Opioids

How to Identify Opioid Dependence

OPIOIDS – an opiate, or any similar synthetic compound: formerly referring only to the latter, but now the predominant term for both the opium-derived and synthetically produced substances

Ongoing use of opioids (prescription or heroin) will lead to physical dependence. To be classified as having an Opioid Substance Use Disorder (DSM5 classification) means that there is problematic use leading to problems or distress with at least 2 of the following within a 12 month period:

  1. Taking larger amounts or taking drugs over a longer period than intended.
  2. Persistent desire or unsuccessful efforts to cut down or control opioid use.
  3. Spending a great deal of time obtaining or using the opioid or recovering from its effects.
  4. Craving, or a strong desire or urge to use opioids
  5. Problems fulfilling obligations at work, school or home.
  6. Continued opioid use despite having recurring social or interpersonal problems.
  7. Giving up or reducing activities because of opioid use.
  8. Using opioids in physically hazardous situations.
  9. Continued opioid use despite ongoing physical or psychological problem likely to have been caused or worsened by opioids.
  10. Tolerance (i.e., need for increased amounts or diminished effect with continued use of the same amount)
  11. Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

Mortality

In America there is a major opioid crisis with over 130 people dying every day from an opioid overdose. Opioid use has been driven by the doctors prescribing (often inappropriately) opioids for pain management, and the patient moving from physical dependence to a psychological and physical dependence.

In Australia there were 900 opioid associated drug overdose deaths in 2018. (Ref: The Penington Institute Overdose Report 2019).

What Support is Available for Family and Friends

As with other chronic health conditions opioid substance use usually has a major impact upon significant others. The added challenge is the stigma and often hidden nature of the dependence including the patient themselves not necessarily recognising the dependence.

Support for family and friends is available from Family Drug Support

Heroin is an Opioid

Whether dependence develops from opioid prescription medications or heroin sourced from the illicit market treatment options are the same. The main difference is the stigma and often hostility directed to people who use heroin.

Ref: Dealing with Stigma and discrimination – Lives of Substance.

Stigma and Accessing Treatment

Opioid dependence is highly stigmatised and many health professionals either are not aware of the latest treatment options or do not wish to provide treatment.

Ref: “Fighting Back Against the Stigma of Addiction” – Nora Volkow 2020

What Are The Treatment Options

The recommended treatment option for opioid dependence is medication – buprenorphine or methadone products combined with psycho-social interventions. In the past twelve months there has been a major advance in the delivery of treatment through the development of monthly injectable buprenorphine products such as Sublocade, if you have previously not considered medication options due to the regulations governing treatment, this is a time to re-examine treatment options.

Detoxification (withdrawal management) on its own is not an effective treatment and is considered a step towards treatment. Detoxification on its own without other treatment will usually be followed by relapse.

Abstinence Programs will be useful for some people however, they have very high drop out rates. We recommend that those seeking a residential rehabilitation program should look for programs 3+ months long rather than shorter duration.

Attempting recovery from opioid dependence without assistance although possible, is very challenging and it is recommended that individuals discuss their options with a health care professional.

What We Offer

  • Psycho-education on impact and treatment options
  • Risk Assessment
  • Assistance to develop social supports
  • Referral for medication treatment
  • Psycho-social interventions

If you are concerned about your opioid drug use there is a drug dependence screening tool available at the Turn To Help website

Additional Reading: Summary of current state of opioid crisis –

This issue of the Global SMART Update
provides an overview of the multi-faceted opioid crisis and highlights major international
and domestic policy responses to date. The Update also presents key developments
related to NPS with opioid effects and examines how these developments are influenced by existing control measures. It also outlines possible policy responses and assesses how the COVID-19 pandemic may affect the ongoing opioid crisis.