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SIGNS OF OPIOID DEPENDENCE - SUMMARY Behavioral Signs of Misuse More Predictive1: Selling prescription drugs Prescription forgery Injecting oral formulations Frequent self-initiated dose escalations Multiple "lost" or "stolen" prescriptions Concurrent dependence on other drugs (illicit) or alcohol Stealing or borrowing medications from another patient Obtaining prescriptions from nonmedical sources Less predictive1: Aggressive need for higher doses Requests for specific opioids Self-initiated dose escalations Unapproved use of a drug Psychic effects not intended by the prescriber Use of multiple pharmacies Drug hoarding when pain symptoms are reduced Obtaining multiple prescriptions from multiple physicians (doctor shopping) On the lookout: Warning indicators of a possible problem with drug use Needle marks/tracks or "skin popping" scars 2 Atrophied or perforated nasal septum2 Complaints of sexual dysfunction with no other cause found3 Sexually and needle transmitted diseases, including3:     - Endocarditis     - Hepatitis     - HIV/AIDS Appearance of these indicators serves to alert you to potential problems. They do not mean you should withhold appropriate care. Laboratory results that may suggest substance dependence: Elevated MCV2 Abnormal liver enzymes2 Positive urine tests for drugs2 (Physicians must specifically request tests for any synthetic opioids, as many standard screens will not detect them) Fact on Drug Misuse According to nationwide data from SAMHSA's 2004 National Survey on Drug Use and Health (NSDUH), an estimated 4.7 percent of the population misused prescription pain relievers in the past year. Prescription Drug misuse includes: Codeine, Darvocet, Demerol, Dilaudid, Heroin, Hydrocodone, LAAM, Lorcet, Lortab, Methadone, Morphine, MSContin, Norco, Opiates, OxyContin, Percocet, Percodan, Stadol, Vicodin, Zydone and others 1. Passik SD, Portenoy RK, Ricketts PL. Substance abuse issues in cancer patients. Oncology.1998;12:517-521. 2. American Society of Addiction Medicine. Red flags for alcohol and drug abuse. Available at www.asam.org/publ/CAGE.htm. Accessed January 29, 2002. 3.Weaver MF, Jarvis MAE, Schnoll SH. Role of the primary care physician in problems of substance abuse. Arch Intern Med. 1999;159:913-924. RETURN TO TOP UNDERSTANDING OPIOID DEPENDENCE Opioid dependence is a disease in which there are biological or physical, psychological, and social changes. Some of the physical changes include the need for increasing amounts of opioid to produce the same effect, symptoms of withdrawal, feelings of craving, and changes in sleep patterns. Psychological components of opioid dependence include a reliance on heroin or other drugs to help you cope with everyday problems or inability to feel good or celebrate without using heroin or opioids. The social components of opioid dependence include less frequent contact with important people in your life, and an inability to participate in important events due to drug use. In extreme cases, there may even be criminal and legal implications. The hallmarks of opioid dependence are the continued use of drugs despite their negative affect, the need for increasing amounts of opioids to have the same effect and the development of withdrawal symptoms upon cessation. There are a variety of factors than can contribute to the continued use of opioids. Among these are the use of heroin to escape from or cope with problems, the need to use increasing amounts of heroin to achieve the same effect, and the need for a "high." TREATMENT Treatment for opioid dependence is best considered a long-term process. Recovery from opioid dependence is not an easy or painless process, as it involves changes in drug use and lifestyle, such as adopting new coping skills. Recovery can involve hard work, commitment, discipline, and a willingness to examine the effects of opioid dependence on your life. At first, it isn't unusual to feel impatient, angry, or frustrated. The changes you need to make will depend on how opioid dependence has specifically affected your life. The following are some of the common areas of change to think about when developing your specific recovery plan: Physical - good nutrition, exercise, sleep and relaxation. Emotional - learning to cope with feelings, problems, stresses and negative thinking without relying on opioids. Social - developing relationships with sober people, learning to resist pressures from others to use or misuse substances, and developing healthy social and leisure interests to occupy your time and give you a sense of satisfaction and pleasure. Family - examining the impact opioid dependence has had on your family, encouraging them to get involved in your treatment, mending relationships with family members, and working hard to have mutually satisfying relationships with family members. Spiritual - learning to listen to your inner voice for support and strength, and using that voice to guide you in developing a renewed sense of purpose and meaning. During the treatment process, SUBOXONE* will help you avoid many or all of the physical symptoms of opioid withdrawal. These typically include craving, restlessness, poor sleep, irritability, yawning, muscle cramps, runny nose, tearing, goose-flesh, nausea, vomiting and diarrhea. Your doctor may prescribe other medications for you as necessary to help relieve these symptoms. You should be careful not to respond to these withdrawal symptoms by losing patience with the treatment process and thinking that the symptoms can only be corrected by using drugs. To help you deal with the symptoms of withdrawal, you should try to set small goals and work towards them. *SUBOXONEŽ (buprenorphine HCl/naloxone HCl dihydrate) sublingual tablet RETURN TO TOP Home Page | About Us | Signs of Dependence | F.A.Q. 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