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Treatment of Opioid Dependence | Causes of Opioid Dependence

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:

1.     Biological

2.     Psychological

3.     Social

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 processes:

1.     Physical

2.     Behavior

3.     Cognition


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 drugs. 


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 use opiods


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.


Physical signs:


• Abdominal cramps

• Akathisia

• Chills

• Cramps

• Delirium

• Diarrhea

• Dilated pupils

• Elevated respiratory

• Extreme Pain

• Headache

• High blood pressure

• Increased pulse rate

• Itch

• Muscle aches

• Myoclonic jerks

• Perspiration

• Piloerection

• Priapism

• Restlessness

• Rhinitis/ Sneezing

• Seizures

• Tachycardia

• Tremors

• Vomiting

• Weakness

• Yawning


Psychological signs:


• Anxiety

• Cravings

• Depression

• Dizziness

• Dysphoria

• Insomnia

• Malaise

• Nausea

• Paranoia


Rare and serious symptoms:


• Cardiac arrhythmias

• Dehydration

• Seizures

• Strokes

• Suicide attempts

 The patient may exhibit withdrawal symptoms as short as 48 hours or as extensive as 60 days depending on the following factors:

•  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.

• Frequency

• Length of opioid use

• Quantity


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 the drugs.

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 into consideration.


2.     Physical examination.


a)     Injection sites. It will provide helpful information regarding the frequency and duration of drug injection.


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
  • Itching
  • Reduced respiratory rate
  • Sedation


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 disorders.

•       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 dependence.


Works Cited

Christie MJ, m. W. (2001). Cellular and synaptic adaptations mediating opioid dependence. 81(1):299-343.

Opioid dependence.(n.d.). Retrieved September 29, 2011, from

Organization, W. H. (2004). Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention. .


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