Opioid Use Disorder
Substance use disorder is a major public health problem in the United States. This is a problem that is associated with increased morbidity, mortality, and cost of care. It suffices to say that the health care delivery system is significantly burdened by issues that are associated with substance use disorder. Data from 1995 to 2018 shows that there has been an increase in the prevalence rate the use of cannabis as well as other illegal drugs and analgesics (Seitz et al., 2019). This shows how substance abuse presents a serious problem for the health care system. when discussing substance abuse and related disorders, it is very hard to ignore the opioid epidemic in the country. The opioid epidemic is a crisis that has taken millions of lives over the last few decades. This crisis was initially worsened by an augmented use of pharmaceutical opioids. Currently, most deaths due to opioid are caused by overdosing on heroin as well as the illegally manufactured synthetic opioid that is referred to as fentanyl (Lyden & Binswanger, 2019). Death is not the only negative outcome of the crisis. Opioid use is also associated with disorders. Opioid use disorder shall form the description of this paper where the diagnostic criteria shall be presented first. The paper shall then discuss the treatment of opioid use disorder using psychotherapy and psychopharmacologic interventions. Finally, the clinical features of the disorder shall be discussed with reference to the DSM-5 criteria.
Opioid use disorder is described as a pattern of opioid use that is problematic, leading to clinically significant distress or impairment. The distress or impairment should be manifested by at least two symptoms from a list that is provided in the DSM-5. This manifestation should last at least 12 months to make a correct diagnosis (APA, 2013). Notably, if a person exhibits 2-3 symptoms, this is considered a mild case. If there are 4-5 symptoms, this is considered moderate, and 6 or more symptoms demonstrate a severe case. The symptoms as provided in the DSM-5 list include taking opioids in larger amounts or longer period than intended, persistent desire or uncontrolled effort to moderate or stop using opioids, spending so much time using, acquiring and recovering from the use, craving for opioids, failing to fulfill important obligations in life due to opioid use, continued use regardless of social and interpersonal problems that are worsened by the use of opioids, giving up social, occupational and recreational activities due to opioid use, using opioids in situations that are hazardous, and continued use of opioids with the knowledge that it is causing or exacerbating physical or psychological problems. Notably, having a high tolerance for opioids in order to achieve the desire to consume as well as suffering from withdrawals are also symptoms to include in the list but do not apply in cases where opioids are used solely for medication purposes (APA, 2013).
The most effective psychotherapeutic approach in the treatment of opioid use disorder is cognitive behavioral therapy. In one study, the accessibility, feasibility, and efficacy of cognitive behavioral therapy in the treatment of opioid use disorder was confirmed (Barry et al., 2019). This approach is effective in preventing relapse and it is also known to work in preventing those that are taking opioid medications for pain from starting to use other illicit opioid substances. The use of psychotherapy as discussed entails rehabilitation as well as maintenance. While rehabilitation focuses on the use of cognitive behavioral therapy, maintenance includes psychological support and patients are always encouraged to join support groups such as an anonymous program. Education and reward cooperation can be the benefits of these support groups (Dydyk, Jain & Gupta, 2020). In addition, when group approaches are used, patients get to benefit from therapeutic factors such as universality and guidance. The maintenance phase may also require the use of medications.
When cognitive behavioral therapy is used in combination with medication, it is said to be most effective in the treatment of opioid use disorder (Dydyk, Jain & Gupta, 2020). Drugs are used for opioid replacement, maintenance, and substitution therapy. Thus, the drugs that are commonly used include Methadone and Buprenorphine. They are always provided under supervision. These drugs are longer acting though they are not as addictive and euphoric as the illicit opioid drugs. The mentioned drugs are mu opioid receptor agonists, and they are used as opioid substitutions even though they have dissimilar pharmacodynamic and pharmacokinetic properties (Noble & Marie, 2019). Other medications that are used include Naltrexone that helps in reducing the urge to use, hence maintaining abstinence and Lofexidine which may be used to treat side effects associated with withdrawal.
In a person that presents to the clinic and is diagnosed with opioid use disorder, they may have slurred speech, pinpoint pupils as well as sedation. On of the criterion for the disorder is tolerance. This is requiring high amounts to quench the desire. In such cases, patients may not present with acute symptoms. This may also be true in cases where the patient has used a dose that is typical for them. Most acute cases are emergencies due to overdosing (Strain, Saxon & Hermann, 2015). It is therefore very important for any health worker to be keen in identifying the acute symptoms, especially emergency cases in order to prevent deaths due to overdosing of opioids, something that is very common.
Barry, D. T., Beitel, M., Cutter, C. J., Fiellin, D. A., Kerns, R. D., Moore, B. A., … & Schottenfeld, R. S. (2019). An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain. Drug and alcohol dependence, 194, 460-467
Dydyk, A. M., Jain, N. K., & Gupta, M. (2020). Opioid Use Disorder. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK553166/#article-42233.s6
Lyden, J., & Binswanger, I. A. (2019, April). The United States opioid epidemic. In Seminars in perinatology (Vol. 43, No. 3, pp. 123-131). WB Saunders
Noble, F., & Marie, N. (2019). Management of opioid addiction with opioid substitution treatments: beyond methadone and buprenorphine. Frontiers in Psychiatry, 9, 742
Seitz, N. N., Lochbühler, K., Atzendorf, J., Rauschert, C., Pfeiffer-Gerschel, T., & Kraus, L. (2019). Trends in substance use and related disorders: Analysis of the epidemiological survey of substance abuse 1995 to 2018. Deutsches Ärzteblatt International, 116(35-36), 585.
Strain, E., Saxon, A. J., & Hermann, R. (2015). Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. UpToDate, Post, TW, editor. UpToDate. Waltham, MA [cited 2018 Apr 1]