Opioid Use Disorders
dependence, addiction and abuse
Currently, nearly 2 million people abuse or are dependent on prescription opioids and more than half a million abuse or are dependent on heroin.
Objective: In this section you will learn more about opioid addiction its causes, evaluation and treatment
Provide introduction to the science of addiction in general and Opioid Use in particular.
Providing optimal care and interventions to treat Opioid use dsorders.
Provide Evidence Guidelines and tools for treatment of Opioid use disorders.
Addiction is a Chronic Brain Disease
How best to respond to the epidemic of prescription opioid and heroin misuse, addiction and related overdose deaths.
According to the Centers for Disease Control (CDC) Opioid Addiction and overdose have reached epidemic levels in our country. The ASAM defines addiction as ‘‘a primary, chronic disease of brain reward, motivation, memory, and related circuitry,’’ with a ‘‘dysfunction in these circuits’’ being reflected in ‘‘an individual pathologically pursuing reward and/or relief of withdrawal symptoms by substance use and other behaviors.’’ Opioid use disorder is a chronic, relapsing disease, which has significant economic, personal, and public health consequences. We’ve all seen the data and heard the shocking statistics. But what’s not said or heard enough is that the 2.3 million people who need treatment for opioid addiction have a chronic disease of the brain.
While we need to prevent other Americans from developing addiction, these 2.3 million people need treatment. Like other chronic diseases, such as hypertension and diabetes, addiction is the result of a combination of biological (genetic) and environmental factors. Rather than affecting the circulatory or endocrine system, however, addiction affects areas of the brain involved in reward, motivation and memory, and leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, cravings, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.
Opioid use increases the risk of exposure to HIV, viral hepatitis, and other infectious agents through contact with infected blood or body fluids (e.g., semen) that results from sharing syringes and injection paraphernalia, or through unprotected sexual contact. Similarly, it increases the risk of contracting infectious diseases such as HIV/AIDS and hepatitis because people under the influence of drugs may engage in risky behaviors that can expose them to these diseases. Importantly, injection drug use (IDU) is the highest-risk behavior for acquiring hepatitis C (HCV) infection and continues to drive this epidemic. Of the 17,000 new HCV infections in the United States in 2010, more than half (53 percent) involved IDU. In 2010, hepatitis B (HBV) infection rates were estimated to be 20 percent higher among people who engaged in IDU in the United States.
Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. Also like other chronic diseases, addiction can be treated, but it requires long-term management. Historically, we’ve treated addiction in this country acutely, expecting patients to recover after relatively short stints in detox or rehabilitation programs. Unfortunately, this model of care isn’t working, and it’s putting patients at heightened risk for overdose when they return to their communities with a reduced opioid tolerance. Instead, these patients need ongoing chronic disease management, the goal of which is to reduce morbidity and mortality related to their disease, improve functioning, and use the lowest dose of medication possible. Rather than considering whether or not a patient still needs medication to manage his or her illness, we should be looking for treatment outcomes like reduced incidence of infectious disease, increased employment, housing stability, and reduced involvement with the criminal justice system, among other indicators of a return to physical, mental, social and spiritual health.
This section was developed to assist in the evaluation and treatment of opioid use disorder. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This section serves as an overview of the science of addiction in general and Opioids in particular.
About Opioids (Google Docs)
Prescription Drugs Q & A
The HBO 2006 Documentry on Addiction
Aspen Festival of Ideas 2015
Addiction has been scientifically established as a disease, not an absence of willpower. Neuroscientists are studying how drugs of abuse alter the brain, animal models are guiding us to new knowledge at the molecular level, and genetic tests are helping to distinguish many forms of addiction. With such research comes hope for better prevention strategies, more effective pharmaceutical regimens, reduced stigma, and new guidelines for achieving lasting recovery. Ironically, some of the future drugs to treat addiction may come from the very companies that also sell drugs that addict, such as painkillers. Is that an ethical problem? Where is the latest science taking us, and what does it mean for treatment? How do we measure success?
Speakers: Jamison Monroe, Gary Mendell, Eric Nestler, Nora D. Volkow, Alan Weil
Overview of Opioid Use Disorders
Assessment and Diagnosis of Opioid Use Disorder
Psychosocial Treatment in Conjunction With Medications
Experimental Pharmacologic Treatment
Treating Opioid Withdrawal
Harm Reduction: Opioid Overdose Treatment Options
Naloxone for the Treatment of Opioid Overdose
Individuals With Pain
Individuals With Co-occurring behavioral health conditions
Individuals in the Criminal Justice System
Content will be in various forms including articles, infographs, interviews, links to other websites, video and other media forms
ASAM Practice Guideline for the evaluation and treatment of opioid use disorder and for the management of opioid overdose.
ASAM’s National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use was developed to promote evidence-based clinical treatment of opioid use disorder and to assist physicians in the decision-making process for prescribing pharmacotherapies to patients with opioid use disorder. It’s the first guideline to address all the FDA-approved medications available to treat addiction involving opioid use and opioid overdose - methadone, buprenorphine, naltrexone and naloxone. The guideline offers specific clinical recommendations on the assessment and diagnosis of opioid use disorder, treatment options, managing withdrawal, initiating treatment and switching between medications, psychosocial treatment, and special considerations for populations such as pregnant women, adolescents, and persons involved in the criminal justice system.
Treatment - The best way to deal with opioid addiction is to prevent it, but for a huge and growing number of Americans, it's too late for that. This episode looks at some of the pharmacotherapy and cognitive therapy options for treating opioid addiction, and looks at how we've so far largely failed to treat addicts.