OUD can occur at any age but is usually first identified in the late teens or early 20s (American Psychological Association [APA], 2013). It is considered a problematic pattern of opioid use lead- ing to clinically significant impairment or distress, with at least two of the following in a 12-month period: ● An individual takes opioids in larger amounts over a more ex- tended period than intended. ● A persistent desire or unsuccessful efforts to cut down on opi- oid use occur. ● A great deal of time is spent in activities necessary to obtain opioids. ● An individual has a craving or strong desire or urge to use opioids. ● Recurrent opioid use occurs despite failing to fulfill significant work obligations. ● Opioid use continues despite having persistent recurrent so- cial and interpersonal problems caused by opioids. ● Important social, occupational, or recreational activities are given up or reduced because of opioid use. ● Recurrent opioid use occurs in situations that are physically hazardous. ● Continued opioid use occurs despite knowledge of persistent or recurrent psychological or physical problems. ● Tolerance means a need for a markedly increased amount to achieve intoxication and markedly diminished effect with con- tinued use of the same amount of opioids. ● Withdrawal occurs. (APA, 2013) Epidemiology of opioid use disorders From 1999 to 2020 more than 564,000 individuals died from an overdose involving opioids (CDC, 2020). The rise in opioid over- dose deaths is outlined in three distinct waves. The first wave be - gan in 1999 with increased opioid prescribing. The second wave started in 2010 with rapid increases in overdose deaths involv- ing heroin. Finally, the third wave started in 2013 with synthetic opioids like fentanyl, which now comes across the border and is responsible for hundreds of thousands of deaths (CDC, 2022). