“People become desperate and they become despondent. They’ll do anything to support their drug habits. It’s disheartening.” — Patrick D. McGowan, Minneapolis Police Department (Ret.), Minnesota State Senator (Ret.) and Hennepin County Sheriff (Ret.)
Too many people in the U.S. find themselves in this state of desperation because of opioid use disorder (OUD) — the medical condition that results when someone has an addiction to opioids.
OUD affects more than 2 million people in the U.S., including 3% to 20% of people using prescription opioids. However, those taking prescription opioids aren’t the only people at risk for developing OUD — anyone using opioids can become addicted.
Nearly 75% of all drug overdose deaths in the U.S. involved an opioid in 2020. Overdose deaths that involve opioids have increased at an alarming rate in recent years — by more than eight times since 1999. It’s important to recognize what you can do to help address the opioid epidemic.
How to recognize opioid use disorder
OUD can impact many areas of a person’s life, including health, relationships, work and much more. With such a broad spectrum, it’s not surprising that OUD can look very different from person to person. People can have mild to severe OUD. People can develop OUD whether they are initially prescribed opioids or start with illegal opioids.
Although OUD can manifest in a variety of ways, there are some signs to look for and risk factors that can help predict the likelihood of developing OUD.
Things to look for if you suspect opioid use disorder
People with OUD often:
- Take a higher dose than prescribed or use the medication when they are not in pain.
- Sleep a lot more or less than usual.
- Routinely combine their opioid with other sedating medications or alcohol.
- Borrow medication from others.
- Lie about losing medication to try to get a prescription for more.
- Have excessive mood swings.
- Put themselves and others in danger.
- Engage in criminal activity.
- Are involved in motor-vehicle accidents.
- Perform poorly at school or work.
Risk factors for developing opioid use disorder
Some people with risk factors for OUD never become addicted and others without risk factors do. Still, these risk factors provide valuable information about who is likely to become addicted to opioids. Researchers have identified that people who develop OUD commonly:
- Use high-potency opioids like fentanyl (Actiq, Fentora, Sublimaze) and oxycodone (OxyContin, Roxicodone).
- Take high doses of opioids.
- Inject, snort or use other methods that quickly deliver opioids to the central nervous system.
- Take opioids for long periods of time.
- Are between ages 18 to 45.
- Have a genetic susceptibility for addiction.
- Have a personal or family history of substance abuse disorder, including legal, prescribed and illegal substances.
- Have a mental health disorder like depression, anxiety, bipolar disorder, schizophrenia or other disorders.
- Live with other people who use opioids.
- Use other drugs in addition to opioids.
How to treat opioid use disorder
With OUD, the brain becomes tolerant to opioids. This means that over time people who use opioids need to use higher doses or more potent opioids to get the same feel-good rewards. Helping the brain return to a state that isn’t dependent on opioids requires careful diagnosis and holistic treatment.
Diagnosis
People with OUD are sometimes characterized as having problems with four C’s: compulsion, cravings, consequences and control.
More formally, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) specifies the criteria to diagnose OUD. According to the DSM-5, those with OUD display two or more of behaviors such as:
- Taking more of an opioid than intended.
- Trying to stop taking opioids and failing.
- Spending lots of time trying to get opioids.
- Craving opioids.
- Failing to fulfill obligations.
- Having repeated conflicts with people.
- Giving up important things for opioids.
- Using opioids in dangerous situations.
- Knowing that opioids are causing significant consequences and using them anyway.
- Having tolerance for opioids.*
- Experiencing withdrawal symptoms.*
(*Denotes criteria that cannot be counted if a person is using opioids appropriately as prescribed by their provider.)
Common approaches used in treatment
Although OUD treatment is customized to best fit an individual, treatment programs often use a three-pronged approach to address biological, psychosocial and spiritual issues related to OUD.
- Biological treatments use medications like methadone (Methadose, Methadone HCI Intensol), buprenorphine (Suboxone, Sublocade) and naltrexone (Vivitrol) to help with physical recovery.
- Psychosocial treatment includes individual, group and family counseling as well as cognitive behavioral therapy and 12-step programs to help with mental and emotional recovery.
- Spiritual treatment can include involvement in religious or spiritual activities to help with healing the spirit or soul.
People involved in treatment
Once OUD is diagnosed, the next step is to determine a treatment plan and put that plan into action. With holistic treatment, your care team may include:
- Primary care physicians.
- Psychiatrists.
- Addiction medicine specialists.
- Psychologists.
- Clinical social workers.
- Nurse practitioners.
- Physician assistants.
- Counselors, including chemical dependency counselors.
- Family and friends.
How to prevent opioid use disorder and opioid overdose
In addition to efforts that health care providers use to prevent OUD, such as screening for addiction and overdose risk factors before prescribing opioids, you can play an active role in prevention of OUD and OUD relapses for yourself or a loved one.
Educate yourself on the signs and symptoms of overdose — and be prepared
When someone has overdosed on opioids, they can exhibit a variety of symptoms, including:
- Inability to be awakened.
- Vomiting.
- Very slow or stopped breathing.
If you suspect someone you care about has overdosed on opioids:
- Call 911.
- Follow the directions given to you by the 911 operator.
- Administer naloxone (Kloxxado, Narcan, Zimhi).
Rely on safe strategies and support
To help protect yourself against OUD:
- Take opioids exactly as prescribed.
- Don‘t take anyone else’s medication.
- Share any other medications or substances you use with health care providers, so they can consider potential interactions.
When someone you care about is using or abusing opioids, you can proactively take steps to help prevent them from developing OUD:
- Prevent access to opioids and situations that can trigger opioid use.
- Consider or suggest opioid alternatives to manage pain.
- If you think someone you know has OUD, and they won’t get help, you might consider staging an opioid intervention.
To explore more strategies for identifying, treating or preventing OUD, read “Ending the Crisis: Mayo Clinic’s Guide to Opioid Addiction and Safe Opioid Use.”
