. Since it takes the place of using opioids, it also reduces the risk of contracting infectious diseases such as HIV and hepatitis, which are associated with using needles to inject drugs.

Psychological treatment may also be necessary. Often, there is a mental or emotional reason why people begin using opioids, and without treating these issues, relapse may be more likely. If a person chooses to treat opioid dependency by going to a rehabilitation facility, he or she will take part in some group and individual therapy. It is advisable to keep working on the emotional issues with a professional after leaving rehab.

Identifying an opioid user early and getting treatment quickly can greatly increase the odds of recovery. Remember, though, that the user must want to change. Once this happens, he or she can begin to reduce opioid dependence.

According to the Office of National Drug Control Policy there were 977,000 people dependent on heroin in the United States in 2000. The study also shows that an estimated 146,000 individuals used heroin for the first time in 2000. 2001 saw over 600,000 emergency room visits for drug related emergencies and Heroin accounted for 15% of all emergency department visits nationwide in the same year.

Sources:

https://www.who.int/substance_abuse/en/

https://www.aatod.org/

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What is Buprenorphine?
 Buprenorphine is an FDA approved opioid addiction treatment. Currently Subutex® & Suboxone® are the only Buprenorphine medications approved by the FDA. Buprenorphine itself is opioid itself, but the maximal effects are less than other more dangerous opioid agonist like methadone and herion. By producing enough agonist, individuals taking Buprenophine that have become addicted to other opioids are able to discontinue abuse with minimized withdrawl side-effects. In 1965, K.W. Bentley discovered the class of compounds synthesized from an alkaloid of thebaine, the opium poppy plant, known as Papaver somniferum. Among these semi-synthetic compounds is Buprenorphine - the first in a series of opioid agonists. Many were more than 1000 times more effective than the analgesic, morphine. In the 1980s, Reckitt & Colman, today known as Reckitt Benckiser, introduced Buprenorphine hydrochloride for sale. Buprenorphine, an analgesic, was first made in sublingual tablets of 0.2 mg (Temgesic). It was also made as an injectable of 0.3 mg/ml (Buprenex). Read More...

What is Suboxone®?
 Suboxone® is the first narcotic drug available for prescription from a doctor's office for use in the treatment of opioid dependence under the Drug Addiction Treatment Act of 2000 or DATA 2000. The primary active ingredient in Suboxone is Buprenorphine, which itself is a partial opioid agonist. This means the the opioid effects and withdrawal symptoms from Buprenorphine are less than other full opioid agonists such as heroin, methadone, morphine, oxycodone, hydrocodone, codeine, and others. Suboxone, taken as sublingual tablets or "under the tongue", has been shown to help in suppressing opioid withdrawal symptoms, decrease illicit opioid cravings and use, and under the correct supervision can help with overcoming an opioid dependence. Suboxone comes in 2mg and 8mg sizes of sublingual tablet form. Suboxone contains naloxone, which blocks the effects of medicines and drugs like methadone, morphine, and heroin. This is added to prevent people from injecting Suboxone and improper use of the medication. Injecting naloxone can cause withdrawal symptoms. Suboxone is the most commonly prescribed medication and given to patients during the maintenance phase of treatment. Subutex is typically given during the first couple of treatment. Because Suboxone has a lower potential for overdose and abuse, unlike methadone, Certified Doctors are able to prescribe take home supplies of Suboxone in certain circumstances. Read More...

The Benefits of Medication Assisted Treatment for Opioid Addiction
 Since 1949, the 12-step program developed by Alcoholics Anonymous has been the dominant way we think about facing and fighting addiction. Many people have successfully used this community- and willpower-based approach to escaping addiction. However, countless others have tried it, and relapsed. With the powerful hold that opioid addiction has on so many people in America, it’s time to face addiction with an equally powerful—and proven—method: medication-assisted treatment (or MAT). MAT is the practice of using drugs like suboxone and subutex to help people dependent on painkillers gradually ease themselves off their addiction. While these treatments have been available for many years, there is a stigma to relying on these medications to help fight addiction rather than the traditional willpower and community approach of a 12-step program. Here are five benefits to using an MAT approach to ending opioid dependency:
1. MAT is proven to have better results than conventional programs alone.
2. MAT stops withdrawal symptoms so patients can live a normal life.
3. MAT is flexible, allowing medication to be taken at home or in a clinic
4. MAT offers multiple drugs (like suboxone and buprenorphine) to find what works for you
5. It’s easy to find an MAT/suboxone provider near you Read More...