Identifying Opioid Addiction: Signs and Treatment Options

Key Takeaways

• Opioids are a class of drugs used for pain management but carry risks of addiction and overdose.
• The opioid epidemic has evolved in three waves, with over a million lives lost to overdoses since 1999.
• Physical signs of opioid addiction include needle marks, constricted pupils, and changes in sleep and weight.
• Opioid addiction disrupts sleep patterns, leading to sleep-related issues like insomnia and sleep apnea.
• Behavioral changes in opioid addiction include social withdrawal, financial difficulties, and mood swings.
• Secrecy and financial strain are significant aspects of opioid addiction, impacting personal relationships and economic stability.
• Psychological symptoms of opioid addiction include anxiety, depression, and cognitive impairments.
• Opioid addiction strains relationships and can lead to domestic violence and social isolation.
• Treatment options for opioid addiction include medication-assisted treatment (MAT), counseling, and behavioral therapies.

Overview of Opioids: Definitions, Medical Uses, and Varieties

Opioids are a class of drugs primarily used for pain management, derived from or designed to mimic the natural substances found in the opium poppy plant. They function by binding to specific receptors in the brain and other parts of the body, reducing the perception of pain and promoting feelings of pleasure. However, their potent effects also come with significant risks, including the potential for addiction and overdose. The Centers for Disease Control and Prevention (CDC) distinguishes between prescription opioids, heroin, and synthetic opioids like fentanyl.

Types of Opioids

There are various forms of prescription opioids, which can be categorized based on their duration of action:

• Long-acting opioids, such as extended-release formulations, are prescribed for chronic pain conditions
• Short-acting opioids are used for more acute pain episodes.

Opioid Administration

Johns Hopkins Medicine notes that opioids can be administered orally, via skin patches, under the tongue, or by injection.

Legal vs. Illegal Opioids

Illegal opioids like heroin are classified as Schedule 2 drugs under the Drug Enforcement Administration (DEA) due to their high potential for abuse and lack of accepted medical use in the U.S. Prescription opioids, while legal when prescribed by a doctor, also carry risks of misuse and addiction. 

It’s crucial for individuals prescribed opioids to follow their healthcare provider’s instructions and to be aware of alternative pain management strategies. For those struggling with opioid addiction, a combination of medication and counseling is often recommended as part of the treatment.

A Brief History of the Opioid Epidemic

The opioid epidemic has been a devastating public health crisis, claiming over a million lives since 1999 due to drug overdoses, with a significant percentage involving opioids. This crisis has evolved in three waves:

• The first wave, early 1990s: The first wave of the opioid epidemic coincided with a sharp increase in the prescribing of opioids for pain management. Misguiding reports and advocacy led to regulatory changes that allowed more permissive use of opioids, inadvertently contributing to widespread misuse and addiction.
• Shift in the heroin market: As the crisis unfolded, heroin, often of higher purity and sourced predominantly from Mexico, became more accessible in suburban and rural areas. This shift in the heroin market capitalized on the growing population of individuals already misusing or addicted to prescription opioids. The transition from prescription opioids to heroin was further fueled by heroin’s lower cost and the misconception that it could be used safely without injection.
• The synthetic opioid phase in 2013: The emergence of synthetic opioids, particularly fentanyl, marked a new phase of the epidemic around 2013. These substances, which are inexpensive to produce and extremely potent, led to a marked increase in overdose deaths. The proliferation of fentanyl has been linked to manufacturing in countries like China and subsequent smuggling into the U.S. via mail and express consignment systems or through established drug trafficking routes.

Efforts to Combat the Crisis

Efforts to combat the crisis include:

• policy requirements for clinicians to use prescription drug monitoring programs (PDMPs)
•  integrated health delivery systems, which have shown promise in reducing overdose risks. 

Despite these efforts, the opioid epidemic remains a pressing issue, with socioeconomic factors, genetic predispositions, and co-occurring mental illnesses continuing to contribute to the challenge of opioid misuse and opioid use disorder (OUD).

Identifying Physical Indicators of Opioid Addiction

Opioid addiction manifests through various physical signs that can serve as critical indicators for identifying the condition. Recognizing these signs is essential for timely intervention and treatment. These indicators include:

• Needle Marks: Visible on arms and legs from intravenous use.
• Constricted “Pinpoint” Pupils: Common reaction to opioid use.
• Sleep Changes: Difficulty staying awake or falling asleep inappropriately.
• Weight Changes: Significant and unexpected weight loss or gain.
• Other Symptoms: Flushed, itchy skin, heart problems, bloodborne infectious diseases.

Withdrawal Symptoms

Withdrawal symptoms present another clear sign of addiction. These can include diarrhea, sweating, and moodiness, among other symptoms. It is crucial to seek medical attention upon noticing these signs, as opioid use disorder (OUD) is a condition that varies in severity and requires a professional diagnosis for effective treatment.

