Opioids are substances produced naturally in the body as well as synthetically produced substances that act at the opioid receptors. They are a morphine-like effect that can quickly lead to addiction. Opioid abuse is therefore the use of such substances leading to addiction or supporting addiction. For prevention, every physician should be cautious about prescribing opioids. Treatment and therapy must be done by withdrawing the opioids.
What is opioid abuse?
There are many different opioids on the market. Most of them are prescribed for severe pain. Only occasionally are opioids also used as emetics or else to control diarrhea. One group of patients who may benefit from the good pain-fighting effects of administered opioids are cancer patients with disease-related chronic pain. If a physician properly manages prescribed opioids, there is no fear of dangerous side effects or even deaths from opioid abuse. Opioid abuse is said to occur when the dosage of these medications no longer meets the patient’s actual needs. This can then lead to serious damage to health. In the worst case, affected individuals can die as a result.
Causes
The causes of opioid abuse can vary. Because most opioids are prescription medications due to the dangers they pose, it is often only due to a lack of caution on the part of treating physicians that opioid abuse occurs in the first place in many patients. However, there are also some lighter-acting opioids available over-the-counter at pharmacies. In these cases, it is very difficult to prevent abuse because dependent patients can switch to another pharmacy at any time to purchase their addictive drugs. However, in addition to the opioids that are often negligently prescribed by doctors, there is also a black market for them, which contributes to the fact that opioid abuse can repeatedly lead to serious health damage and even death for many people.
Symptoms, complaints, and signs
The analgesic effect of opioids is noticed less and less as people become habituated, and the dose is increased more and more. In some circumstances, the cause of the pain that was once present in the source may no longer be there at all. However, due to the addictive nature of opioids, people who abuse them continue to perceive the pain as being there and need more and more of this addictive drug. With overdose, life-threatening complications can occur. If the drug is injected, scarring and inflammation of the injection sites occurs. Urinary retention, severe constipation, respiratory depression to the point of suffocation, extreme itching, slowing of the pulse, as well as a severe drop in blood pressure. Life-threatening oxygen deprivation, colicky pain in the biliary system, stiffening of the muscles or constant vomiting are also some of the possible side effects of opioid abuse.
Diagnosis and disease progression
A good way for the treating physician to detect opioid abuse is to closely observe the patient’s pupils. Usually, the pupils are severely constricted in this case. However, this does not always have to be the case. If the opioid abuse has already caused a very severe lack of oxygen in the patient’s body, the pupils may also already be very dilated for this reason, as opioid intoxication has then already occurred. If the doctor suspects opioid abuse and the patient is willing to provide information, it is first important to find out how this patient obtained the opioids. If he or she is prescribed them by another physician, that needs to be clarified. Otherwise, it must be clarified whether he can obtain opioids over-the-counter or whether he can obtain them illegally. The course of the disease then also depends on the extent to which the treating physician can persuade the patient to admit to his incipient addictive behavior.
Complications
Chronic opioid abuse often leads to psychological and physical dependence. Because of the ever-increasing need for opioids, regular use in excessive amounts increases the risk of developing complications, which can range from constant fatigue and sleep disturbances to slowed heartbeat and a drop in blood pressure.Other possible sequelae include impotence, constipation, severe weight loss, tooth decay and hair loss; speech and movement disorders also occur. If the opiate is administered improperly intravenously, there is a risk of disease transmission through contaminated syringes: Bacteria can enter at the injection site and cause local inflammation, and repeated use of syringe equipment often results in HIV or hepatitis C infection. In pregnancy, opioid abuse can cause miscarriage: If the child is carried to term, there is a risk of malformations or developmental delays. If dependence already exists, discontinuation of opioids is noticeable through agonizing withdrawal symptoms such as sweating, cramps, diarrhea, nausea, vomiting, anxiety and restlessness; suicidal ideation may also occur. An acute life-threatening complication is an overdose: In this case, a decreased respiratory rate and depth can lead to a fatal lack of oxygen. In the psychosocial realm, opioid abuse often entails neglect of one’s needs apart from opioid use as well as interpersonal relationships; depletion of financial reserves may eventually result in acquisitive crime.
When should you see a doctor?
