All opiate drugs come from opium, which is extracted from the poppy plant, or they are synthetic copies of substances in the poppy plant. Oxycodone, like all opiate drugs, is an opiate agonist that readily attaches to the neurons in the brain that are specialized to be involved in the natural suppression of pain, stress, exertion, etc. These drugs have extremely high potential for abuse and the development of physical dependence.
The DEA classifies narcotic medications like OxyContin as Schedule II controlled substances. These substances are highly regulated and can only be legally obtained with a prescription from a physician. In addition, due to numerous issues with the abuse of narcotic medications, the federal government has started monitoring their distribution much more tightly than it monitors the distribution of some other Schedule II substances. Despite the extra attention paid to this class of drugs, opiate drug abuse still remains a major concern among law enforcement agencies, politicians, medical personnel, and citizens.
Opiate Use Disorder
A substance use disorder represents a severe form of a mental health disorder that occurs when an individual experiences issues associated with their use of alcohol, some type of drug, medicine, or illicit substance. The term substance use disorder is now the preferred clinical term for what was previously referred to as either substance abuse or substance dependence (addiction). This is because research in the area of addictive behaviors indicates that there is no finite line between earlier designations of abuse and dependence, and these occur on a continuum. Individuals who develop a substance use disorder as a result of abusing narcotic drugs like OxyContin would be formally classified with an opiate use disorder, specifying that their substance use disorder is centered on the abuse of opiate drugs.
According to the medical textbook Substance Use Disorders, an opiate use disorder involves a number of behavioral symptoms that are used by clinicians in the diagnosis of the condition. These include:
- Recurrent nonmedicinal use of opiate substances
- Continued use of opiate drugs despite experiencing significant distress or functional impairment as a result of their use
- A number of behaviors that indicate that the individual has lost control of their ability to use opiate medications
- A number of behaviors that suggest that the individual’s nonmedicinal use of opiate drugs has become dysfunctional
- The development of tolerance to opiate medications
- The development of withdrawal symptoms that occur when one either stops using the drug abruptly or significantly cuts down on the amount they use
Treatment for Opiate Addiction
Individuals who develop opioid use disorders have very severe mental health conditions that require professional intervention. Because there is a very strong potential that individuals who abuse these substances on a regular basis over a period of several weeks or more have developed physical dependence on them, it is extremely important that individuals who enter recovery programs for opiate abuse are thoroughly evaluated. The evaluation should consist of a full physical, psychological, and emotional evaluation, assessment of one’s social and living situation, and a full cognitive evaluation to determine the individual’s ability to become engaged in aspects of treatment. These evaluations will help the individual’s treatment providers to design a targeted plan that will specifically address their strengths and weaknesses and also treat any co-occurring mental health disorders or medical conditions.
While any effective recovery program will be personalized to fit the specific needs of the individual, recovery programs also follow a general blueprint. According to Concepts of Chemical Dependency and The Science of Addiction: From Neurobiology to Treatment, this blueprint consists of:
Initially addressing physical dependence
Initial enrollment in medical detox is required for opiate addiction. For withdrawal from OxyContin abuse, the medical detox program will most likely include the administration of an opiate replacement medication. Buprenorphine is a partial opioid agonist, meaning it attaches to the same neurons in the brain that other opioid drugs like oxycodone do, but its effects are not as significant. This means that the individual will not experience significant withdrawal symptoms and will not crave narcotic drugs, but will not achieve the same euphoric effects they got from OxyContin.
Once the physician has ascertained an initial starting dose where the recovering individual does not experience significant withdrawal symptoms, the physician will slowly taper down the dose of the medication at periodic intervals to help the individual wean off opiate drugs altogether. The process is lengthier than stopping use of opiates suddenly; however, the individual’s withdrawal symptoms can be managed so they remain comfortable and able to engage in other aspects of recovery.
Other medications may be used as needed to address specific symptoms or co-occurring conditions. Withdrawal management programs are ideally suited to be delivered on an inpatient basis; however, in very specific instances, they may be initiated for individuals on an outpatient basis.
While medications can certainly be useful in recovery, there are no medications that can treat a substance use disorder. The major component of any recovery program is addiction therapy. The type of therapy that is often considered to be best suited for the treatment of substance use disorders is Cognitive Behavioral Therapy (CBT). CBT allows the therapist and client to work together to identify the reasons for using substances and how the client’s beliefs and expectations interact with their substance abuse and other behaviors. They then develop a plan to help the client address these issues and change them in a way that promotes positive recovery. In addition, CBT helps individuals develop long-term relapse prevention programs and other issues that may be co-occurring, such as anxiety, depression, personality issues, etc.
Substance use disorder therapy can be delivered in individual sessions, group sessions, or in a combination of individual and group sessions.
Treatment for co-occurring conditions
Individuals diagnosed with any form of addiction are often also diagnosed with other mental health disorders, such as anxiety, major depressive disorder, bipolar disorder, etc. Research into treatment for substance use disorders has indicated that is imperative that co-occurring psychological disorders be treated along with the substance abuse issue. Trying to treat only one condition is counterproductive and will not result in significant recovery. Co-occurring disorders need to be treated concurrently.
Another vital component of recovery is support from family, friends, and others. One of the best ways to foster this support is to get family involved in the individual’s recovery. Another important aspect of recovery is participation in support groups, such as 12-Step groups or other peer support groups (e.g., Narcotics Anonymous). Support group attendance is often a way for recovering individuals to continue to engage in recovery-focused activities as part of a long-term aftercare program, as these groups are ongoing whereas formal therapy will eventually be terminated or significantly lessened in frequently. Support groups are not formal therapy groups because they do not use trained therapists; however, some types of support groups like SMART Recovery are founded on CBT principles.
Part of the personalization aspect of recovery programs is to include specific types of interventions that are needed in the specific case. These can range from tutoring for individuals in school, vocational rehabilitation, and speech therapy to getting individuals involved in volunteer services or in complementary and alternative forms of treatment, such as animal-assisted therapy or music therapy.
It’s important to ensure that individuals have other needed supports to foster a successful recovery, such as transportation to therapy sessions, financial assistance, placement services, etc.
A key factor in recovery is that individuals maintain their participation in the recovery program for a significant length of time. Research indicates that individuals who maintain participation in recovery programs for 5-7 years after they had been abstinent have higher rates of long-term or lifelong success. This is why resources like social support groups can be extremely useful for ongoing recovery.