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What is it?
The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines opioid abuse as a maladaptive pattern of opioid use leading to clinically significant impairment or distress in personal, social, or job-related responsibilities within a 12-month period, including:
Most individuals who meet the criteria of opioid abuse and continue to use eventually meet the criteria of opioid dependence.
Opioid use and abuse has increased markedly in the North America starting in the 1990s and continuing to the present. The increase in opioid abuse coincides with the availability of high-purity heroin, which allows users to begin use by snorting or smoking, rather than by IV. Moreover, increased opioid abuse coincides with the enormous increase in opioid prescriptions since the 1990s through to today. During this period of time, abuse of prescription opioids has grown at a particularly fast rate. A few statistics dramatically illustrate this problem:
The statistics below are drawn from data from the 2006 National Survey on Drug Use and Health (NSDUH), sponsored by the Substance Abuse and Mental health Services Administration (SAMHSA), and illustrate the increase in prescription opioid abuse over the previous decade.
number of persons aged 12 and older illicitly using
prescription pain relievers doubled from 2.6 to 5.2 million between
1999 and 2006. In 2006, 2.2 million persons aged 12 or older used
prescription pain relievers illicitly for the first time. This is more
than any other illicit drug, including marijuana, with 2.1 million new
users aged 12 or older in 2006. The fact that opioids are prescribed by
doctors has led many people to believe they are safe, one of the
reasons for the large spike in new users.
So where are all these pills coming from?
The 2006 NSDUH Survey also showed that the great majority of illicitly used prescription opioids are obtained not from drug dealers, but rather from a single physician. In 2006, among those aged 12 and older who have used prescription pain relievers non-medically in the past 12 months:
So these numbers suggest that in reality drug dealers are a relatively small source of illicitly used prescription opioids. The greatest source of illicit opioids comes from diversion through family and friends, and the majority of these opioids are obtained from a single physician rather than from "doctor shopping."
Moving from illicit use of opioids to opioid dependence carries some dire consequences. The yearly mortality rate for those who are opioid dependent is approximately 2%. As sustained remission from opioid dependence is difficult to achieve, most users will continue to struggle with dependency for their whole lives. There has been a large increase in drug poisoning related mortality since 1990. This increase is in large part the result of unintentional drug overdoses attributed either to opioid pain relievers or unspecified drugs.
The US Centers for Disease Control and Prevention (CDC) reported that methadone contributed to 31.4% of opioid-related deaths in the US from 1999-2010, while Methadone alone also accounted for 39.8% of all single-drug opioid-related deaths. Methadone is associated with a significantly higher overdose death rate than that of other opioid drugs.
Increases in accidental heroin overdoses may be due in part from both a decrease in cost and increase in purity. According to the DEA, average heroin purity increased from 7% in 1980, to 48% in 2000, to 70% in 2003. This allows first-time users to get high by snorting or smoking heroin, both of which may be perceived as being much less dangerous than IV use. Many users also believe that risk of overdose is minimal when snorting or smoking heroin, though the risk of overdose remains substantial regardless of route of administration. The increase in purity also means that mistakes in dosing are potentially more lethal.
Treatment of patients with methadone or buprenorphine (Suboxone) maintenance therapy results in substantially reduced mortality rates.
Many users who are dependent on opioid also have significant medical and psychiatric issues. Also associated with opioid dependency are adverse social, familial, and vocational consequences. The risk of criminal activity and legal consequences also increases as dependence becomes more severe. Increased risk of blood-borne infections such as hepatitis B, C, and HIV is associated with intravenous injection of opioids.
Just as with mortality
rates, many of
these comorbidities are reduced by opioid substitution therapies (e.g.
methadone maintenance). This has been confirmed in studies such as in a
12-month controlled trial involving various German
treatment centers which examined over 1,000 patients who were severely
dependent and treated them with supervised oral methadone or intravenous
Overall, males abuse opioids more commonly than females. For heroin users, the male-to-female ratio is approximately 3:1. However, the male-to-female ratio is much closer for prescription opioids at 1.5:1.
Most commonly, illicit use of opioids begins in late adolescence or early adulthood. Generally, experimentation with tobacco, alcohol, and other drugs precedes experimentation with opioids. The period of time from initial use to dependency is extremely variable, ranging from a few weeks to several years, with a percentage of individuals never progressing past the abuse phase.
Read about how prolonged opioid abuse leads to physical and psychological dependence, and what that means for the user.
Learn the factors that contribute for the complex disease of addition and how opioid addiction differs from opioid dependence.
Opioid withdrawal refers to the symptoms that can occur after stopping or reducing intake of opioid drugs in opioid-dependent persons. Find out what the symptoms of withdrawal are and how long they last.
Signs of Opioid Addiction
There are many ways to recognize opioid addiction. If you or a loved one is addicted to opiates, knowing these signs can help identify when the use of opiates has become abusive.
Updated August 30, 2016