This illness affects an estimated 1.7 million people in the U.S.
In 2017, an estimated 1.7 million people in the United States suffered from opioid use disorder, according to the National Institute on Drug Abuse (NIDA). While this is a smaller number than for other substance use disorders—over 14 million U.S. adults live with alcohol use disorder—the opioid crisis is one of the primary concerns among medical professionals and public health experts.
“In the world of addiction, we think of opioid use disorder on one hand, and all other substance abuse on the other hand,” says Jonathan Avery, MD, director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital. “The reason we make that distinction is the deaths.”
The Severity of Opioid Use Disorder
Heavy use of substances like alcohol and cigarettes cause millions of deaths around the world each year. However, these deaths are often from related causes, such as cirrhosis, cancer, or COPD. These are problems that develop over time, which means there are more opportunities for intervention to decrease someone’s risk of death.
Opioids, on the other hand, can have fast and fatal effects. “The real scare about prescribing opioids for pain, or for people that get stuck on opioids, or experimenting with substances on the street, is that they'll have an accidental overdose, and they'll die,” says Dr. Avery.
Opioids affect a region of the brain that regulates breathing, so if taken in too high of amounts, opioids can lead to something called respiratory depression, or severely slow and shallow breathing. This is what leads to fatal opioid overdoses, which on average takes the lives of 128 people in the U.S. daily, according to NIDA.
Opioid use disorder is not simply using opioids. Taking prescribed opioids for the recommended duration—such as to relieve pain after a major surgery—can be safe and effective without causing addiction.
“Opioid use disorder is when you're using opioids in a way that impairs your function,” says Dr. Avery, “and this can happen quick with opioids because they're a very difficult molecule to stop using once you take it.”
Why Opioids Are So Addictive
Like many addictive substances, opioids cause effects in the reward center of the brain, leading to a “high” with feelings of ease and elation. Over time, the body can develop a physical dependence on the drug, and the body experiences unpleasant withdrawal symptoms without more opioids.
“The physical pull of opioids then leads to all these functional impairments in your personal life, family life, work life, and then you end up with an opioid use disorder,” says Dr. Avery.
Symptoms of OUD
You may have an opioid use disorder if you are experiencing:
Changes in hobbies, interests, and habits
Isolation from loved ones
While the opioid crisis is a major concern, there’s reason to be hopeful: “There [are] more people in recovery in the United States than with active substance use disorder,” says Dr. Avery.
“When you're in the middle of [a] substance use disorder, it can feel hopeless at times, [and] it can feel like it's something you want to hide, but it's my experience once you get it out in the open, once you involve family, once you get the right treatment, that outcomes can be very positive,” says Dr. Avery.
Dr. Avery is the director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.
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All narcotics and dangerous drugs have legitimate medical uses.
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Many are indispensable for pain-killing and sleep-producing properties,
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but in the hands of the addict, their use is perverted
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to secure an escape from reality.
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In the world of addiction, we think of opioid use disorder
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on one hand, and all other substance abuse on the other hand,
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and the reason we make that distinction is the deaths.
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And so the real scare about prescribing opioids for pain
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or for people that get stuck on opioids or experimenting
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with substances on the street is that they'll have an accidental
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overdose, and they'll die.
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So opioid use disorder is when you're using opioids in a way
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that impairs your function, and this can happen quick with opioids
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because they're a very difficult molecule to stop using 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 from opioids used on the street,
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and you can get very quickly into this physical dependence on it,
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where it becomes very hard to not use, or you go into withdrawal.
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and sort of the physical pull of opioids
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that then leads to all these functional impairments in your personal life,
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family life, work life, and then you end up with an opioid use disorder.
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I'd gotten out of jail, and uh,
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it wasn't long before like I had made some fake checks,
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I robbed somebody, and like I had got some money together.
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I started using again, but I'd actually had a good rapport
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with one of my caseworkers at the outpatient I was going to.
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So he was like, "Look, you're gonna die."
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And so many of my friends, I'm pretty much the last one
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out of the group of friends that I hung with when I was younger
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that got into heroin, so, you know,
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I think of them, and you know, I just, you know,
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they let me know that I have no reason to complain or anything
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to feel bad about anymore, so that's kind of what keeps it green for me.
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As an addiction provider, I'm very hopeful for people
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who are misusing substances or have an opioid use disorder.
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There's more people in recovery in the United States
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than with active substance use disorder,
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and when you're in the middle of an addiction
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and in a substance use disorder, it can feel hopeless at times,
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it can feel like it's something you want to hide,
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but it's my experience once you get it out in the open,
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once you involve family, once you get the right treatment,
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that outcomes can be very positive.
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And we know there are good treatments for opioid use disorder.
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The meds classified under medication-assisted treatment,
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the psychosocial treatments, they're out there, and they can help,
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and I've treated many, and certainly many around the country
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that get better and go on to lead the lives that they want.
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Alcohol facts and statistics. National Institute on Alcohol Abuse and Alcoholism, 2020. (Accessed on April 9, 2020 at https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics.)
Information sheet on opioid overdose. Geneva, Switzerland: World Health Organization, 2018. (Accessed on April 9, 2020 at https://www.who.int/substance_abuse/information-sheet/en/.)
Opioid overdose crisis. National Institute on Drug Abuse, 2020. (Accessed on April 9, 2020 at https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.)Signs of opioid abuse. Baltimore, MD: Johns Hopkins Medicine. (Accessed on April 9, 2020 at https://www.hopkinsmedicine.org/opioids/signs-of-opioid-abuse.html.)