The definition of opioid abuse and dependence is given in the Fourth Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association as repeated use of a drug of opioid class to the point of causing multiple problems. The definition also requires evidence of three or more in a year, including tolerance, withdrawal, and quantity of use more than required despite consequences. This is dependence of opioid. Abuse can be defined as not having dependence but demonstrate repeated opioid related problems with law, inability to meet obligation and use of opioid despite problems.
The use of opioid for intoxication is about 10% in high school seniors in the. Male female ratio is almost same.
There is some role of genetics in the development opioid abuse and dependency. In a study involving more than 3000 male twins proved that genetics is involved to some extent. This includes overall vulnerability towards substance abuse and problems.
Three groups of people are more prone to develop opioid abuse, though anyone can develop it. The first group is persons with chronic pain like back pain, joint pain and muscular pain. They misuse their prescribed drugs. If physical dependence develop any drop in opioid level in blood causes severe pain and patient take more opioid and the cycle continues .That is why, doctor should advice the patient that moderate treatment with acceptable pain is the best approach to treatment instead of absence of pain with high dose of opioids, that lead to dependency. Behavior modification techniques like muscle relaxation and meditation should be used when appropriate to help reduce pain and improve function, along with carefully selected exercises.
The second group at high risk is doctors, nurses, pharmacists and other health care professionals, due to easy accessibility. Doctors may start use of opioids to help with sleep or reduce stress or pain and escalate to tolerance and physical dependence. That is why all doctors are advised not to prescribe opioids for themselves and family members.
The third groups of people are those who buy street drugs to get high. Some of them have prior history of some social problems. The typical person begins with occasional opioid use after trying tobacco, marijuana and other substance. This occasional became regular and development of dependency.
Opioid dependent persons are likely to continue their experiments with other drugs. Alcohol, cocaine are some of them. Cocaine is sometimes administered along with opiods intravenously called ‘speed balls’. This is a deadly combination.
Opioid user’s mortality is very high compare to general population. Mortality is mainly from suicide, homicide, accident, infection like tuberculosis, hepatitis or AIDS. Mortality from those diseases is about 15 times higher in drug abusers. But good news is that, even without any treatment 35 to 40 % of the drug abusers will permanently abstain from using drug after the age of 40 years. As with drug users a favorable prognosis is associated with prior history of marital and employment stability and fewer criminal records. Help from family and friends go a long way to care and reduce substance abuse in susceptible population.