Definition

Mental and behavioral disorders due to opioid use are mental health disorders that arise as a result of opioid abuse. Opioids are natural or synthetic chemicals (created in a laboratory to mimic the properties of natural opioids) that can interact with opioid receptors on nerve cells in the body and brain to reduce pain. The use of opioids is intended to treat acute pain (such as recovery from injury or post-surgery), chronic pain, active phase cancer treatment, palliative care, and end-of-life care. Apart from having an anti-pain effect, opioids also act as depressants on the central nervous system, so they have the potential to cause euphoria (a very strong feeling of happiness).

Opioid use disorder includes the desire to obtain and consume opioids despite social and professional consequences and is usually accompanied by increased opioid tolerance and a withdrawal syndrome when discontinued. This disorder is usually a chronic disease that frequently remits and recurs and is associated with significantly increased rates of morbidity and mortality.

Causes

Mental and behavioral disorders due to opioid use can stem from the misuse of prescribed opioid medications, the use of repurposed opioids, or the use of illegally obtained heroin. Opioids can be derived naturally from the poppy plant or synthesized in a laboratory. Commonly prescribed opioids for pain relief include Oxycodone, Hydrocodone, Codeine, Morphine, and others. Synthetic opioids, which are also frequently involved in misuse, include Fentanyl, Methadone, Pethidine, Tramadol, and Carfentanil. These substances, whether natural or synthetic, can lead to severe mental and behavioral health issues when misused.

The term opioid refers to natural and synthetic substances that act on one of the three main opioid receptor systems in the brain, namely Mu, Kappa, and Delta. Opioids can have analgesic (pain relieving) and central nervous system depressant effects and have the potential to cause euphoria. Apart from reducing the perception of pain, opioids can also cause drowsiness, confusion, nausea, and constipation. If taken in high doses, opioids can slow your breathing and heart rate, which can cause death.

When opioid drugs travel through the blood and attach to opioid receptors in brain cells, the cells release signals (endorphins) that dampen your perception of pain and increase strong but temporary feelings of pleasure. When the opioid dose wears off, you may find yourself wanting that good feeling back as soon as possible. This is the first stage in the addiction process.

Addiction is defined as an irresistible desire for a drug, uncontrolled and compulsive use of the drug, and continued use of the drug repeatedly despite harmful consequences. Repeated and continuous use of opioids will cause your body to slow down in producing endorphins so that the same dose of opioids no longer triggers the desired feeling of pleasure. This condition is called tolerance, which will encourage a person to increase the dose of opioids so that they can still feel the effects.

Everyone who uses opioids is at risk of becoming addicted. Your personal history and the length of time you have used opioids play a role, but it is difficult to predict who will be susceptible to eventual dependence and abuse of these drugs.

Risk factor

Certain factors that can cause someone to abuse opioids, causing mental and behavioral disorders, include:

• Using opioids in a different method than prescribed, such as crushing pills so they can be snorted or injected.
• Length of time using opioids. Taking opioid medications for more than a few days increases the risk of long-term use, which increases the risk of addiction.
• Previous history of substance/drug abuse.
• Family history of drug abuse and genetics.
• Have psychological problems, such as mental disorders, sensation-seeking behavior, history of severe depression or anxiety, and stressful conditions.
• Heavy tobacco use.
• Socioeconomic factors, such as young age, poverty, unemployment, history of criminal activity, or legal problems.
• Environmental factors, such as regular contact with high-risk people or a high-risk environment for drug abuse.

Symptoms

Mental and behavioral disorders resulting from opioid use must involve opioid use and recur within 12 months of two or more of the eleven symptoms. Symptoms that arise can include withdrawal syndrome with stopping opioid use, giving up important things in life in favor of opioid use, and excessive time on opioid use. Individuals also have significant impairment or suffering as a result of opioid use. Six or more symptoms in the criteria indicate a severe condition. 

