Opioid dependency

Opioid dependency is a medical diagnosis characterized by an individual's inability to stop using opioids even when objectively in his or her best interest to do so.

Causes
Some feel that this is a physical and psychological condition that develops from the long term use, or more often abuse, of naturally occurring opiates such as morphine or codeine or synthetically derived opiates (opioids) such as Demerol or oxycodone. Others feel that the disease state is a failure to relate to other individuals and that the opioid use itself, while critical for the diagnosis, is only the first target of treatment. Treatment approaches include abstinence-based and harm-reduction methodologies. Both include participation in detoxification through the use of methadone or other long-acting opioids. Alternative detox protocols call for total abstention from all opiates, with the use of various benzodiazepines and other medications to reduce the uncomfortable withdrawal symptoms associated with abstinence. In an abstinence-based approach, a gradual taper of the medications follows detox, while in the harm-reduction approach, the patient remains on an ongoing dose of methadone or buprenorphine.

Symptoms of withdrawal
Symptoms of withdrawal from opiates include, but are not limited to, depression, leg cramps, abdominal cramps, vomiting, diarrhea, insomnia, and cravings for the drug itself. Detoxification is best conducted in an in patient facility that provides a controlled environment. Patients who are isolated and exposed solely to care givers and other patients in this environment have a better rate of staying clean then those who detox out-patient.

Additional withdrawal symptoms include, but are not limited to, rhinitis (irritation and inflammation of the nose), lacrimation (tearing), severe fatigue, lack of motivation, moderate to severe and crushing depression, feelings of panic, sensations in the legs (and occasionally arms) causing kicking movements which disrupt sleep, increased heartrate and blood pressure, chills, gooseflesh, headaches, anorexia (lack of appetite), mild or moderate tremors, and other adrenergic symptoms, severe aches and pains in muscles and perceivably bones, and weight loss in severe withdrawal.

Depending on the quantity, type, frequency, and duration of opioid use, the physical withdrawal symptoms last for as little as 5 days and as much as 14 days. The user, upon returning to the environment they usually used opiates, can experience environmentally implied physical withdrawal symptoms well-after regaining physical homeostasis - or the termination of the physical withdrawal phase by synthesis of endogenous opioids (endorphins) and upregulation of opioid receptors to the effects of normal levels of endogenous opioids. These implied symptoms are often just as distressing and painful as the initial withdrawal phase.

Prognosis
It can take up to two months for the brain's opioid receptors to return to their normal efficacy to endogenous opioids, meaning depression and anxiety can linger for this time period. Opioid use usually leaves no permanent damage to the brain or the opioid receptors.