Opioids entail derivatives of opium and substances related to the same that are used in suppressing pain, producing euphoria and employed in treating the neurological and behavioural orders that result from the misuse of opioid. The powerful drugs are addictive despite being invaluable agents of therapy (Bawor et al., 2017). They may further cause errors in medication, misuse and overdose as well as poisonings that cause many fatalities on a yearly basis. The United States has seen a great illicit usage of opioids both heroin and the prescribed analgesics like oxycodone, fentanyl and hydrocodone which have reached epidemic proportions in the country.
The US recorded 36000 deaths in the year 2008 because of drug overdose. A good number of these deaths involved the opioid analgesics prescriptions (Bawor et al., 2017). The opioid use disorders take place in accordance to a continuum of severity following various patterns of usage in both the urban and rural settings and within different types of subpopulations such as the usage of heroin in the urban areas that entail older users that are more diverse in terms of ethnicity. In addition to the same, there is more usage of heroine among the young persons and more so with the non-Hispanic whites (Martins et al., 2012). It is well to appreciate that opioid usage is more rampant and frequent as a component of polysubstance use disorders.
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The poisonings and overdose deaths of opioid take place across all societal segments although clinicians that serve homeless persons or houses that are unstable indicate that such individuals are at a high risk of both opioid use disorders and fatal overdoses. Limited access to treatment and therapy do well to exacerbate the situations when facing an overdose (Martins et al., 2012). A research that took five years and on 28,033 homeless persons that had received treatment from the Boston Health Care for the Program of the Homeless between the years 2003 and 2008 discovered that the drug overdose had taken over HIV as the primary cause of death among the homeless adults in the city of Boston and was also the cause of at least one-third of the fatalities of the persons aged between 25 and 44 (Brown et al., 2007). It was reported that Opioid analgesics and heroin were responsible for 81% of the overdose deaths (Bawor et al., 2017). Adults between the ages of 25 and 44 were nine times more likely to die than the aged adults in houses in Massachusetts and the persons between the ages of 45 and 64 had a 4.5 times likelihood of death (Fischer, 2006).
As earlier mentioned, the opioids usually entail prescription analgesics that are products of the poppy plant such as opium and codeine. Patients may take the drugs and develop serious problems even though the opioids are usually prescribed for the control of pain, sedation and tranquillity (Fischer, 2006). Such problems may include the need for escalating doses in a bid to attain the desired effects whereas such levels may overwhelm the drive of the respiratory system and cause death. The disorders of opioids are seen from all persons regardless of educational or socio-economic backgrounds. The recognition of such kinds of disorders have led to the efforts of changing the practices of prescription by physicians and thus train first responders in regards to the parenteral administration of the naloxone that is an antagonist of mu-opioid.
According to Brown et al., (2007), 400,000 people have used heroin in the past month in the United States with four million having reported the nonmedical usage of prescription of pain relievers. Rough estimates insist that at least 17,000 deaths on an annual basis are related to the opioids with drug poisoning as one of the main causative agents of accidental deaths in the US. Approximately three million people in the US and 16 million across the world have a current or a past disorder of opioid (Bawor et al., 2017). The burden of opioid related diseases is a burden across the globe with its conditions approaching 11 million life years lost from the problems related to health disabilities and early deaths.
Opioid disorder according to the Diagnostic and Statistical Manual of Mental Disorder of the American Psychiatric Association is the repeated occurrence in a period of 12 months of two or more than 11 problems that entail withdrawal, giving up on key events in life in order to use the opioids and the excessive spending of time using the opioids (Martins et al., 2012). A cluster of six more items suggest a severe situation. The clinical course of the usage of opioid disorders entails the exacerbation periods and remission although the vulnerability that underlies it does not disappear (Brown et al., 2007). The pattern likens to the some of the chronic conditions that lead to the relapse in cases such as hypertension and diabetes where the perfect symptom control is difficult and the adherence of patients to treatment if often incomplete. The chances of one dying courtesy of the accidental overdose, trauma and the likes of suicide as well as infectious diseases is twenty times more even if persons the suffer from the disorder undergo periods of opioid abstinence and may seem to be sojourning well (Fischer, 2006). The problems in the legal arena are more likely for persons that have criminal records with high impulsivity and the risk of negative results decreasing with a markedly opioid abstinence.
