Opioid dependence: What you need to know

What are opioids?

Opioids, also known as narcotics, are chemicals that work in the brain and are often prescribed as powerful pain relievers. Opioids also affect emotions and can produce the experience of euphoria, or the feeling of being “high.” Some opioids such as heroin are illicit, or illegal. Prescription opioids are controlled or scheduled substances, which means that the government regulates their use.1

There are many different kinds of opioids available for prescription. Doctors often prescribe opioids to help treat pain from dental procedures, injuries (including specific work-related injuries), surgeries, or conditions such as cancer. When used correctly, prescription opioids are generally safe, but when they are used without a doctor’s prescription or in ways other than what the doctor prescribed, they can be very dangerous.1

What are common prescription opioids?2

Name Brand Names As of 1/21/15 according to the United States Patent and Trademark Office
Hydrocodone bitartrate Vicodin®, Lortab®, Lorcet®, Zohydro ER
Hydromorphone Dilaudid®
Oxycodone HCl OxyContin®, Percodan®, Percocet®
Codeine Fiorinal® with codeine, Robitussin A-C®, Tylenol® with codeine (Tylenol #3)
Propoxyphene* Darvon®, Darvocet®
Morphine Duramorph®, MS Contin®, Avinza®
Oxymorphone Opana®
Meperidine Demerol®
Fentanyl Actiq®, Duragesic®


This is not a comprehensive list.
*Withdrawn from US market November 2010.
All brand names cited above are the property of their respective owners.
Vicodin is a registered trademark of AbbVie Inc.
Lortab is a registered trademark of UCB Inc.
Lorcet is a registered trademark of Libertas Pharma Inc.
Zohydro ER is a trademark of Zogenix, Inc.
Dilaudid, OxyContin, and MS Contin are registered trademarks of Purdue Pharma L.P.
Tylox is a registered trademark of Janssen Pharmaceuticals Inc.
Percodan, Percocet, and Opana are registered trademarks of Endo Pharmaceuticals Inc.
Fiorinal is a registered trademark of Actavis, Inc.
Robitussin is a registered trademark of Wyeth LLC
Avinza is a registered trademark of KING PHARMACEUTICALS RESEARCH & DEVELOPMENT, INC.
Tylenol Codeine 3 is a registered trademark of TYLENOL COMPANY,
Darvon is a registered trademark of Xanodine Pharmaceuticals Inc.
Darvocet is a registered trademark of AAIPHARMA LLC CORPORATION.
Duramorph is a registered trademark of HIKMA (MAPLE) LIMITED CORPORATION
Demerol is a registered trademark of SANOFI-AVENTIS U.S. LLC.
Actiq is a registered trademark of ANESTA, LLC.
Duragesic is a registered trademark of Johnson and Johnson Corporation.

 


How are opioids misused?

Opioids are misused when they are taken more often or in higher quantities than prescribed, or when they are used recreationally, or nonmedically. Opioids, which are usually pills, may also be crushed into powder to snort or injected with a needle. Snorting or injecting opioids causes them to enter the bloodstream and brain very quickly. Taking opioids in this way is very dangerous and increases the risk of both dependence and overdose.3,4

People who take opioids recreationally without a valid prescription may get or take opioids from a friend or family member. Others may buy them illegally from a mail-order company or on the street. Dependence can make people do things they wouldn’t ordinarily do to acquire opioids.3,4

What is opioid dependence?

Opioid dependence is a chronic disorder like diabetes or high blood pressure, and can develop as a result of either legitimate use or misuse of opioids. Frequent opioid use physically changes the brain, so that the brain starts to think that it needs opioids to function normally. That is why people with opioid dependence experience cravings and symptoms of withdrawal when the effects of opioids begin to wear off.5

Similar to other chronic disorders4:

  • There is no known cure for opioid dependence
  • Some people are more likely to develop opioid dependence than others
  • Relapse is common and may be successfully addressed with the right treatment plan, which may include a combination of support and/or counseling and medication
  • You can still live a healthy, productive life with the right treatment plan

Who becomes opioid dependent?