Impact of Opioid Addiction on Sleep Patterns

Opioid addiction significantly disrupts sleep patterns, leading to a range of sleep-related issues. Research indicates that over 75 percent of individuals with opioid use disorder experience sleep problems, including irregular sleep schedules, insufficient sleep, and sleep disorders like insomnia and sleep apnea. These disturbances have profound effects on daily functioning and behavior, and can exacerbate the cycle of addiction. They include:

• Altered Sleep Architecture: Opioids affect sleep stages, often reducing rapid eye movement (REM) sleep and slow-wave sleep (SWS), which are critical for cognitive function and overall health.
• Daytime Sleepiness: Long-term opioid use, especially in methadone maintenance therapy (MMT) programs, is associated with daytime sleepiness and complaints of insufficient sleep.
• Sleep Disordered Breathing: Opioid-induced respiratory depression can lead to sleep-disordered breathing, including snoring and sleep apnea, which further disrupts sleep quality.

Impact on Recovery

Poor sleep quality is linked to higher rates of psychiatric comorbidities, substance abuse, and reduced retention in treatment programs. Cognitive-behavioral therapies for pain and insomnia may help improve sleep quality and pain management in those with opioid addiction.

Understanding Weight Fluctuations in Opioid Addiction

Opioid addiction can have a profound impact on an individual’s physical health, including significant changes in weight. These fluctuations in weight can be attributed to a variety of factors associated with the use and abuse of opioids:

• Decreased Appetite: Leading to weight loss.
• Digestive Issues: Slowed system causing constipation.
• Sedentary Lifestyle: Due to lethargy, leading to weight gain.
• Nutritional Deficiencies: Such as low potassium and magnesium.

Recent research has also explored the potential of certain weight-loss drugs to reduce opioid cravings, which could have implications for both managing addiction and preventing associated weight fluctuations. As the medical community continues to seek innovative treatments for opioid addiction, it’s crucial to consider the complex interplay between addiction, physical health, and nutrition.

Identifying Behavioral Indicators of Opioid Addiction

Opioid addiction, known clinically as opioid use disorder (OUD), manifests through various behavioral changes that can serve as warning signs for loved ones and healthcare professionals. Recognizing these signs is crucial for early intervention and treatment. Some of the most significant behavioral indicators include:

• Social withdrawal: Individuals may isolate themselves from friends and family, often to hide their substance use.
• Secrecy: Increased secretive behavior, such as lying about whereabouts or activities, can be a sign of opioid addiction.
• Financial difficulties: Unexplained financial problems may arise as individuals spend substantial amounts on obtaining opioids.
• Mood swings: Erratic changes in mood, ranging from euphoria to depression, can be associated with the highs and lows of opioid use.
• Changes in sleep patterns: Opioid addiction can lead to disturbances such as insomnia or excessive sleepiness.
• Legal problems: Encounters with law enforcement or legal issues may occur due to behaviors linked to opioid acquisition and use.
• Work or school neglect: A decline in performance and attendance at work or school is often a red flag.
• Increased tolerance: Needing more of the substance to achieve the desired effect indicates a growing dependence.

It is important to approach individuals showing these signs with compassion and encourage them to seek professional help. Treatment options typically involve a combination of medication-assisted therapy, counseling, and support groups. For more information on treatment, visit the SAMHSA National Helpline.

Understanding the Secrecy in Opioid Addiction

Individuals struggling with opioid addiction often exhibit increased secrecy, a behavior that can serve as a red flag for friends and family. This secretive behavior is not only a symptom of the desire to hide drug use but also a manifestation of the shame and stigma associated with addiction. As opioid use progresses, individuals may withdraw from social interactions, avoid eye contact, or become defensive when questioned about their activities or whereabouts. The need for concealment often leads to a breakdown in trust and communication within personal relationships, further isolating the individual.

Reducing Stigma

The recent changes in regulations by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Health and Human Services (HHS) aim to reduce the stigma of seeking help for opioid use disorder (OUD). By permanently implementing the flexibilities introduced during the COVID-19 pandemic, such as broadening the definition of ‘treatment practitioner’ and amending OTP admission criteria, HHS has made it easier for individuals to access treatment without the added burden of secrecy. 

The Financial Toll of Opioid Addiction

Opioid addiction can have a devastating impact on an individual’s financial stability. The cost of obtaining opioids can drain personal savings and lead to significant debt, as individuals prioritize drug acquisition over other financial responsibilities. This can result in an inability to pay for basic needs, such as housing and food, and may lead to legal issues if funds are obtained through illicit means.

Broader Economic Impact

The economic burden of opioid addiction extends beyond the individual. It affects workplaces through lost productivity and increased healthcare costs. Efforts to combat the financial impact of opioid addiction include federal investments, such as the $47.8 million in grant funding distributed by HHS for programs expanding access to medications for opioid use disorder (SAMHSA). These initiatives aim to reduce the prevalence of opioid misuse and provide support for recovery, ultimately alleviating the economic strain on individuals and society.

Understanding the Psychological Symptoms of Opioid Addiction

Opioid addiction, also known as opioid use disorder (OUD), affects individuals both physically and psychologically. Psychological symptoms are a critical aspect of OUD, often manifesting in the following ways:

• Anxiety
• Depression
• Cognitive Impairments

These symptoms can be as debilitating as the physical signs of addiction and are crucial for diagnosis and treatment.

