It’s hard not to be aware of the opioid crisis in America right now. According to state-by-state cause-of-death data, more people are dying of drug overdoses than died of AIDS at the height of the AIDS epidemic. So why aren't patients who are struggling with these drugs being treated? Unfortunately, too many people still see substance use as a moral failing, and wrongly dismiss it as a bad choice that "gives people what they deserve.” Such stigma and misperceptions can make it hard for patients to seek help. When patients don't get help, it can be devastating for them and for those around them. It has been estimated that between 24% and 36% of opioid-dependent adults cycle in and out of jails each year.
Patients with Opioid Use Disorder, also known as OUD, can be treated easier than one might think, most of the time in office. And while many people may think of heroin when they hear about opioids, 75 percent of heroin users actually start with prescription pain relievers. But most patients use pain relievers as prescribed. So how do we recognize if a patient has developed an Opioid Use Disorder? The DSM-V defines OUD as "a problematic pattern of opioid use leading to clinically significant impairment or distress." The following symptoms are strong indicators for a potential OUD. Anyone who uses opioids regularly, including people who use them as prescribed over longer periods of time, will develop tolerance. But any change in behavior due to opioid cravings is an important sign that a patient is developing OUD. When a person's brain adjusts to expect an increased amount of opioids in their system, that can lead to agonizing withdrawal if they stop using.
Opioid withdrawal symptoms can be managed medically -- also called "detox" or "rehab." But just going through withdrawal doesn't treat the underlying OUD. In fact, after a period of abstaining from opioids, people lose their physical tolerance, but continue to have the same cravings, triggers, and emotional distress they had before, sometimes for years. This often drives them to return to opioid use. But if someone who lost their tolerance takes the same amount of opioid they used to take, they can easily overdose. This can make the cycle of detoxification and relapse deadly for patients.
Fortunately, there are effective therapies that can reduce the risk of overdose and support recovery. Along with behavioral counseling, we can use medications specifically tailored to opioid receptors to help patients manage opioid use disorder with far less danger of relapse and overdose. These types of combined therapies are known as Pharmacotherapy for OUD.