Anyone can be dependent on opioids; it doesn’t mean you are a bad person or lack willpower. People become dependent on opioids in many different ways. Some people first begin misusing opioids after a doctor prescribed them for pain following a surgical procedure or accident. Other people misuse opioids recreationally, which means they take them just because they like the way they make them feel.4,5

The fact is, millions of people in the United States are considered to have opioid dependence.6 But certain people are at higher risk7:

  • Males
  • People who suffer from depression or anxiety
  • Those with a personal or family history of alcoholism or drug abuse
  • People under age 30: almost one-third of the people in the United States who are dependent on opioids are between the ages of 18 and 256
  • People who are prescribed or misuse opioids for long periods of time
  • ZUBSOLV contains an opioid that can cause physical dependence. Do not stop taking ZUBSOLV without talking to your doctor. You could become sick with uncomfortable withdrawal signs and symptoms because your body has become used to this medicine.
  • Physical dependence is not the same as drug addiction.
  • ZUBSOLV is not for occasional or “as needed” use.

How can you tell if you or someone you know has opioid dependence?

Opioid dependence can be characterized by the 4 Cs8:

CRAVINGS

or an intense desire to keep taking the opioid

COMPULSIVE
USE

of opioids

CONTINUED

use of opioids, despite the consequences

LOSS OF CONTROL

over opioid use


Many people with opioid dependence will go to great lengths to try and hide it. However, the following behaviors and emotions may be signs of opioid dependence9:

  • Mood swings, depression, anger, irritability
  • Marital or relationship problems
  • Social isolation, loss of friendships
  • Missing school or work
  • Poor performance at school or work
  • Financial problems, such as recent debt

symptoms-diagram

 


Only a doctor can accurately diagnose opioid dependence. If you think you or someone you know has a problem with opioids, you should talk to a doctor.

Opioid dependence is more common than you think

Opioid dependence by the numbers

15 MILLION

Over 15 million people around the world are opioid dependent11

5.1 MILLION

In the U.S., 5.1 million people misuse opioids, leaving them at risk for dependency6

2 MILLION

Currently, about 2 million people in the U.S. are opioid dependent6

Taking opioids more often or in higher quantities than prescribed, or using opioids for nonmedical recreational purposes.

The effects of opioid dependence4,12-16


Socially

  • Opioid dependence can have a negative impact on families and whole communities
  • Leads to more crime and the spread of disease

 

 

 

 

Personally

  • Opioid dependence can severely strain personal relationships with friends or family and with people at school or at work
  • May lead friends, family, coworkers, or classmates to recommend treatment

 

 

 

 

 

 

On well-being

  • Nearly half a million emergency room visits were due to dependence on opioids in 2011, a 154% increase from 2004
  • US deaths from prescription opioid overdose now exceed those from cocaine and heroin combined
  • People with opioid dependence may also share needles or make bad decisions about who they have sex with. Because of this, they are more likely to acquire HIV, hepatitis, or sexually transmitted diseases

Financially

  • The cost of opioid dependence is enormous
    • $56 billion per year in total US costs
    • Healthcare costs account for $25 billion
    • Average healthcare cost per person is 8 times higher compared to people who do not have opioid dependence
  • Each time a person relapses, incremental costs accrue

 


Relapse is common and not a failure

Relapse is a part of this chronic disorder, just like symptom breakthrough is with other chronic conditions. Relapse happens when someone with opioid dependence who had stopped taking opioids begins taking opioids again.5

Long-term use of opioids causes physical changes in the brain that make people with opioid dependence feel like they need opioids in order to function properly. Because of this, people are at risk of having cravings or encountering triggers that can lead to relapse even if it has been a long time since they stopped taking opioids.5

A lot of things can trigger cravings which, if acted upon, can lead to a relapse5:

