Opioid use disorder (e.g., heroin, Oxycontin®, Vicodin®)
The diagnostic criteria for a substance use disorder were previously reviewed. These criteria apply to opioid use disorders.
The terms opioid and opiate are very similar. Opiate drugs are naturally derived from the opium poppy plant. Opioids include opiates but also a wide variety of synthetic drugs made in a laboratory. Therefore, DSM-5 uses the word opioid as this is the more inclusive term. Both types produce a similar effect on the body.
There are many different opioid drugs. The most common opioids are opium, morphine, heroin, codeine, methadone, oxycodone, fentanyl, and buprenorphine. Street names for heroin include China white, black tar, horse, smack, chiva, junk, and dope. People also abuse prescription pain medications such as Oxycontin® and Vicodin®. Opioids are can be taken orally by mouth, or by injection into veins. In some cases, opioids are smoked or snorted. We call these different methods of use, routes of administration. Many people mistakenly believe they aren't "addicts" because they "only" snort, smoke, or swallow these drugs. Opioid use can easily escalate to addiction regardless of the route of administration.
Opioids can be obtained by prescription from a physician, as many of these drugs have a legitimate use in severe pain management. Usually this requires faking or exaggerating symptoms, such as back pain. Opioids can also be obtained from the illegal market. Just as alcohol problems are an occupational risk for bartenders, opioid use is a risk for medical personnel who have ready access to opiates.
Opioid addiction may be evident when its use interferes with personal responsibilities or safety. In more severe cases, opioid addiction is characterized by excessive and compulsive drug use. These substances often lead to tolerance and withdrawal.
Opioid Withdrawal (e.g., heroin, Oxycontin®, Vicodin®)
Opioid withdrawal occurs after the cessation (or significant reduction) of heavy and prolonged use. The speed and severity of withdrawal largely depend on the half-life of the drug. The half-life of a drug refers to how quickly your body can clear the drug from your system. Drugs that remain in your system a long time have a long half-life. These are called long-acting drugs. Drugs are cleared fairly quickly have a short half-life. These drugs are called short-acting drugs. For short-acting opioids such as heroin, withdrawal symptoms begin within 6-12 hours after the last dose and last for 5-7 days. For long-acting opioids, withdrawal symptoms may take several days to emerge and may last for several weeks, but with less intense symptoms.
Opioid withdrawal is often very uncomfortable. Withdrawal symptoms may include anxiety; restlessness; irritability; muscle aches; depressed mood; nausea/vomiting/diarrhea; sweating/fever; yawning; cravings; and difficulty sleeping. While highly uncomfortable, opiate withdrawal is usually not life threatening. However, opiate use itself can be fatal.
Effects of Opiates: Opioid Intoxication (e.g., heroin, Oxycontin®, Vicodin®)
Opioid intoxication can be extremely dangerous. The various symptoms include: mood swings (usually an elevated mood followed by a flattened demeanor); impaired judgment/attention/memory; change in pupil size; slurred speech; drowsiness; hallucinations; and even coma. Those who use opioids intravenously may have visible "track marks" at injection sites. Because needles require a prescription, many IV drug users re-use and share unsterile needles. As a result, they are at risk for acquiring hepatitis, tuberculosis, and HIV. The death rate for people who overuse opioids is high. Death may occur because of overdoses, accidents, medical complications, and violent injuries associated with obtaining the drugs. If a pregnant woman is a heavy user of opioids, her newborn may have a severe withdrawal syndrome.