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The Opioid Crisis: Treating Addiction

Executive Summary

Addiction to Opioids has strong implications for the Opioid Crisis. As many as 1 in 4 patients receiving opioids for chronic pain develop opioid use disorder. Addiction is a multifaceted issue that affects each person individually. This article will examine how to assess and diagnose a patient as well as understanding treatment and interventions.

For more information: Opioid Crisis Management: Foundation Roadmap

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Opioid use disorder or opioid addiction occurs when individuals who use prescribed or recreational opioids have a hard time controlling their opioid use, resulting in significant health or social problems.[4] Fortunately, there are various known approaches that can be taken to treating opioid addiction and individuals with substance use disorders can regain a healthy, productive life but often the care of medical professionals and substance abuse treatment providers is needed for a successful recovery. [2]

There are two classes of treatment options available: medical and behavioural. Neither is guaranteed to successfully treat opioid addiction and the effectiveness of combinations vary by person. Treatment in most cases, is an interdisciplinary process. Popular treatments options include using naloxone, methadone, and buprenorphine, which are more effective when combined with a form of behavioral treatment. Most of these treatments, with the exception of naloxone in some jurisdictions, are doctor prescribed and regulated. [1]


Diagnosis and Assessment of Opioid Use Disorder

Assessment

Assessing an individual’s Opioid Use Disorder should be comprehensive and is crucial for accurate diagnosis. Treatment most suitable for a patient can only be determined upon proper assessment. 

Determining the physical, psychological and social health-care needs of the patient is an important part of assessment. Assessment should also include factors that may influence drug use, such as past treatment experiences, living conditions, legal issues, occupational situation, and social and cultural factors. Assessment is completed through gathering patient history, screening tests including urine and infectious disease screening, and assessing the severity of withdrawal. [3]

There are certain factors that put some people at a higher risk of addiction; these include: genes, temperament, or personal situation. [2]

Diagnosis

The International Classification of Diseases, 10th edition (ICD-10) defines opioid dependence as “a cluster of physiological, behavioural, and cognitive phenomena in which the use of opioids takes on a much higher priority for a given individual than other behaviours that once had greater value”. Once a person is opioid dependent, returning to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.[3]

Making a diagnosis is made by examining injection sites, interpreting urine drug screens, determining the degree of opioid intoxication and withdrawal, and identifying whether an individual is opioid addicted or dependent. [2] 


Mental Health and Addiction

The inability to cope with mental health problems and stress is a common link to substance abuse. They might develop independently as a result of common risk factors or one might lead to the other as a result of self-medication or prolonged distress.

Prevention of and early intervention for mental health and substance use problems is best, but when concurrent disorders develop, they require specialized intensive services. [6] Opioid use disorder prevention strategies can be found here.


Medical Detoxification and Withdrawal

Medical Detoxification is a controlled and medically supervised withdrawal from opioids, usually under the care of a physician. Using opioids can cause physical dependence overtime and stopping them can result in withdrawal symptoms in people with this dependence. The detoxification process is designed to treat the immediate bodily effects of stopping opioids and to remove any toxins left in the body as a result of any additional chemicals found in the opioids.[7]

Withdrawal is associated with many acute physical reactions that are often uncomfortable and can work as a barrier against halting opioid use. Some symptoms can be severe and can last from 1 week to 1 month, but supervised detox, often with the involvement of medications can prepare an individual for long-term recovery. Emotional symptoms associated with withdrawal, however, such as anxiety, insomnia, and low energy can last for a few months, especially for those used to high opiate doses. With medical detox, clients are monitored until withdrawal is over, so their safety and comfort can be prioritized. [5]


Medication-Assisted Treatment

Medication-Assisted Treatment is a treatment for opioid addiction that includes the use of opioid agonist medication along with counseling and other support. Examples of some medications used in this type of treatment include Methadone, Buprenorphine, Suboxone, and Naltrexone. 


Behavioural Treatment

Behavioral therapies help engage people in drug abuse treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and prompt another cycle of compulsive abuse.[8]

It has been shown that medical treatments tend to get better results when accompanied by behavioral treatment. Popular behavioral treatment options include group or individual therapy, residential treatment centers, and Twelve-step programs such as Narcotics Anonymous.

Residential treatment centers allow for a 24-hour drug-free environment to decrease the chances of relapse. These centers allow individuals seeking treatment to be in supportive environments during the difficult time of detox.[1]

Twelve-step programs are one of the most well-known options where a group of people sharing the same addiction can remain abstinent with the support of and spiritual connection to others who empathize and understand.[1]


Psychosocial Interventions

Interventions at a social level can include assistance with basic needs such as food, clothing, accommodation and employment, as well as basic health-care, friendship, community and the pursuit of happiness.

Interventions at a psychological level range from unstructured supportive psychotherapy and motivational interviewing techniques, to highly structured psychological techniques. Clinicians and health providers should choose which psychosocial intervention to offer to opioid-dependent patients, based on research evidence, how appropriate a method is to the patient’s individual situation, how acceptable it is to the patient, whether trained staff are available, and cultural appropriateness. [3]

The two subtypes of therapy that dominate the literature are CBT and contingency management. Cognitive Behavioural Therapy (CBT) has become the leading approach in a variety of mental and behavioural disorders and in substance dependence is based on the principle that addictions are learned behaviours that can be modified. [3]

Contingency management rewards or punishes specific types of behaviours using a structured, transparent approach that increases learning of desired behaviours. Most programmes focus on positive behaviours, with reinforcement for the desired behaviour. Contingency management can be administered by staff with relatively little training.[3]


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