Opioid use disorders consist of indications that reflect on the compulsive, and increased administration of the substances of opioid used for the illegitimate non-medical purposes or in the event of another necessary treatment of the opioid treatment used greatly in doses in excess amounts needed for the medical condition (Fischer, 2006). Persons suffering from the opioid use disorder usually bring forth the development of particular patterns of the compulsive use of drug that the daily activities plan around in administering of the opioids. People get the opioids through black markets or courtesy of physicians that exaggerate the sickness hence the prescription of a patient with the intent of having an excess dosage.
The health care professionals that suffer from the disorder will often obtain the opioids by writing themselves prescriptions or diverting the opioids which have been prescribed to other patients or from supplies in the pharmacy. Good deals of persons that suffer from opioid disorder have high levels of tolerance and proceed to experience withdrawal that is an abrupt discontinuation of the opioid substances. Individuals that suffer from the disorder will most likely develop responses that are conditioned to stimuli that is related to drugs which is a phenomenon that takes place when a good number of drugs cause serious changes in the psychology of a person using or rather abusing the opioids analgesics hence suffering from the disorder.
Features associated with the diagnosis of Opioid Use Disorder
The opioid use disorder can be traced or related to a history of crimes relating to drugs such as the possessing and or distributing the drugs, robbery, larceny, reception of stolen goods and burglary. The many healthcare professionals that have immediate access to controlled substances indicate a different trend of illegal activities that involve issues with the boards that license the drugs in the state, professional staffs of the hospitals and agencies of administration. Issues to do with difficulties in marriage such as divorce, unemployment and irregular form of employment usually relate to the opioid use disorder at every level of the socioeconomic.
Prevalence
The prevalence period of opioid use disorder standing at 12 months is estimated to be 0.37% among adults above the age of 18 in the population of the community. However, the number may be underestimated because of the significant number of persons that are incarcerated and suffer from opioid use disorders. The rates are quite high in the males than in the females standing at 0.49% and 0.26% respectively (Brown et al., 2007). In fact, the ratio of male to female is usually 1.5 to 1 for the opioids as compared to heroin whereas it is 3 to 1 for heroin.
Female adolescents may prove to have more chances of developing the opioid use disorders. The prevalence decreases in relation to age where it is at its highest at 0.82% among the adults aged 29 years or younger and continues to decrease to 0.09% among the adults aged 65 years and above (Degenhardt, 2012). It is well to appreciate that the prevalence of the opioid use disorder is lower among the African Americans standing at 0.18% being overrepresented among the Native Americans at 1.25% (Degenhardt, 2012).
The prevalence of the disorder in the population of the community is estimated to be 1.0% among persons of the ages between 12 and 17 in the entire period of the 12 months of prevalence. However, the prevalence of heroin sits at a lower value than 0.1% (Brown et al., 2007). Contrary to the normal, the analgesic use disorder is approximately 1.0% in prevalence when it comes to persons aged between 12 and 17 years touching on the significance of the analgesics of opioids as a group of substances that bear health consequences.
Development of the Opioid Use Disorder and its Course
The opioid use disorder can start at any stage or age but the problems that are associated with it begin to become evident in the late teens or early twenties. The disorder continues over a long frame of time once it has developed although there are usually frequent incidences of abstinence. The relapse may go as high as 2% per annum in treated populations with approximately 20 to 30% of the people suffering from opioid use disorder achieving abstinence for a long time (Degenhardt, 2012). However, there is an exception when it comes to the persons in the military that gravely depend on the opioids during and after war. For instance, 90% of the military population was dependent on opioids during and after deployment in Vietnam (Degenhardt, 2012). The soldiers attained abstinence after some time after their return but experienced a serious rate of alcohol and amphetamine use disorder with an increase in suicidality. Increase in age associates significantly with a decreased prevalence courtesy of the premature mortality and symptom remission after persons attain the age of 40 years that is referred to as maturing out.
Health Effects of Opioid Use Disorder
The major side effect of opioid use disorder is constipation and nausea. The other key side effects of the disorder include dizziness, sedation, vomiting, physical dependence, depression of the respiratory system and tolerance. The less common or effective effects include gastroparesis that is the disorder also called delayed emptying of the gastric and one that either slows or stops the movement of food from the stomach to the small intestine causing immense pain, excess gas, heartburn, bloating and loss of weight (Brown et al., 2007). The other effect is hyperalgesia that is hypersensitivity to pain that result from the use of opioid and thus makes the nervous system become extremely sensitive to both painful and non-painful stimuli. Muscle rigidity also serves as a key effect of the disorder and entails the inability of the muscles to relax in a normal way hence causes pain in the muscles ensuring they stay contracted for long periods of time. The last effect in this regard is the myoclonus that is a sudden twitching or jerking of the muscle which is involuntary and hence cannot be controlled.
