How to identify, treat and prevent opioid use disorder

Only 33% stated that a healthcare provider expressed concern over their drug use. In comparison to the general population, the decedents were also more likely to have financial problems, unemployment, physical disability, mental illness and engaged in alcohol/substance use (Johnson et al., 2013). Differences in drug practices seem to exist between injecting heroin and smoking/inhaling it, also known as ‘chasing the dragon’. Those who inhale heroin tend to have less severe dependence scores and are less likely to be daily users than injectors. Inhalers also tend to be younger, female and have more non-drug using friends than intravenous drug users.

• MOUD can help you stop using the drug, get through withdrawal, and cope with cravings.
• Often, opioid users have alternate motives to using opioid pain relievers other than getting rid of pain.
• While universal and selective prevention programme strategies have not targeted opiate misuse specifically (prevalence is too low), effects on gateway or other hard drugs have been promising (Sussman, 2017; Sussman & Ames, 2008).
• A new study shows a dramatic spike in the number of counterfeit fentanyl pills being seized by law enforcement, an indication of the growing illicit drug supply driving the country’s historic opioid crisis.

Gender differences in initiation of injection drug use

• Medications used in the treatment of opioid use disorder can help normalize brain chemistry, relieve cravings, and in some cases prevent withdrawal symptoms, thereby supporting a person’s recovery.
• Heroin use disorder has also increased, up by 150% since 2007 (Jones, Logan, Gladden, & Bohm, 2015b).
• A study of injecting drug users in Los Angeles and San Francisco found that opioid users who used cannabis in the last 30 days used opioids less frequently (Kral et al., 2015).
• About 45% of people who use heroin started with misuse of prescription opioids.
• It’s common not to talk about your concerns because you fear that your relationship or family will fall apart.

In addition, one study evaluating the longitudinal effects of a brief universal prevention intervention for middle schoolers found significant relative rate reductions of prescription opioid misuse in the participant’s later adolescent and young adult years (Spoth et al., 2013). Still, much is left to be done to prevent those at risk for developing opioid use disorder, and to help those that are already affected. Unfortunately, sometimes legislative action that aims to reduce pain killer prescribing may actually lead to increased heroin use (Kolodny et al., 2015). In 2010, Purdue Pharma was approved by the FDA to make a tamper-resistant OxyContin formula (Food and Drug Administration, 2009), which was meant to stop users from crushing up pills to sniff or smoke them to circumvent their time-release action.

What is naloxone and how can it help with an overdose?

Methadone maintenance treatment is generally funded by the public sector in the United States, and buprenorphine treatment is generally only offered in private clinics and offices. Buprenorphine has been shown to have no ceiling effect for pain relief (analgesia), while at the same time limiting the respiratory depression effects it has on the body, mitigating some of the potentially fatal consequences of the drug (Pergolizzi et al., 2010). Additionally, unlike some other opioids which have been shown to produce hyperalgesia (increased sensitivity to pain; Fishbain, Cole, Lewis, Gao, & Rosomoff) buprenorphine produces significant anti-hyperalgesia effects (Pergolizzi et al., 2010). These approaches are effective in approximately 50% of opiate addicts (Sussman & Ames, 2008). Methadone has been identified as the first-line medication assisted treatment for opioid use, however, there are mixed results of which is better – methadone, buprenorphine or heroin-assisted treatment. Other variables such as polydrug use, physical and mental health and criminal activity have been mentioned as important outcomes that should be measured in the opioid treatment research.

Steps to prevent opioid use disorder

Over time, people who use opioids (for pain or other reasons) develop a physical dependence on the drug, meaning that if they stop taking opioids, they experience withdrawal symptoms. At that point, some may take signs of opioid addiction opioids to put an end to withdrawal symptoms rather than to achieve pain relief or a high. Importantly, physical dependence with tolerance and withdrawal alone do not mean someone has an opioid use disorder.

How to Recognize Opioid Overdose

This approach is promising, in part, because people who inject drugs often express reluctance to assist with injecting someone for the first time (Guise, Horyniak, Melo, McNeil, & Werb, 2017; Guise et al., 2018; Wenger et al., 2016). Certain drugs have more severe consequences of use than others, can be more addictive, harmful to the body or even lethal. However, legality of a drug does not consistently predict severity of consequences.

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• Abusing drugs — even prescription drugs — can change how your brain works.
• Methadone and buprenorphine help reduce withdrawal symptoms by targeting the same centers in the brain that opioids target.
• Many approaches are currently in various stages of implementation to help decrease the incidence of prescription opioid misuse, abuse, and diversion.
• In 2016, more than 42,000 Americans died of an opioid overdose — a record number that was a 28 percent increase over 2015, driven in large part by accidental ingestion of fentanyl.
• In the United Kingdom, for example, 13% of all opioid prescriptions are dispensed for cancer pain (Wiffen et al., 2017).
• Barriers such as not having the drug in stock at the pharmacy, pharmacists questioning the need for a prescription and reduction of refills or number of pills were all cited by cancer patients (ACS CAN, 2018).
• The most common opiates that will be discussed in this review are heroin and prescription opioids.

Safe Use, Storage, and Disposal of Opioid Drugs