  • Stress at work or home
  • Relationship problems
  • Emotional pain or difficult situations
  • Pain from an injury or medical procedure
  • Certain people from your past

When people relapse, they sometimes feel they have failed. But that isn’t always the case. Everyone has different needs, and a relapse can simply mean that a person isn’t getting the support and/or counseling he or she needs or that they may need to try a different medication. Sometimes finding the right combination of support and/or counseling and medication can make the difference needed for a successful recovery.5

The good news: opioid dependence can be treated4,17


The importance of a comprehensive treatment plan

Opioid dependence is a chronic condition in need of long-term management, but there is no single treatment that is right for everyone. Before treatment begins, or following a relapse, people with opioid dependence should work with their doctors, counselors, and any others involved with their treatment to develop a plan based on their individual treatment goals. An effective treatment plan should include support and/or counseling that is designed to meet that person’s specific needs and may also include medication.18

How medications for opioid dependence are used

  • Maintenance treatment: A form of treatment that involves a sustained treatment period, during which medication is taken every day

Support and counseling

In addition to their doctor, some people lean on their friends and family during their recovery process while others prefer the confidentiality of a therapist or counselor. Some like to share their experiences while others seek help privately. Either way, counseling and support should be a key part of any treatment plan.

There are a number of different kinds of support and counseling available for the treatment of opioid dependence. These include behavioral therapy, group therapy, self-help groups, and personalized support programs. Personalized support programs allow people with opioid dependence to customize their experience to meet their specific needs and goals.

Maintenance medications

Maintenance medications, when taken every day, can help reduce cravings, without making the person feel “high.” These help give people a chance to change their habits and to avoid relapse.

  • During treatment with maintenance medication, people take a dose of medication each day. Depending on the person and his or her goals for treatment, this step can last for weeks, months, or even years before tapering off is considered
  • ZUBSOLV is a controlled substance (CIII) because it contains buprenorphine, which can be a target for people who abuse prescription medicines or street drugs. Keep your ZUBSOLV in a safe place to protect it from theft. Never give your ZUBSOLV to anyone else; it can cause death or harm them. Selling or giving away this medicine is against the law.

The benefits of maintenance medication

Maintenance medications can help reduce cravings without making the person feel “high.” This helps free a person from thinking about opioids all the time. Because opioid dependence is a chronic disorder, it is never really cured. The maintenance step is about managing the disorder so that the person is able to regain control of his or her life.

Maintenance medication, in combination with support and/or counseling, is critical to preventing relapse. Unfortunately, many people are not able to stick with their treatment plan like they should.

Current treatments for opioid dependence offer options

Everyone is different…so why should treatment plans be the same?

Choice of medication

Medications are available that offer advantages in:

  • Taste
  • Dissolve time
  • Size
  • Delivery
  • Cost

ZUBSOLV® (buprenorphine and naloxone) sublingual tablet (CIII) is a prescription medicine used to treat adults who are addicted to opioid drugs (either prescription or illegal) as part of a complete treatment program that also includes counseling and behavioral therapy.

Personalized Support and Counseling

Some people lean on their friends and family during their recovery process while others prefer the confidentiality of a therapist or counselor. Some like to share their experiences while others seek help privately.

Personalized support programs allow people with opioid dependence to customize their experience to meet their specific needs and goals.

