Opioid dependence is a real medical condition. It can happen
to anyone - it is estimated that between 26.3 and 36.1 million people are
dependent on opioids worldwide and yet it’s a form of drug dependency not
spoken about often enough.
Many people know someone who has been affected by opioid
dependence, and sometimes it can be those close to us who are dependent on
drugs, for example a neighbour or a colleague. Opioid dependence is increasing
and it’s not limited to dependence on the illegal opioid drug heroin.
In South Africa, 44.8% of people seeking treatment for
prescription medicine dependence reported the use of opioid containing
painkillers. The increased usage of
prescription painkillers and the risk of becoming dependent on them is a
serious issue and presents an urgent need for awareness and education.
People with severe
“For people with severe pain, opioids are very effective
medicines, and many patients treated for pain with opioids do not become
addicted. For some people, however, opioid dependence is an unexpected
consequence of proper pain treatment. The problem comes when someone is unable
to stop using the drug after the pain passes,” says Dr Volker Hitzeroth,
President of the South African Addiction Medicine Society (SAAMS).
Hitzeroth explains that opioids are drugs with opium-like
qualities that are either derived from opiates or are chemically related to
opiates or opium. Opioids act by
attaching to specific proteins called opioid receptors, which are found in the
brain, spinal cord and gastrointestinal tract.
When these drugs attach to the opioid receptors, they block the
transmission of pain messages to the brain.
Opioids can also cause euphoria by affecting certain brain
regions that mediate what we perceive as pleasure. These factors lead to the drugs being highly
addictive and some people who are appropriately treated for chronic or acute
pain can become dependent on opioids.
Link between chronic
pain and other diseases
Opioid dependence has been defined as a chronic, relapsing
brain disease and has several things in common with other chronic illnesses
such as diabetes and asthma:
- It can be successfully managed
- A combination of medication and behavioural
changes may help manage the disease
- Opioid dependence has a genetic basis and can be
- Symptoms can fluctuate over time with periods of
“We need to be clear that addiction to a drug is not the
same as physical dependence. Addiction
is a condition that involves a physical, psychological and behavioural need for
the opioid drug that is unrelated to medical necessity,” says Hitzeroth.
Opioid dependence has been defined as the co-occurrence of
three or more of the following symptoms:
- Drug tolerance
- Withdrawal symptoms
- Use of the drug in larger quantities or for
longer periods than required for medical necessity
- Repeated unsuccessful attempts to decrease or
- Significant time spent obtaining the substance
or recovering from its effect
- Drug use to avoid withdrawal
- Foregoing important activities, or willingness
to accept severe physical, social or professional negative consequences, due to
Although the causes of opioid dependence vary from person to
person, certain factors, such as the drug itself, genetics and the individual’s
environment, are known to be important in its development. Some people appear to be genetically
predisposed to dependence, raising the possibility that susceptibility to the
disease may be hereditary.
Levels of drugs in
Also, individual absorption levels of the drug into the
blood can vary widely for different people, thus causing very different
effects. Lastly, substance abuse, which
can lead to dependence, is often highly influenced by societal norms and peer
That’s why doctors consider opioid dependence a long-term
medical condition – one that can be treated effectively on a home-based
out-patient basis, thus offering medical and personal benefits to patients and
their families, and the broader society.
Several forms of treatment are available.
A website for Turn-to-help, has been
developed to help patients find out more about opioid dependence and encourage
them to seek treatment. Alternatively, a
health care professional can visit both Turn-to-help and SAAMS websites
or to find out more on opioid dependence and how they can help
with the treatment.
Overcoming opioid dependency is a difficult journey but with
the proper knowledge and support, it is possible to be part an effective
treatment solution that can help people and those close to them overcome the
Opioid Dependency Treatment Week will be held from the 22nd
of April to the 26th of April.