Opioid Dependence

Definition

Opioids are a class of drugs that include both natural and synthetic substances. The natural opioids (referred to as opiates) include opium and morphine. Heroin, the most abused opioid, is synthesized from opium. Other synthetics (only made in laboratories) and commonly prescribed for pain, such as cough suppressants, or as anti-diarrhea agents, include codeine, oxycodone (OxyContin), meperidine (Demerol), fentanyl (Sublimaze), hydromorphone (Dilaudid), methadone, and propoxyphene (Darvon). Heroin is usually injected, either intravenously (into a vein) or subcutaneously (under the skin), but can be smoked or used intranasally (i.e., "snorted"). Other opioids are either injected or taken orally.

The manual that is used by mental health professionals to diagnose mental disorders is the Diagnostic and Statistical Manual of Mental Disorders. The latest edition of this manual was published in 2000, and is also known as the DSM-IV-TR. DSM-IV-TRlists opioid dependence and opioid abuse as substance use disorders. In addition, the opioid-induced disorders of opioid intoxication and opioid withdrawal are listed in the substancerelated disorders section as well.

Symptoms

OPIOID DEPENDENCE.The DSM-IV-TRspecifies that three or more of the following symptoms must occur at any time during a 12-month period (and cause significant impairment or distress) in order to meet diagnostic criteria for opioid dependence:

• Tolerance: The individual either has to use increasingly higher amounts of the drug over time in order to achieve the same drug effect or finds that the same amount of the drug has much less of an effect over time than before.
• Withdrawal: The individual either experiences the characteristic abstinence syndrome (i.e., opioid-specific withdrawal) or the individual uses opioids or similar-acting drugs in order to avoid or relieve withdrawal symptoms.
• Loss of control: The individual either repeatedly uses more opioids than planned or uses the opioids over longer periods of time than planned.
• Inability to stop using: The individual has either unsuccessfully attempted to cut down or stop using the opioids or has a persistent desire to stop using.
• Time: The individual spends a lot of time obtaining opioids, getting money to buy opioids, using opioids, being under the influence of opioids, and recovering from the effects of opioids.
• Interference with activities: The individual either gives up or reduces the amount of time involved in recreational activities, social activities, and/or occupational activities.
• Harm to self: The individual continues to use opioids despite having either a physical or psychological problem (depression, for example) that is caused or made worse by the opioid use.

OPIOID ABUSE.The DSM-IV-TRspecifies that one or more of the following symptoms must occur at any time during a 12-month period (and cause significant impairment or distress) in order to meet diagnostic criteria for opioid abuse:

• Interference with role fulfillment: The individual's use of opioids repeatedly interferes with the ability to fulfill obligations at work, home, or school.
• Danger to self: The individual repeatedly uses opioids in situations in which it may be physically hazardous (while driving a car, for example).
• Legal problems: The individual has recurrent opioidrelated legal problems (such as arrests for possession of narcotics).
• Social problems: The individual continues to use opioids despite repeated interpersonal or relationship problems caused by or made worse by the use of opioids.

OPIOID INTOXICATION.The DSM-IV-TRspecifies that the following symptoms must be present in order to meet diagnostic criteria for opioid intoxication:

• Use: The individual recently used an opioid.
• Changes: The individual experiences significant behavioral or psychological changes during, or shortly after, use of an opioid. These changes may include euphoria initially, followed by slowed movements or agitation, impaired judgment, apathy("don't care attitude"), dysphoric mood (depression, for example), or impaired functioning socially or at work.
• Opioid-specific intoxication syndrome: The pupils in the eyes get smaller. In addition, drowsiness or coma, slurred speech, and/or impaired memory or attention during, or shortly after, opioid use occur.

OPIOID WITHDRAWAL.The DSM-IV-TRspecifies that the following symptoms must be present in order to meet diagnostic criteria for opioid withdrawal:

• Abstinence: Either the individual has stopped using (or has reduced the amount of) opioids, or an opioid antagonist (i.e., a drug, such as naloxone, that blocks the action of opioids) has been administered.
• Opioid-specific withdrawal syndrome: Three or more symptoms develop after abstinence. These symptoms include dysphoric (negative) mood, nausea or vomiting, muscle aches, runny nose or watery eyes, dilated pupils, goosebumps, or sweating, diarrhea, yawning, fever, and insomnia.
• Impairment or distress: The withdrawal symptoms must cause significant distress to the individual or impairment in functioning (socially, at work, or any other important area).
• Not due to other disorder: The withdrawal symptoms cannot be due to a medical condition or other mental disorder.