Impact on Brain Function

Anxiety and depression in individuals with OUD may stem from the drug’s impact on brain chemistry, particularly in areas regulating mood and emotions. The cycle of euphoria followed by withdrawal can lead to severe mood swings and emotional instability. Research indicates that the psychological burden of addiction can exacerbate these mental health issues, creating a feedback loop that makes recovery more challenging.

Recognizing these psychological signs is essential for early intervention and treatment. 

Understanding Mood Swings in Opioid Addiction

Opioid addiction can profoundly impact an individual’s emotional stability, leading to significant mood swings. These fluctuations can range from feelings of extreme euphoria to periods of deep depression. Research highlights how opioids influence emotional processing, emphasizing the dual nature of the experience.

Recognizing the signs of opioid abuse in a loved one can be challenging. However, erratic mood swings are a key indicator. The euphoria associated with opioid use is often followed by a crash into negative emotional states, which can include anxiety, irritability, and severe depression. These mood swings may not only be a result of the pharmacological effects of the drugs but also stem from the psychological and social stressors related to addiction. As tolerance to the opioids builds, individuals may find themselves in a cycle of using the substance to regain the euphoric feeling, only to fall back into a depressive state as the effects wear off.

Opioid Addiction and Its Impact on Memory and Concentration

Opioid addiction can have a significant impact on cognitive functions, particularly memory and concentration. Chronic use of opioids, especially when abused intravenously and in high doses, is associated with cognitive deficits. These deficits can manifest as difficulties in attention, complex working memory, and episodic memory. The hippocampus, a critical brain region for learning and memory, is affected by the action of exogenous opioid drugs, leading to impaired anterograde and retrograde recall in patients according to research.

Brain Function Recovery from Opioid Use

There is potential for recovery of brain function with appropriate treatment. Studies suggest that during methadone treatment, brain function can improve, particularly in cognitive domains that are similar to the training provided. This indicates that while opioid addiction may cause memory and concentration problems, these effects may not be permanent, and cognitive functions can be rehabilitated as evidenced by scientific findings. It is important to note that the extent of cognitive recovery may vary among individuals and is influenced by several factors, including the duration and intensity of drug use, as well as the presence of other substances of abuse.

The Impact of Opioid Addiction on Relationships

Opioid addiction has far-reaching effects that extend beyond the individual to the fabric of their relationships. Interpersonal connections are vital for emotional well-being, yet opioid dependence can severely strain or sever these ties. As addiction progresses, individuals may prioritize substance use over social obligations, leading to secrecy, missed engagements, and a gradual withdrawal from relationships outside of the drug-use sphere. This erosion of social ties contributes to isolation, which can exacerbate the addiction cycle.

Domestic and Professional Relationships

Domestic violence is another tragic consequence, with addiction sometimes fueling aggressive behavior that can escalate into abuse. The impact of opioid addiction on relationships is not just limited to domestic settings; it can also affect friendships and professional relationships, leading to a sense of disconnection and lack of trust. Moreover, the stigma associated with substance use disorders can further alienate individuals from their community, making recovery more challenging.

Exploring Treatment Options for Opioid Addiction

Addressing opioid addiction requires a comprehensive approach that includes various treatment modalities to support recovery. 

Medication-Assisted Treatment (MAT)

One of the critical components is medication-assisted treatment (MAT), which combines medications with counseling and behavioral therapies. MAT has been shown to improve patient survival, increase retention in treatment, and reduce illicit opioid use. Medications such as methadone, buprenorphine, and naltrexone are commonly used in MAT to manage withdrawal symptoms and cravings.

Regulatory Updates and Increased Accessibility

Recent regulatory updates have made these treatments more accessible. The Substance Abuse and Mental Health Services Administration (SAMHSA) has implemented permanent changes to remove barriers for Opioid Treatment Programs (OTPs), allowing more patients to receive care. Additionally, the definition of ‘treatment practitioner’ has been expanded to include a broader range of providers, making it easier for patients to access necessary medications for OUD treatment.

Telehealth Services and Increased Flexibility

Telehealth services have also been enhanced, offering patients the ability to receive care remotely, which is particularly beneficial for those in underserved areas. This increased flexibility includes permitting take-home doses of medications like methadone and allowing nurse practitioners and physician assistants to order these medications.

Individualized Treatment Plans

It’s essential to recognize that treatment needs vary from person to person, and a successful recovery plan may include a combination of detoxification, inpatient or outpatient therapy, support groups, and ongoing counseling. 

Goals of Treatment

The overarching goal is to provide an integrated treatment plan that addresses the physical, psychological, and social aspects of addiction, ultimately leading to sustained recovery and improved quality of life.

Drug and Alcohol Addiction Treatment at The Recovery Village Palm Beach at Baptist Health

If you are struggling with a drug or alcohol addiction, it might be time for professional treatment. The experts at The Recovery Village Palm Beach at Baptist Health are able to identify and treat substance use disorders as well as other co-occurring mental health conditions. Contact us today to learn more about treatment programs that can work well for you.