  • ZUBSOLV is a prescription medicine used to treat adults who are addicted to opioid drugs (either prescription or illegal); as part of a complete treatment program that also includes counseling and behavioral therapy.
References
  1. American Academy of Family Physicians (AAFP). Opioid addiction: overview. http://familydoctor.org/familydoctor/en/diseases-conditions/opioid-addiction.html. Accessed August 08, 2013.
  2. National Institute on Drug Abuse. Commonly abused prescription drugs chart. Revised October 2011. http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/commonly-abused-drugs-chart. Accessed Aug 08, 2013.
  3. National Institute on Drug Abuse. Research Report Series: Prescription drugs: abuse and addiction. NIH Publication No. 11-4881. US Department of Health and Human Services; 2001. Revised October 2011.
  4. US Department of Health and Human Services. Medication-assisted treatment for opioid addiction facts for families and friends. 2009; HHS Publication No. (SMA) 09-4443.
  5. National Institute on Drug Abuse. Principles of drug addiction treatment: a research-based guide, 3rd edition. NIH Publication No. 12-4180. http://www.drugabuse.gov/sites/default/files/podat_1.pdf. Accessed May 11, 2013.
  6. Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
  7. Sehgal N, Manchikanti L, Smith HS. Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician. 2012;15:ES67-ES92.
  8. Kahan M, Srivastava A, Wilson L, et al. Misuse of and dependence on opioids: study of chronic pain patients. Can Fam Physician. 2006;52:1081-1087.
  9. New York City Department of Health and Mental Hygiene. Buprenorphine: an office-based treatment for opioid dependence. City Health Information. 2008;27:25-32.
  10. MedlinePlus. US National Library of Medicine. Opiate withdrawal. http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm. Accessed Aug 08, 2013.
  11. World Health Organization (WHO). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. http://www.who.int/substance_abuse/publications/Opioid_dependence_guidelines.pdf. Accessed May 11, 2013.
  12. Flassing J. Buprenorphine: a more accessible treatment for opioid dependence. JAAPA. 2010;23:40-43.
  13. Birnbaum HG, White AG, Schiller M, et al. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011;12:657-667.
  14. National Institute for Health & Clinical Excellence (NICE). Drug Misuse: Opioid Detoxification. Leicester, UK: The British Psychology Society, and London, UK: Royal College of Psychiatrists; 2008:1-269.
  15. Tetrault JM, Fiellin DA. Current and potential pharmacological treatment options for maintenance therapy in opioid-dependent individuals. Drugs. 2012;72:217·228.
  16. White AG, Birnbaum HG, Mareva MN, et al. Direct costs of opioid abuse in an insured population in the United States. J Manag Care Pharm. 2005;11:469-479.
  17. National Institute on Drug Abuse, National Institutes of Health, US
    Department of Health and Human Services. Principles of Drug Addiction Treatment: A
    Research-Based Guide. 3rd ed. NIH Publication No. 12-4180; Revised December 2012.
    http://www.drugabuse.gov/sites/default/files/podat_1.pdf. Accessed December 18, 2014.

Ask your doctor about ZUBSOLV!

What is ZUBSOLV®?

ZUBSOLV® (buprenorphine and naloxone) sublingual tablet (CIII) is a prescription medicine used to treat adults who are addicted to opioid drugs (either prescription or illegal) as part of a complete treatment program that also includes counseling and behavioral therapy.

IMPORTANT SAFETY INFORMATION

  • Do not take ZUBSOLV if you are allergic to buprenorphine or naloxone as serious negative side effects, including anaphylactic shock, have been reported.

  • ZUBSOLV can cause serious and life-threatening breathing problems. Call your doctor right away or get emergency help if (a) you feel faint, dizzy, or confused; (b) your breathing gets much slower than is normal for you; (c) you feel sleepy and uncoordinated; (d) you have blurred vision; (e) you have slurred speech; (f) you cannot think well or clearly; or (g) you have slowed reflexes and breathing. In an emergency, have family members tell the emergency department staff that you are physically dependent on an opioid and are being treated with ZUBSOLV.

  • ZUBSOLV contains buprenorphine, an opioid that can cause physical dependence with chronic use. Physical dependence is not the same as addiction. Your doctor can tell you more about the difference between physical dependence and addiction. Do not stop taking ZUBSOLV without talking to your doctor. You could become sick with uncomfortable withdrawal signs and symptoms because your body has become used to this medicine.

  • Your doctor may monitor liver function before and during treatment with ZUBSOLV.

