Features April 2018 Issue

Understanding Opioid Addiction

Addiction is a concern with opioid drugs. But not everyone who takes them gets addicted.

With all the attention being paid to the problem of opioid abuse, you might hesitate to take these medications for any reason, fearing you might become addicted. While drug abuse is a serious problem, not everyone who takes opioids becomes addicted.

New research shows that only about 6 percent of people who take opioids for one to seven days become long-term users of opioids. The chances are higher for those who take these medications for a longer period of time.

Physical Dependence

Understanding addiction can be confusing. “Some people who take opioids for more than a few weeks may become physically dependent on these powerful pain-killing medications,” says Cleveland Clinic psychiatrist Mohsen Vazirian, MD.

Physical dependence means that the body adapts to the drug over time. If the drug is stopped abruptly, there will be withdrawal symptoms. Over time, people can also develop tolerance, meaning more of the drug is needed to achieve the same effect.

After chronic use, you have to wean off opioids gradually. “They are reduced and then stopped, and the person is no longer physically dependent,” says Dr. Vazirian.

What Is Addiction?

Opioid addiction, the official term for which is opioid use disorder, differs from physical dependence. It happens when substance use goes out of control. The person craves and seeks out the drug, with little concern for the consequences.

pill bottle

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Opioids work on brain chemistry in ways that dampen pain sensations. They also work on the reward system in the brain, which creates feelings of pleasure. People who become addicted can’t stop themselves from taking the drugs to sustain this feeling. Repeated use leads to brain changes that further impair self-control. It becomes a destructive compulsion.

“The person who started taking opioids for pain now needs more medication than the doctor prescribed,” say Dr. Vazirian. He or she starts running out of medication and may go to different doctors to get more. Some people turn to street drugs, such as heroin.

“We can’t predict who will become addicted to a substance,” says Dr. Vazirian. But there are certain factors that increase risk. People with a family history of substance abuse are more prone to becoming addicted. People with mental health issues, such as depression, anxiety or post-traumatic stress disorder, or high levels of stress may also succumb to addiction.

Treatment Is Available

If you have any concerns about your own use of opioids, Dr. Vazirian recommends talking to your doctor. Help is available for addiction.

There are two main types of treatment. With abstinence-based treatments, the person is first weaned off of opioids, either gradually in an outpatient setting or faster in an inpatient setting. The person is then offered medications to reduce cravings, such as naltrexone (Vivitrol®), given as daily pills or a monthly injection.

The second type of treatment is for those who, for different reasons, cannot stay off of opioids despite abstinence-based treatment. In this form of treatment the person is given either methadone (only available in a small number of federally regulated clinics) or buprenorphine.

“They will remain physically dependent on opioids, but otherwise can conduct a normal life free from drug abuse,” says Dr. Vazirian.

There’s also counseling and groups like Narcotics Anonymous, which can be effective. “There’s no single treatment for addiction,” says Dr. Vazirian. “We assess each person and recommend treatment based on their particular circumstances.”

Minimize Risk

To minimize the chances that you might become addicted, Dr. Vazirian advises taking opioid medications only as prescribed. Talk to your doctor about nonopioid alternatives.

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