Opioid Use Disorder FAQs

Our patients are individuals with an Opioid Use Disorder involving prescription drugs such as OxyContin, Vicodin, Percocet, hydrocodone, Codeine, Morphine or non-prescription opioids. Opioid Use Disorder knows no boundaries and attacks individuals regardless of age, sex, race, profession, social class or ethnicity. Our focus is to help affected individuals live drug-free lives and prevent the transition to Opioid Use Disorders. As their lives change, so do the lives of the people around them. We have seen countless families re-established, watched people go back to the work they love, and most importantly, we have celebrated as people look at life through the lens of hope and happiness again.

Opioids, which are also sometimes called Opiates, are a family of drugs that have morphine-like effects, with their primary medical application being pain relief. Doctors and dentists may prescribe opioids to people with acute or chronic pain resulting from disease, surgery, or traumatic injury. Medication Assisted Treatment (MAT) has been found to successfully help treat dependence on opioids, such as prescription pain pills. Careful tapering can prevent patients from developing an Opioid Use Disorder.

An opioid use disorder (OUD) is a deep-rooted, relapsing disease of the brain that results from the prolonged effects of intense exposure to the drugs. Opioid use disorders create a compulsive, physical need for continued opioid use. As the person becomes dependent on the drug, he or she must continue taking it or suffer severe withdrawal symptoms also known as Discontinuation Syndrome. Seeking and using opioids becomes the primary purpose in the life of the person with an opioid use disorder. Important social, employment, and recreational activities are given up or reduced because of this intense preoccupation.

Affinity Healthcare Group provides Opioid Use Disorder treatment services in an outpatient setting. There are two essential aspects to treatment:

1. Medication Assisted Treatment (MAT) using methadone, the “Gold Standard” for treating Opioid Use Disorders, combats the physical effects of the addiction. The patient’s physical dependence must be stabilized first in order to begin effective Behavioral Therapy.
2. Behavioral Therapy (i.e., counseling) addresses the psychological dependence to stabilize the patient and provide the tools to live drug free. We help individuals develop and utilize the necessary coping skills and resources to make their lifelong road of recovery as successful as possible.

It is extremely difficult to overcome an Opioid Use Disorder without assistance. Many have tried to “just quit,” but unfortunately, they typically do not succeed. Because of the physical effects of prolonged exposure to opioids , the body has become chemically dependent on the very thing it should avoid. We have consistently found – and independent research proves – that by combining Medication Assisted Treatment (MAT) with extensive Behavioral Counseling, our programs give people a tremendous opportunity for success.

Yes, our treatment centers are subject to high standards of accountability and regulation.  Treatment programs are licensed by both State and Federal Authorities and are accredited by the Joint Commission, the same agency that accredits hospitals nationwide.

Substance Use Disorders ignore every socio-economic variable and find their way into every community.  Treating such disorders is far less costly than ignoring them.  Demographic data on patients indicates that the vast majority of patients in treatment have long associations with the community as individuals struggling with their disease.  It is far better for any community to provide and encourage treatment of opioid dependent individuals than to ignore the problem and live in the community where individuals with substance use disorders are untreated.

To understand the nature of addiction, it is important to understand the difference between tolerance, physical dependence, and addiction:

As individuals take opioids for an extended period of time, they become less sensitive to the substance and require more to achieve the same effect. Receptors in the brain become less sensitive. This means they need more and more of the opioid to achieve the same effect. This is called tolerance. When the body can no longer make enough natural opioids to satisfy the less sensitive receptors, the body becomes dependent on the external source. This is physical dependence.

Physical dependence is a physiological state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal. It is possible to be physically dependent on a drug without being addicted to it. Physical dependence is the result of physical changes in the brain. It is not a matter of willpower; rather it is a result of physiology.

In contrast to physical dependence, addiction is a behavioral syndrome characterized by the repeated, compulsive seeking (psychological dependence) or use of a substance despite adverse social, psychological, and/or physical consequences, along with the physical need for an increased amount of a substance as time goes on to achieve the same desired effect. Addiction is often but not always accompanied by tolerance, physical dependence, and withdrawal syndrome.

For illustration, consider that people are dependent on water and food but are not addicted to them. A second example demonstrates physical dependence in a medically managed situation, such as when a cancer patient is taking large doses of painkillers. In this situation, the individual will become tolerant and physically dependent on the painkillers (meaning the individual  will experience withdrawal symptoms if the drug is abruptly removed). However, this is not addiction, but rather physical dependence.

Frequently, individuals taking prescribed opioids develop both physical dependence and psychological dependence on the drugs. Without an appropriate treatment plan instituted early by the prescriber, an abrupt taper from long-term opioid use can result in use disorders. For example, if an orthopedic patient has multiple surgeries planned, it would be beneficial to initiate a treatment plan focused on the prevention of opioid use disorders. If the plan fails and the patient continues to display symptoms of opioid dependency, then referral to an Addiction Medicine Specialist is warranted. Referring patients to Addiction Medicine Specialists will aid in the prevention of or transition to an Opioid Use Disorder. 

The American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine recognize the following definitions: .

1. Addiction: Addiction is a primary chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
2. Physical Dependence: Physical dependence is a state of adaptation that is manifested by a withdrawal syndrome (specific to the type of drug) that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
3. Tolerance: Tolerance is a state of adaptation in which exposure to a drug induces changes that result in lessening the drug’s effects over time.

Summary: Addiction is uncontrollable compulsive behavior caused by alterations of parts of the brain from repeated exposure to high euphoric responses.

Withdrawal syndrome or ( Discontinuation Syndrome) consists of a predictable group of signs and symptoms resulting from abrupt removal of or rapid decrease in the regular dosage of a psychoactive substance. The syndrome is often characterized by over-activity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. In other words, withdrawal induces the opposite effect of the drug. If the drug suppresses depression, then the person becomes depressed while in withdrawal. If the substance suppressed pain, then the person experiences pain while in withdrawal.

Withdrawal from opioids can be severe and excruciating. Withdrawal generally begins between 4 to 72 hours after the last opioid use (depending on dose and opioid). The symptoms are both physical and emotional.

Physical connections create pathways in the brain that can be altered when we learn something new. These changes to the brain can be seen with medical imagery. With long-term difficult challenges like learning to play a musical instrument, the changes can be permanent. Addiction is a learned behavior that changes the brain as well. The brain becomes conditioned to want the substance. However, through Counseling and other Behavioral Modifications, we can actually change the brain physically in some cases. Any change in environment – starting a new job, developing new hobbies and friendships, etc. – alters the brain in some way. 

Similarly, it is possible to undo some of the changes that can occur as a result of drug use. Therapy is able to recondition the brain to bring it closer to its pre-addiction status. This prepares the patient for a time when he or she may no longer require medication.

Medication alone can reduce cravings and withdrawal, but recovering from a Substance Use  Disorder requires a rewiring of the brain, and medication alone is not enough. In addition, eliminating factors contributing to stress or depression will help minimize the chance of relapse.

Disassociating with friends with active Substance Use Disorders can be difficult, but is very necessary. An experienced counselor/therapist will be able to teach other techniques that will further help undo some of the brain changes and conditioned learning that occurred as a result of a substance use disorder.