Opioid dependence is caused by a combination of physical, psychological, and emotional factors. One of the main causes of opioid use disorder is untreated or uncontrolled pain.
The Causes of Opioid Dependence
Opioid use disorder (OUD), often just called opioid addiction, is the development of both physical and psychological dependence on opioid medications. An addiction consists of physical dependence which refers specifically to physical dependence and withdrawal symptoms after discontinuing use, and psychological dependence.
Physical Factors: Pain and Withdrawal
Opioids are used as pain medications. Opioids attach to what are called mu-opioid receptors in our brain cells. These receptors are important to the biochemical reward systems that make humans (and other mammals) feel good when engaging in pleasurable activities like eating, exercise, and sex. With long term use of opioids, the body increases the number of opioid receptors that our cells express, leading to increased tolerance and physical dependence on opioids in order to achieve the same pain relief. In addition, when those receptors are used to being filled with opioids and the person discontinues opioids, they will often experience symptoms of withdrawal including headache, nausea/vomiting, diarrhea, stomach cramping, irritability, shakes, hot flashes, and anxiety. In time, patients may simply be using opioids to avoid these withdrawal symptoms.
Opioid misuse often begins from legitimate attempts at pain management. If a person experiences pain as the result of surgery or other medical condition, opioids can serve a legitimate role in treating a person’s pain for a short period of time. However, long term use can lead to physical dependence and eventually, OUD. One study found 80% of heroin users began their use with a prescription opioid. The high rate of opioid prescriptions in the United States are thought to have largely contributed to the opioid epidemic.
It’s also believed that there is a genetic component to opioid use disorder, with some people having a significantly higher susceptibility to opioid misuse even with all other factors being equal. Genes involved in what is called the endogenous opioid system, the system opioids interact with, seem to play a role in how people react to opioids, although the specifics are not yet fully understood.
Psychological Factors: Depression, Anxiety and Psychiatric Illness
Several psychological factors also predict a person’s risk for opioid misuse and the risk they may develop an opioid dependence. One comparative study found that 59% of chronic pain patients had depression, 64% had anxiety, and 30% had somatization (when a person experiences real, physical symptoms as a result of psychological distress).
In one study, the rate of drug misuse among depressed patients was more than double (12%) than that of non-depressed patients (5%). Among the patients in the study, women with depression and men with somatization disorder had significantly higher rates of illicit drug use (approximately 22%).  The link between depression, anxiety and other psychiatric/mental health conditions and increased risk of drug use has been well established.
Other Important Factors That Lead to Opioid Misuse
We know the causes of drug use are extremely complicated and multi-factorial. Some factors known to affect a person’s risk of drug misuse but that don’t necessarily fall neatly into the above categories include a history of trauma, social and economic status, personal genetics, and the concurrent use of substances by close friends and/or family members. In addition, easy access to opioid medications, particularly among health care workers, has also been associated with increased risk.
Seeking Help for Opioid Misuse
If you or someone you know shows signs of opioid misuse, it’s important to get help. Opioid misuse can cause long-term problems with health and quality of life. Even just admitting there is a problem is a major milestone, as it means a person can begin taking the steps to get help.
There are several ways to treat OUD. Often, it’s best to begin by talking to a health professional who specializes in addiction treatment. They can help you talk about the specifics of your situation and identify what may have led to your opioid misuse. They can also connect you to other resources that will be helpful in your journey to recovery.
Common treatment options for opioid use disorder include the following:
- Group therapy
- Medication for Addiction Treatment (MAT)
- Individual psychotherapy (often just called therapy)
- Support groups
If a person is in crisis or otherwise struggling to control their drug use through the above methods, they may enroll in a residential or inpatient treatment program. These treatment programs involve staying at a facility overnight for anywhere from a few days to multiple weeks, where patients can receive focused care from addiction specialists in an environment that is meant to help someone recover in comfort and safety.
If you are concerned about your pain management and your use of opioid medications, reach out to us here at Bicycle health for support and resources.
Medically Reviewed By 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 ... Read More
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