What is Opiod dependence?
Opiod dependence refers to a clinical condition described as a
person's failure to cease from making use of opiods in spite of the
benefits of its discontinuance.
Opiod dependency was also defined by the World Health
Organization through its committee formed to study dependence on
the drugs, as a set of observable facts manifested in a person's
behavior, thinking and physical aspects that vary in intensity
wherein the consumption of the drug is the main concern. According
to the World Health Organization, the causative factors of
dependence to the drugs include the following:
The problems that may arise out of the dependence may be a
product of the interaction of these factors depending on the
severity of the effects of opiod dependence. This statement is
similar to the description of opiod dependence made by the
International Classification of Diseases, 10th edition (ICD-10). It
defined the condition as a group of phenomenon involving the three
ICD-10 further maintained that the basic character of this
syndrome focuses on the strong and at times, uncontrollable craving
for opiods regardless if it is prescribed or not. In their
work,Cellular and synaptic adaptations mediating opioid dependence,
Williams, Christie and Manzoni postulated that an opiod dependent
will experience a quicker recurrence of the withdrawal symptoms if
the former returns to opiods after abstaining from it in a
period of time compared to users who are not yet dependent on the
A person can only be diagnosed with dependence if he or she
exhibits at least three of the ICD-10 diagnostic criteria for
opioid dependence listed below:
1. An irresistible urge or compulsion to
2. Experiences trouble in having power
over one's behaviors in the use of opiods. The person is
ineffective in controlling the initiation, dosage, and termination
of drug use.
3. The person exhibits physical
withdrawal symptoms upon abstaining from the drugs:
a. Distinctive withdrawal symptoms.
• Abdominal cramps
• Dilated pupils
• Elevated respiratory
• Extreme Pain
• High blood pressure
• Increased pulse rate
• Muscle aches
• Myoclonic jerks
• Rhinitis/ Sneezing
Rare and serious symptoms:
• Cardiac arrhythmias
• Suicide attempts
The patient may exhibit withdrawal symptoms as short as 48
hours or as extensive as 60 days depending on the following
• Type of opiates. Oxycodone and hydromorphone are
short-acting opiods and may cause short withdrawal period.
Methadone and buprenorphine are long- acting opiates that may
produce extended period of withdrawal.
• Length of opioid use
b. The person uses opiods or similar
substances to relieve or avoid the symptoms of withdrawal.
4. Tolerance. The person increases the
dose of the drugs in order to attain the euphoric and pleasant
effects it previously provided in reduced dosage.
5. Remarkable disregard of leisure
activities or pastime formerly enjoyed due to preoccupation in the
use of opiods.
6. The largest part of time is spent in
getting the narcotics or convalescing from it.
7. Continued use of opiods in spite of
its unfavorable effects on the person's life. In most cases the
person is aware of its perilous effects but refuses to let go of
8. The set of patterns in a person's
daily activities is narrowed down to one thing-that is opiate
consumption. This is the classic sign of opiod dependence.
These symptoms must be experienced within the preceding year. It
is noteworthy to consider the fact that a person cannot develop
drug dependence without using the drugs for a regular period of
time. However, dependence is not induced by repetitive use alone.
There are still other factors that must be considered in the
diagnosis of opiod dependence.
Factors to consider in making the diagnosis:
1. History. The patient provides the
information but this should be corroborated with other factors
since the person may play down or play up the symptoms. The
narrative of the patient's significant others should also be taken
2. Physical examination.
a) Injection sites. It will provide
helpful information regarding the frequency and duration of drug
b) Urine drug test. It provides proof
that illicit drugs are taken in the past few days.
c) Physical signs.
Characteristic signs of opioid intoxication:
- Constricted pupils
- Drooping eyelids
- Head nodding
- Reduced respiratory rate
What Causes Opiod dependence?
Recent study entitled, "An examination of psychiatric
comorbidities as a function of gender and substance type within an
inpatient substance use treatment program"has made a claim that the
following factors cause opiod dependence:
• Psychiatric comorbidity.
Before a patient develops dependence to opiods the former already
suffers from at least one personality disorder or depressive
• Opiods are
antidepressants, antipsychotics and anxiolytic drugs. Because of
these properties, self-medication often results to dependence.
• Dysregulation of the
opioid receptor mechanism. In 2009, a study entitledVentral
Tegmental Area BDNF Induces an Opiate-Dependent-Like Reward State
in Naive Ratsshowed the possibility of permanent impairment of
regulatory mechanism of the opiod receptors in the brain once they
are exposed to opiates for a long period of time. This results to
inappropriate or weak response of the receptors thereby causing the
Christie MJ, m. W. (2001). Cellular and synaptic adaptations
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Organization, W. H. (2004). Substitution maintenance therapy in
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