The challenge:

 

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 an introduction to the science of addiction in general and Opioid Use in particular. 

Providing optimal care and interventions to treat Opioid Use Disorders.

Provide Evidence Guidelines and tools for the treatment of Opioid Use Disorders.

 

Overview:

 

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.  

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