If opioid abuse is present, it is generally advisable to see a doctor in the short term, even if there are no acute symptoms. In a trusting conversation with the doctor, the reasons for the abuse should be discussed. A visit to a doctor is particularly advisable if the abuse of opioids is not a one-off event and the patient has had problems with opioids on several occasions. This refers not only to illegal substances, but also to prescription medications that contain opioids. The treatment provider can then take steps to prevent the misuse of opioids from developing into an addiction that is difficult to control. In addition, it may be necessary to adjust an existing medication regimen of prescription medications. However, if acute symptoms occur, a doctor should be sought immediately in the case of opioid abuse to avoid complications. Warning signs include abscesses or inflammation of the skin. Affected individuals should also seek medical attention quickly if they suspect an existing hepatitis condition, as hepatitis can significantly exacerbate the adverse effects of opioid abuse.
Treatment and therapy
Once it has been clarified how a patient came to be abusing said opioids and that patient is also willing to seek treatment, the next steps can be discussed. If a strong addiction is already present, it will not be possible to help the patient without treatment in an addiction clinic. The doctor must then assist in finding a place in such a clinic. Often there is a more or less long waiting period that has to be bridged. Here, the doctor is called upon to ensure that the patient’s motivation to seek treatment is maintained until he or she is admitted to the addiction clinic. In mild cases and also to bridge such waiting periods, it is possible to strive for an accompanying outpatient therapy. If it is possible, it is advisable to motivate the patient to stop taking these drugs immediately, even before admission to the addiction clinic. Even if this is accomplished, the therapy should be done so that the causes for this behavior can be worked through in an in-depth analysis. This will help prevent a relapse later on.
Outlook and prognosis
Few sufferers are able to refrain from further use after a single episode of harmful opioid abuse. These are usually medically informed patients with a stable outlook on life and no previous mental illness. In very many cases, the abuse of opioids leads to a life-threatening addiction. Whether and how quickly addiction develops depends on the patient’s general mental state, family environment, and medical history, as well as on the primary disease present. The prognosis of those affected improves if they receive medical care. The most promising option for opioid dependence is inpatient withdrawal therapy or substitution therapy.Which form of therapy can achieve the most favorable prognosis depends on the patient’s particular situation. Without the involvement of a physician, the prospects for the affected person are very poor. Untreated opioid dependence also leads to a worsening of the underlying primary disease in the further course and thus to severe pain again. Affected patients therefore turn to opioids even more frequently. With regular consumption, coping with everyday tasks or practicing a profession is usually hardly possible anymore. Often, repeated opioid abuse due to overdose leads to the death of the affected person.
Prevention
The best prevention of opioid abuse is basically for treating primary care physicians to be aware of their responsibility when prescribing opioids to their patients for pain management. This should always be carefully considered and done only when truly necessary, and even then, not without remembering to thoroughly educate patients about the addictive nature of these medications.
Follow-up
Prolonged abuse of substances regularly leads to habituation. If the body then no longer receives its intoxicating agents, it shows clear withdrawal symptoms. These can be countered by a patient only with strong will and a helping environment. For this reason, opioid abuse is usually followed by a longer period of aftercare. A stay of several weeks in an addiction clinic is advisable. In many cases, the aim is to experience everyday life without painkillers. Patients need to perceive their sensations and actions as pleasant under the absence of an opioid. Possible complications can arise in particular if the patient is no longer monitored seamlessly. Many then fall back into old patterns, for example by combating stress with painkillers. Selective aftercare in the form of discussions with a psychotherapist or a general practitioner can pave the way to a healthy life. Sports and relaxation techniques strengthen willpower and, in our experience, help many patients to manage without painkillers. Contact with like-minded people can also help to strengthen the will. Basically, it must be noted that the success of aftercare depends mainly on the decisions made by the patient. This is the reason for the sometimes high number of relapses.
What you can do yourself
Individuals who abuse opioids are often more difficult to convince to seek therapeutic treatment than alcoholics. Relatives should show the person the consequences of the addiction as well as ways to get out of it to increase the chance of withdrawal. However, the sufferer himself must have the will to stop opioid abuse. If this will is present, inpatient or outpatient withdrawal is an option. The first step is to discontinue the drug or replace it with a less harmful drug. Opioids should be gradually reduced under a doctor’s guidance to minimize psychological and physical withdrawal symptoms. After withdrawal, the individual must learn to relieve stress and tension naturally. This can be achieved through exercise, yoga, autosuggestive methods and many other measures. To achieve long-term success, withdrawal and subsequent therapy must be professionally guided. Accompanying this, any accompanying mental illnesses such as depression or anxiety disorders must be treated. In the course of psychotherapy, the addict learns coping mechanisms and can also get in touch with other sufferers. Individual and group therapies are an important support after overcoming opioid abuse.
