Symptoms of Opioid Use Disorder: What to Look Out For
This disease rewires the brain + causes some obvious behavior changes.
Treating opioid use disorder (OUD) early can be life-saving. OUD can really derail someone’s life and affect their relationships, their career, their health, and more. There is also the scary risk of a fatal opioid overdose, such as by taking opioids laced with fentanyl.
The problem is, it can sometimes be tough to recognize opioid use disorder—whether you’re the patient, a friend of a patient, or even the medical provider.
“Substance use disorders can be difficult to diagnose,” says Jonathan Avery, MD, director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital. “As clinicians, we look for sustained use of a substance over time that's impairing their function.”
Many of the symptoms of OUD are behavioral changes caused by the rewiring of the brain. “Once you start using, you get this incredible dopamine spike that you want to replicate,” says Dr. Avery. “Basically, your neurocircuitry gets rewired so that your brain is just motivated to use.”
Signs of OUD may include:
Taking opioids in increasingly larger amounts
Taking opioids for longer than prescribed
Spending a lot of time, effort, or money to obtain opioids
Not being able to fulfill responsibilities due to opioid use
Losing interest in other hobbies or relationships
Continuing to use opioids despite consequences
Experiencing withdrawal symptoms
“Opioid withdrawal is a very unpleasant state and it's often the reason that people keep using once they've started using,” says Dr. Avery. “You feel anxious, … your nose runs, you can have uncomfortable stomach symptoms, feel cold or shiver.” These opioid withdrawal symptoms can be powerful enough to motivate someone with OUD to continue using.
Getting Help and Fighting Stigma
If you know someone who you believe needs help for OUD, it’s important to remember that OUD is a disease that “deserves sensitive, compassionate medical treatment,” says Dr. Avery.
“Folks with addiction aren't bad people becoming good, but they're sick people becoming well,” says Dr. Avery. “I think that's the proper way to think about addiction and substance use disorders, and not as something that we need to arrest our way out of or punish.”
Dr. Avery is the director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.
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Substance use disorders can be difficult to diagnose,
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especially because people at different points have
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different insight into the level of their substance use.
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As clinicians, we look for sustained use
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of a substance over time that's impairing their function,
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and this can happen quick with opioids
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because they're a very difficult molecule to stop using
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once you take it.
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It provides, for some people, a very dramatic intoxication state
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that one wants more of from a prescribed opioid
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or opioids used on the street.
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Then you end up with an opioid use disorder.
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Once you start using, you get this incredible dopamine spike
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that you want to replicate, and then what happens
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as you use over time is that you get the dopamine spike
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in your brain about acquiring the substance,
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and so basically your neurocircuitry gets rewired
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so that your brain is just motivated to use,
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and the way that plays out is that using opioids
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becomes the answer to every question
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because your brain's sort of wired in that direction.
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What to do after school, after work,
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what to do when you're feeling anxious, bored, want to have fun.
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And you lose that menu of options of things that you can do,
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and you can get very quickly into this physical dependence
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on it, where it gets very hard to not use
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or you go into withdrawal.
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Opioid withdrawal is a very unpleasant state
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and it's often the reason that people keep using once they're,
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once they've started using.
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And basically everything, you feel anxious,
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everything runs, your nose runs,
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you can have uncomfortable stomach symptoms,
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feel cold or shiver,
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and it's a very unpleasant physical state to be in.
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And so often those that are either prescribed opioids
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chronically or misusing opioids in the community,
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they're very fearful of this state, and that's what perpetuates
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use going forward for a lot of folks.
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The biggest misconception about substance use disorders
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is it's bad people doing bad things,
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and it's not a brain disease.
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I think the biggest disservice that is done for addiction overall
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is this idea that we need to punish people for it
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and it's bad people making bad choices,
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but there's certain people with a genetic risk
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or environmental risk, and it becomes almost impossible
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for them to stop because their brain gets hijacked
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with the substance use disorder.
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Well, there was a time in my life where I thought that,
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you know,
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you know, some people are meant to do well,
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some people are meant to do drugs.
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Some people are meant to die from drugs.
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You know, some people are just bad,
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and I just want to tell people that that's not true.
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Like, we all deserve a decent life.
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I deserve a decent life, and so do you.
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Folks with addiction aren't bad people becoming good,
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but they're sick people becoming well,
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and I think that's the proper way to think about addiction
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and substance use disorders, and not as something
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that we need to arrest our way out of or punish.
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But really, that deserves sensitive, compassionate medical treatment.
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Module 5: assessing and addressing opioid use disorder (OUD). Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on April 13, 2020 at https://www.cdc.gov/drugoverdose/training/oud/accessible/index.html.)
Opioid use disorder: epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. Waltham, MA: UpToDate, 2020. (Accessed on April 13, 2020 at https://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis.)