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The Stages of Opioid Use Disorder

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April 18, 2022

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Patients and doctors alike often define “addiction,” “abuse,” and “use disorder” very differently. When we say “opioid use disorder,” what do we really mean? What differentiates “use” from “abuse” from “addiction” from “dependence”? More importantly, how do we know when there is a problem for which we should seek help? 

How is opioid use disorder defined?

The Diagnostic And Statistical Manual of Mental Health Disorders (referred to as the DSM-V) defines opioid use disorder (OUD) as “the problematic pattern of opioid use leading to impairment or distress meeting at least two out of eleven “criteria” (1):

  1. The patient takes more drugs or larger doses than they first intended.
  2. Fails to cut down or quit drug use despite trying.
  3. Puts a lot of energy into getting the drugs and then spends time recovering from the effects.
  4. Craves more opioids.
  5. Has problems fulfilling responsibilities at school or work.
  6. Continues drug use despite problems with family and friends because of it.
  7. Cuts back or quit certain daily activities because of drug use.
  8. Uses opioids in a place or situation that is dangerous to their health or safety
  9. Continues using opioids even if it results in mental and physical problems.
  10. Develops tolerance for opioids
  11. Has withdrawal symptoms.

What are the stages of opioid use disorder?

1. Tolerance

Repeated opioid use can change the brain’s chemistry. The brain adjusts to the dose a patient takes and starts to need higher doses of the drug to get the same effects as the patient used to get on a lower dose. A patient shows signs of tolerance when they take more of a drug than they used to in order to get the same effect. This is a sign that the patient is developing tolerance to the drug.

2. Dependence

Once a patient has been using opioids regularly, their body starts depending on the drugs in order to function properly. 

3. Withdrawal

This refers to negative symptoms experienced by patients without the drug. The likelihood of dependence increases with the time of consumption. Some of the most common symptoms of withdrawal from opioids are anxiety, tremulousness/shakiness, abdominal cramping, diarrhea, nausea/vomiting, and strong cravings for opioid medications. It is helpful to know how to prep for opioid withdrawals when beginning suboxone treatment

4. Cravings

Thoughts about wanting or needing to use opioids.

5. Misuse

This stage refers to the use of illicit drugs or taking medications in a way other than how a doctor has prescribed them. That includes taking too much medicine, getting prescriptions from multiple doctors, or obtaining them from illegal sources. Recognizing early signs of opioid addiction or symptoms of opioid dependence or abuse is important. 

Conclusion:

These definitions are just guidelines. Everybody’s opioid use story is different. Some people will “misuse” opioids even if they don’t have significant “withdrawal symptoms” or before they notice any “dependence” on the drug in order to function. Others might experience “tolerance” for the opioid long before they start to notice “cravings.” This is part of the reason that “opioid use disorder” can creep up on us, insidiously starting before we realize it is a problem. For this reason, it is important to learn the signs of OUD so that we can identify when a loved one or we may be struggling from problems from opioid use and need help. 

Buprenorphine/naloxone (Suboxone) is one of the best FDA-approved treatment options for opioid use disorder. For more information on opioid use disorder and what Suboxone treatment is like, you can read more here about what Suboxone is and how it works

To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.

Photo by Sam Lion from Pexels

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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