The long term usage of the opioids can lead to serious side effects and more so when administered or consumed in high doses (Chou et al., 2015). The prolonged usage of the opioids may bring forth adverse consequences when it comes to treating the pain and the body of one. Some of less adverse effects mentioned above become more prone when the opioids are used in large quantities and over a long period of time. The long term effects of the opioid use include hormonal dysfunction, immunosuppression, and addiction (Degenhardt, 2012).
Hormonal dysfunction entails the prolonged usage of opioid which result in the changes in the menstrual periods as well as reduction in fertility, sex drive and the libido. Immunosuppression entails a prolonged usage of opioids that can lead to immunosuppression or rather the weakening of the immune system. The effect that is most prevalent when it comes to immunosuppression induced by opioid is reported to be the increased susceptibility to infection that increases the risk of cancer and HIV infection in the drug abusers (Degenhardt, 2012). The long-term use of the opioid can lead to abnormal sensitivity to pain, amenorrhea or irregular menses, galactorrhoea and the excessive and inappropriate milk production. It may further lead to a reduction in the energy and drive of an individual, reduced fertility and libido as well as depletion of the testosterone.
Opioid Addiction
The effects of opioid use disorder scale from a life that is filled with discomfort to one that is life –threatening. However, the potential of abusing opioids is a situation that deserves the extra attention of concerned parties considering the risk involved in developing the addiction to the opioids is high and one of the principal reasons as to why America languishes in a unprecedented crisis of opioid (Chou et al., 2015). The addiction leads to the pursuance of rewards of opioids by the brain because remembering the work of opioids ensures they reduce the pain perception that comes from triggering special chemicals that are released and activate the reward system of the brain.
Opioid tolerance which is the quest and need to have more One of the key side effects of the opioid use disorder is the tolerance that takes place when a person is need of great amounts of the drugs to obtain a therapeutic effect (Chou et al., 2015). The last effect is the withdrawal that comes when the nerve receptors work in the brain that in the long-run becomes dependent on the drug for it to function. Withdrawal sets in when a user decides to stop using or decreases the use of the opioid drug and this may lead withdrawal of physical forms that range from mild to medium and finally to severe.
Conclusion
Opioids entail derivatives of opium and substances related to the same that are used in suppressing pain, producing euphoria and employed in treating the neurological and behavioural orders that result from the misuse of opioid. The opioid use disorders take place in accordance to a continuum of severity following various patterns of usage in both the urban and rural settings and within different types of subpopulations such as the usage of heroin in the urban areas that entail older users that are more diverse in terms of ethnicity. The major side effect of opioid use disorder is constipation and nausea. The other key side effects of the disorder include dizziness, sedation, vomiting, physical dependence, depression of the respiratory system and tolerance.
References
Bawor, M., Dennis, B., MacKillop, J., & Samaan, Z. (2017). Opioid Use Disorder. Integrating Psychological and Pharmacological Treatments for Addictive Disorders: An Evidence-Based Guide, 124.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological inquiry, 18(4), 211-237.
Chou, R., Turner, J. A., Devine, E. B., Hansen, R. N., Sullivan, S. D., Blazina, I., ... & Deyo, R. A. (2015). The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention WorkshopEffectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain. Annals of internal medicine, 162(4), 276-286.
Degenhardt, L., & Hall, W. (2012). Extent of illicit drug use and dependence, and their contribution to the global burden of disease. The Lancet, 379(9810), 55-70.
Fischer, B., Cruz, M. F., & Rehm, J. (2006). Illicit opioid use and its key characteristics: a select overview and evidence from a Canadian multisite cohort of illicit opioid users (OPICAN). The Canadian Journal of Psychiatry, 51(10), 624-634.
Martins, S. S., Fenton, M. C., Keyes, K. M., Blanco, C., Zhu, H., & Storr, C. L. (2012). Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychological medicine, 42(6), 1261-1272.
