Opioid Use Disorder

What is Opioid Use Disorder?

Opioid Use Disorder (OUD) is a mental health condition in which the individual has a pattern of opioid misuse, which causes emotional distress, physical consequences and/or begins to impair ones social, academic, and/or work life. Opioid Use Disorder is a chronic condition, that can significantly impact one’s wellbeing, and cause severe strain on one’s relationships.

Individuals who suffer from Opioid Use Disorder (OUD) have difficulty controlling their use of opioids, even when it begins to cause significant consequences in their life. The condition frequently becomes a main focus of one’s attention, and a great deal of time is spent seeking out, using, and recovering from, opiate and opioid use.

Because of the highly addictive nature of opioids, individuals who regularly use these substances often report, that shortly into their Opioid Use Disorder, the fear of withdrawal (as opposed to the euphoric effect of the substances) becomes the primary motivating factor for continued use.

Individuals with Opioid Use Disorders frequently suffer from co-occurring psychiatric illness(es) and treating both the Opioid Use Disorder, and the co-occurring Anxiety, Depression, Bipolar Disorder or other psychiatric illness, is often necessary for one’s successful recovery from this addiction.

Opioid Use Disorder is Characterized by (must have 2 of 3, in the last 12-month period to meet Criteria for this diagnosis):

• Physical Dependence: Tolerance to the substance (needing more over time for the same effect) and/or withdrawal if one stops using the substance.
• A loss of control: Taking greater quantities than planned, or using longer than planned. An inability to quit or cut back. Devoting a great deal of time getting, using, or recovering from opioids.
• Continued Use Despite Consequences: Consequences could be at home, school, work, or in relationships. They can be mental or physical consequences. Individuals may use opioids in situations that are dangerous.

How Common is Opioid Use Disorder?

Approximately 5-20% of individuals who take Opioid prescription pain medications develop Opioid Use Disorder. It is unfortunately not uncommon for individuals who develop an addiction to prescribed opioids, to turn to the street for similar substances (such as heroin or fentanyl), once their prescriptions run out, or when their tolerance increases to a level beyond what they are prescribed, for a similar effect. Almost half of individuals who abuse heroin or fentanyl, began using opioids with a legal prescription.

Why Should I be Concerned About Opioid Use Disorder?

• Opioids are responsible for approximately 100,000 deaths in the US each year (per 2023 CDC data).
• Opioid Use Disorder affects individuals of all races, cultures, socioeconomic backgrounds, genders and orientations. The opioid crisis is a national epidemic.
• Illicit Substances and counterfeit pills are increasingly being laced with fentanyl – a highly lethal opioid.

What are Opiates vs. Opioids?

The term opioid refers to a class of controlled medications and illicit substances, that when taken activate the opioid receptors in the human body, and can have the effect of decreasing pain, or producing a euphoric feeling. These medications, known as narcotics, are commonly prescribed after surgery or acute injuries, or to manage chronic pain caused by cancer, or pain in the terminally ill. Opiates refer to naturally occurring substances that fall within the opioid class (such as morphine and codeine), and the term opioid refers to both naturally occurring opiates, and substances that are made in a lab (such as fentanyl, methadone and oxycodone), that fall within this class.

Both naturally occurring (opiates) and synthetic (lab made) opioids have high risks of abuse, dependence and/or overdose (which can cause death), when taken to excess, taken recreationally, taken with medications that are sedating or cause cardio-respiratory suppression, or are taken by mistake (which is unfortunately not uncommon with fentanyl being added to many illicit drugs and counterfeit pills purchased both online and on the street in the US.

When Should I reach out for Help with my Opiate or Opioid Use?

For individuals prescribed opiates by their physician or other medical provider, for an indicated medical condition:

• If you exhibit any of the symptoms discussed above (criteria for an Opioid Use Disorder), it is vital that you discuss your concerns with your prescriber. You may also benefit from an evaluation with an Addiction Specialist, who can collaborate with your medical prescriber regarding next steps.
• If you take any opiates that are prescribed, in a way that is not consistent with the directions from your provider, or if you take additional opiates from elsewhere, then it’s incredibly important that you get help now.

For all other individuals:

• Anyone who takes opioids recreationally, opioids off the street, or abuses prescription opioids is advised to urgently seek an evaluation and treatment from an Addiction Specialist who is experienced in the treatment of Opioid Use Disorders. With high rates of overdose and death from fentanyl, counterfeit pills, heroin and other opioids, it is not worth waiting until you feel that you meet certain criteria. Get help now.