The following are the symptom criteria for disorders caused by opioids:

• Continue use despite worsening physical or psychological health
• Persistent use that leads to social and interpersonal consequences
• Decreased social or recreational activities
• Difficulty fulfilling professional duties at school or work
• Excessive time to obtain opioids, or recover from their consumption
• Using more opioids than planned
• Having an excessive desire for opioids
• Cannot reduce the number of doses used
• The emergence of tolerance
• Using opioids in a physically dangerous environment
• Withdrawal syndrome occurs when you stop consuming opioids

Apart from that, sufferers with mental and behavioral disorders due to opioids can also find:

• Reduced perception of pain
• Looks restless and sleepy
• Slurred speech
• Problems with attention and memory
• The pupil (the black part in the middle of the eye) is narrowed
• Lack of awareness or attention to the people and objects around him
• Problems with coordinating body movements
• Depression
• Confusion
• Constipation
• Runny nose or mouth ulcers (if using the drug through the nose)
• There are needle marks (if the drug was used via a syringe)

Diagnosis

In diagnosing mental and behavioral disorders due to the use of opioids, the doctor will start by conducting an interview to ask about the symptoms experienced, asking for several histories, such as the history of use of certain substances/drugs, complete social history and previous mental health history. The doctor will also perform a physical examination, especially to determine withdrawal symptoms or opioid poisoning. Opioid withdrawal symptoms include:

• Stomach cramps
• Having a strong craving for opioids
• Restlessness, shaking, and goosebumps
• Diarrhea
• Pupil dilation
• Worry
• High blood pressure
• Sneezing and sweating
• Increased heart rate
• Watery eyes
• Muscle ache
• Have a cold
• Insomnia (difficulty sleeping)

Symptoms of opioid poisoning include:

• Confusion
• Pupil constriction
• Hypersomnia (sleeping a lot)
• Nauseous
• Euphoria
• Constipation
• Decreased pain perception.

If an opioid overdose is suspected, the doctor will check for pinpoint pupils, low body temperature, slowed heart rate, and decreased responsiveness or awareness. The doctor may also recommend several additional examinations, such as a urine test to determine the type of substance/drug consumed. Head CT scan or chest X-ray, especially in patients who experience decreased consciousness. If the patient has a history of drug abuse with needles, screening for HIV, hepatitis B, and C should be performed.

Management

The main goals in the management of mental and behavioral disorders due to opioid use are to stop opioid use, prevent future reuse, and overcome the withdrawal syndrome resulting from opioid withdrawal. Several drug options that are usually used to overcome the desire to consume opioids include Methadone, Buprenorphine, Naltrexone, and others. The doctor may also prescribe other medications to treat other symptoms of withdrawal syndrome, such as anti-nausea medications or stomach cramp relievers. In addition to medication, you may also be given additional therapy, such as behavioral therapy, which can help you learn how to manage depression. This therapy can also help you avoid opioids, overcome excessive cravings for opioids, and repair damaged relationships with people around you. Some behavioral therapies include individual counseling, group or family counseling, and cognitive therapy.

Complications

Some complications that can arise due to opioid abuse include

• Infection, due to non-sterile methods of use, such as using syringes
• Disorders of the digestive tract, such as constipation or flatulence
• Hyperalgesia, namely increased sensitivity to pain
• Fibrosis (formation of scar tissue) in the liver
• Brain disorders, such as Opioid Amnestic Syndrome
• Overdose and death

Prevention

The most effective way to avoid developing mental and behavioral disorders caused by opioid use is to refrain from abusing them. Opioids are considered safe only when used for a maximum of three days to treat acute pain, such as pain following surgery or a fracture. If you require opioids for acute pain, it is recommended that you discuss with a medical professional about utilizing the lowest possible dose for the shortest possible duration. If you suffer from chronic pain, opioids might not be the most suitable choice for long-term treatment that is both safe and effective.

When to see a doctor?

Consult your doctor if you have symptoms of mental and behavioral disorders due to opioid use, and if there are several conditions, such as:

• You cannot stop using certain medications
• You continue to use the drug even though it causes harm
• Drug use has led to dangerous and unsafe behavior
• You experience withdrawal symptoms after stopping use of the drug