  • ZUBSOLV is not recommended for initiation of treatment in patients with moderate hepatic impairment due to the increased risk of precipitated withdrawal. However, ZUBSOLV may be used with caution for maintenance treatment in patients with moderate hepatic impairment who have initiated treatment on a buprenorphine product without naloxone.

  • Keep ZUBSOLV in a secure place away from children. If a child accidentally takes ZUBSOLV, this is a medical emergency and can result in death. Get emergency help right away.

  • The most common side effects of ZUBSOLV include: headache, drug withdrawal syndrome, nausea, decrease in sleep (insomnia), vomiting, pain, increased sweating, swelling of the extremities, and constipation. Tell your doctor about any side effect that bothers you or that does not go away.

  • Opioid use may cause adrenal insufficiency, a potentially life-threatening condition. Seek immediate medical attention if you experience nausea, vomiting, anorexia, fatigue, weakness, dizziness, or low blood pressure as these are signs and symptoms that may be associated with adrenal insufficiency.

  • Do not switch from ZUBSOLV to other medicines that contain buprenorphine without talking with your doctor. The amount of buprenorphine in a dose of ZUBSOLV is not the same as the amount of buprenorphine in other medicines that contain buprenorphine. Your doctor will prescribe a starting dose of buprenorphine that may be different than other buprenorphine-containing medicines you may have been taking.

  • ZUBSOLV is not for occasional or ““as needed”” use. An overdose, and even death, can happen if you take benzodiazepines, sedatives, tranquilizers, or alcohol while using ZUBSOLV. Ask your doctor what you should do if you are taking one of these. You should not drink alcohol while taking ZUBSOLV, as this can lead to loss of consciousness or even death.

  • Do not inject (“”shoot-up””) ZUBSOLV. Injecting ZUBSOLV may cause life-threatening infections and other serious health problems. Injecting ZUBSOLV may cause serious withdrawal symptoms such as pain, cramps, vomiting, diarrhea, anxiety, sleep problems, and cravings.

  • Before taking ZUBSOLV, tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

  • Cases of serotonin syndrome, a rare but potentially life-threatening condition, have been reported when opioids are used along with serotonergic drugs (such as medications used to treat depression and migraines). Be sure to inform your doctor if you are taking or plan to take any serotonergic medications while taking ZUBSOLV.

  • Before taking ZUBSOLV, tell your doctor if you are pregnant or plan to become pregnant. If you take ZUBSOLV while pregnant, your baby may have signs of withdrawal at birth and that withdrawal is treatable. Talk to your doctor if you are pregnant or plan to become pregnant.

  • Before taking ZUBSOLV, tell your doctor if you are breastfeeding or plan to breastfeed. Nursing mothers: Caution should be exercised when buprenorphine-containing products are administered to a nursing woman. Talk to your doctor about the best way to feed your baby. If you take ZUBSOLV, monitor your baby for drowsiness and difficulty breathing.

  • Chronic use of opioids may cause reduced fertility. It is not known whether these effects on fertility are reversible.

  • Do not drive, operate heavy machinery, or perform any other dangerous activities until you know how ZUBSOLV affects you. Buprenorphine can cause drowsiness and slow reaction times. This may happen more often in the first few weeks of treatment when your dose is being changed, but can also happen if you drink alcohol or take other sedative drugs when you take ZUBSOLV.

  • ZUBSOLV is a controlled substance (CIII) because it contains buprenorphine, which can be a target for people who abuse prescription medicines or street drugs. Keep your ZUBSOLV in a safe place to protect it from theft. Never give your ZUBSOLV to anyone else; it can cause death or harm them. Selling or giving away this medicine is against the law.

This is not a complete list of negative side effects associated with ZUBSOLV. For a complete list please see full Prescribing Information.

To report negative side effects associated with taking ZUBSOLV, please call 1-888-982-7658. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For more information about ZUBSOLV (buprenorphine and naloxone) Sublingual Tablet (CIII), please see the respective full Prescribing Information and Medication Guide.