Think back to grade school when you heard the slogan “Just Say No” to drugs. Your perception of drug addiction may have involved dimly lit streets, shady characters, and feeling far removed from your daily life. At that time, you may not have thought of a doctor office or a 70-year-old grandmother as being involved in substance abuse. The same individuals who use a few pain pills can quickly find themselves injecting heroin.
The opioid epidemic has changed societies perception of drug abuse. A 2017 survey found that 2.1 million people have an opioid use disorder (OUD). This increase in use has led to the opioid crisis. With the rise in opiate use, you will be providing clinical care to clients who are or have been struggling with addiction. As a clinician, you need to be able to define what opiates are, the criteria for opioid use disorder, signs, and symptoms of use.
What are opiates?
Opiates are narcotic drugs that act as depressants on the central nervous system. They are highly addictive and fast acting. Doctors prescribe opiates for surgeries, toothaches, injuries, and chronic pain.
Examples of common opiates are morphine, methadone, hydrocodone, oxycodone, buprenorphine, codeine, and heroin. Brand name opiates are OxyContin, Percocet, Vicodin, and Demerol.
There are several ways individuals can use opiates including snorting/sniffing, shooting up/mainlining, skin-popping, or muscling.
What is Opioid Use Disorder?
The Diagnostic Statistical Manual 5 (DSM-5) outlines the criteria for opioid use disorder.
To confirm a diagnosis of OUD, at least two of the following should be observed within a 12-month period:
- Opioids are often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
- A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
- Craving, or a strong desire or urge to use opioids.
- Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
- Important social, occupational, or recreational activities are given up or reduced because of opioid use.
- Recurrent opioid use in situations in which it is physically hazardous.
- Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Exhibits tolerance.
- Exhibits withdrawal.
The last two diagnostic criteria, related to tolerance and withdrawal, are not considered to
be met for individuals taking opioids solely under appropriate medical supervision.
Tolerance: is defined as either: 1) a need for markedly increased amounts of opioids to achieve intoxication or desired effect, or 2) a markedly diminished effect with continued use of the same amount of an opioid.
Withdrawal: You can refer specifically to DSM-5 Criteria A and B for opioid withdrawal syndrome:
- Either of the following: 1) Cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer), or 2) administration of an opioid antagonist after a period of opioid use
- Three (or more) of the following, developing within minutes to several days after Criterion A: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation, piloerection, or sweating; diarrhea; yawning; fever; or insomnia
Common signs and symptoms
As a clinician be aware that there is a difference in signs and symptoms of opiate use. Signs of opioid abuse can be seen externally. This is different than symptoms of opiate use which are felt internally. There are many signs of opioid abuse that you may witness in your clients or reported by your client’s support system.
Signs of opioid abuse include:
- Poor coordination
- Shallow breathing
- Slurred speech
- Abandoning responsibilities
Symptoms of opioid abuse include:
- Mood swings
- Loss of consciousness
- Physical agitation
- Poor decision making
For your exam prep, be sure to study vignettes involving substance use disorders. There are many assessments and checklist to assist you in diagnosing opioid use disorder. In your study plan include these assessments and list to help you learn the criteria for diagnosis.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author
Dr. Kristie Overstreet is a clinical sexologist, certified sex therapist, licensed professional clinical counselor, author, speaker, and consultant. She holds a Ph.D. in Clinical Sexology, Master of Arts in Professional Counseling, and a Bachelor of Science in Biology. She is a licensed counselor in California, Florida, Georgia, and Louisiana. She is also a Certified Sex Therapist and Certified Addiction Professional. She has over 12 years of clinical experience specializing in sex therapy, transgender healthcare, relationships, and helping counselors build their private practice. She is president of Therapy Department, a private practice that provides counseling, training, speaking, and consulting services across the United States. For more information about Dr. Kristie’s work visit www.KristieOverstreet.com.