Who is at Risk of Developing an Opioid Use Disorder?

Psychiatric providers will ask about your family history, as there is a genetic component to Substance Use Disorders, including Opioid Use Disorder. This does not mean that everyone with a relative (even immediate) that has an opioid problem will develop one, nor does it mean that if you do not have a family history, you are immune. It simply means that if individuals in your family have a history of a Substance Use Disorder, then you are at a higher risk, than the general population of developing one yourself.

Having co-occurring mental health conditions (such as anxiety, depression, bipolar disorder or ADHD) may put you at a higher risk for developing Opioid Use Disorder. You have likely heard the expression that addiction is a symptom of a disease. While we now consider Substance Use Disorders to be a disease themselves, it only makes sense that if someone is additionally suffering from the symptoms of another mental health disorder (particularly if it is untreated), it will only make it more difficult for that person to control their addiction.

Additional Risk Factors include:

• Significant Access to Opioids
• A current or past Substance Use Disorder
• A history of abuse during childhood, or other Adverse Childhood Experiences.
• A diagnosis of a conduct disorder as a child or adolescent

What are the Risks of Abusing Opioids?

Opioid Abuse and Opioid Use Disorder carry substantial risks, and these conditions require treatment. Opioid Use Disorder carries a high risk of overdose and death, and therefore anyone struggling with this condition, or anyone who uses non-prescribed opioids, should have a consultation with an addiction specialist or other mental health professional as soon as possible.

What are the Symptoms of Opioid Withdrawal Syndrome?

The symptoms of Opioid Withdrawal include, but are not limited to:

• Gastrointestinal Distress, typically abdominal pain and diarrhea
• Chills, Sweats and Fevers
• Dilated Pupils
• Insomnia
• Increased Anxiety
• Restlessness and Agitation
• Nausea and Vomiting
• Unstable Vital Signs (such as elevated heart rate and blood pressure)
• Pain (particularly if an individual has an underlying medical condition causing pain)
• Intense Cravings for Opioids

What Types of Treatment are Available for Opioid Use Disorders?

Treatment for Opioid Use Disorder should be tailored to the individual. There is no one-size-fits-all treatment in psychiatry. Your treatment may include:

• Inpatient or Outpatient Detoxification using Medication Assisted Treatment (MAT) such as Buprenorphine.
• Medication Management of withdrawal symptoms and cravings.
• Maintenance Medication Assisted Treatment (MAT) such as Suboxone (Buprenorphine), Methadone or Vivitrol (Naltrexone).
• Referral to 12-step or similar programs such as Narcotics Anonymous or group meetings for your opioid use disorder.
• Psychotherapy with licensed therapists and psychologists.
• Evaluations, Medication Management and Psychotherapy for co-occurring mental health disorders and difficulties (such as anxiety, depression, bipolar disorder or ADHD).
• Behavioral modification: Recommendations regarding sleep hygiene, exercise, diet, social outlets and others, may be part of a patient’s treatment.

Do You Offer Both In-office and Virtual Online Psychiatric Appointments for Opioid Use Disorder Treatment?

Yes, we offer both in-office and virtual online psychiatric appointments for the treatment of Opiate Use and Opioid Use Disorders. *Of note, some providers require in-office visits, and some states require in-office visits as well. Call to discuss your unique situation and needs.

Why Choose Rittenhouse Psychiatric Associates for my Opioid Use Disorder Treatment?

The providers at Rittenhouse Psychiatric Associates are academically oriented providers, most of whom teach, or have taught, at academic institutions. Our providers are Board Certified Psychiatrists and Psychiatric Nurse Practitioners and we have several licensed and doctoral level therapists and psychologists. We are experienced in working with individuals who struggle with various psychiatric conditions, including Substance Use Disorders such as Opioid Use Disorder.

• Fellowship Trained and Board Certified Addiction Specialist, Samantha Wyckoff, MD – recently named the Director of our Addiction Services.
• Additional Board Certified and Licensed Psychiatrists, Nurse Practitioners and Psychologists with training specifically in Opioid Use Disorders & Addiction Treatment
• Academically Oriented providers, most of whom teach, or have taught, at local Academic Institutions, such as Johns Hopkins Hospital & The University of Pennsylvania.
• Appointments generally available within 2 weeks.
• In-office and online Virtual Appointments for the treatment of Opioid Use Disorder.
• Providers experienced in treating co-occurring psychiatric conditions.
• Providers who are welcoming to all individuals.