What are the challenges of treating patients with opioid dependence?
By Clare Waismann
Challenges to treating opioid dependence
The United States is facing a serious opioid epidemic. Nearly 2 million Americans have a substance use disorder related to prescription painkillers, with another 586,000 abusing heroin, according to the American Society of Addiction Medicine.
Although we have effective treatments for opioid dependence, access to these treatments is limited by lack of funding, awareness, or even proper understanding of the condition. Additionally, even when a person does seek help, there are numerous challenges that must be addressed in order for the opioid treatment to be effective.
Before we can help an individual get help with opioid abuse, treatment providers must understand what is perpetuating the problem. A bio-psychosocial model conceptualizes opioid dependence as affecting:
- Biological/physical factors
- Emotional regulation
- Social relationships
Therefore, effective treatments must address each of these three areas in order to help those struggling with opioid addiction get clean. How can clinicians intervene effectively? Continue reading to learn more. At the end, feel free to post your questions and we will try to provide personal and prompt answers to all legitimate inquiries.
What is opioid dependence?
Opioid dependence refers to a physiological condition in which the body comes to rely on opioids for “normal” or comfortable functioning. Opioids could include prescription painkillers such as morphine, oxycodone, or fentanyl. They also include mainstream popular medicines like hydrocodone,Vicodin, Percocet, OxyContin, or codeine. Alternatively, many people dependent on opioids use heroin.
Physiological dependence is the body’s natural reaction to chronic exposure to opioids. This manifests in two ways.
1) First, the body develops an increasingly higher tolerance for the drug. People often notice that they need to take a higher and higher dose of the drug to get the same effect.
2) The second sign of opioid physical dependence is the adaptation to chronic exposure to a drug. This is not the same as addiction, as it represents a physiological response to chronic exposure to opioids.
In either case, withdrawal symptoms usually occur when drug use is suddenly reduced or stopped. This is a sign that the body has come to depend on opioids to maintain a normal level of functioning.
Fortunately, there are effective treatments for opioid dependence!
Physical, emotional, and social challenges often present themselves before, during, and after treatment for opioid dependence. Today, experts agree that a combination of medication assisted therapy and talk therapy work together to achieve successful outcomes in long term sobriety. Additionally, new treatment alternatives are gaining recognition.
This may include inpatient medical opioid detox such as anesthesia-assisted opiate detox commonly referred as “Rapid Detox.” In this procedure, a patient’s receptor sites are cleansed of remaining opioid molecules while sedatives are provided. Going through an effective detox leaves a person able to engage more fully in other parts of treatment that can address the emotional aspects of opioid addiction.
Physical challenges related to the treatment of opioid dependence
The physical challenges related to treatment for opioid dependence are often what patients fear the most. This is due to the withdrawal symptoms that develop when a person no longer has opioids in their system. The acute withdrawal syndrome phase typically lasts several days or even weeks, while other persistent symptoms may last for a month or more. These symptoms can include:
- muscle and bone pain
- cold flashes with goose bumps
- involuntary leg movements
While the connection between opioid overdose and depressed respiration has been established, researchers are also reviewing the long-term effects of opioid use on the brain function. As we know, depressed respiration often causes hypoxia, a condition that describes the lack of oxygen to the brain. Hypoxia has shown to have short- and long-term psychological and neurological effects. These effects can include coma and brain damage.
There are also studies that have shown deterioration of the brain’s white matter due to heroin use. White matter deterioration can affect decision-making, processing speed, and the ability to regulate behavior or respond to stressful situations. These serious consequences can affect the individual’s ability to cope socially and emotionally.
Emotional challenges surrounding opioid dependence
Opioid dependence is the result of physical changes in the brain. It is not a matter of willpower; rather, it is a physiological response.
Addiction is a behavioral syndrome characterized by the repeated, compulsive drug seeking and use despite the negative social, psychological, and physical consequences. Addiction is related to changes in the brain circuitry that controls reward, motivation, and memory. The dysfunction of these circuits leads to:
- emotional, and
- social turbulence
It is usually reflected in the individual pathological need to pursue the reward or relief effects provided by the drug. It is also characterized by the inability to abstain from risky behaviors and a diminished emotional response.
Opioids are often used by vulnerable individuals in a desperate attempt to relieve emotional pain. An individual suffering from an anxiety disorder or depression may start abusing opioids simply to seek some kind of emotional comfort. In any instance, it is important to address the physical dependence component first; this gives the patients and treating professionals the ability to properly assess the level of any mental health component without the presence of physical distress.
During the treatment process, many of these emotional issues can come to the forefront. Effective medical treatment combined with psychological support often can improve the emotional health and quality of life of the individual, with minimal negative side effects.
Social factors related to opioid dependence and treatment efforts
Finally, social factors are another important factor when considering treatment for opioid dependence. Many people who abuse opioids have experienced fractured relationships with friends and loved ones. As substance abuse continues, they may have difficulty performing at work, get into arguments with family members, and fail to meet important obligations. After years of opioid abuse, people often feel defeated and hopeless.
The drug use has disrupted their ability to socialize and they feel like misfits in society. It is important to listen to their concerns and validate their feelings. Again, individualized assessment of each patient is important to determine what will create the most productive treatment environment. For many patients, continuing to feel productive helps them to cope with the challenges of treatment. Thus, having some responsibilities – even if it is not a full workload – during treatment can help.
Opioid dependence: NOT a moral weakness
Like other progressive medical conditions, untreated opioid dependence can result in disability or premature death. As a society, it is important for us to recognize that drug abuse is not a moral weakness but is a complex condition in which genetic predisposition, exposure to opioids, social stress, and mental health issues can all be factors. Having a supportive and non-judgmental social network can be the difference between life and death for many people struggling with opioid use.
If you or a loved one face prescription or illicit opioid dependence or addiction problems, there are ways to seek help! Please use the comments section below to ask any questions regarding treatment processes and available options. We welcome your feedback and try to respond personally and promptly to all legitimate inquiries.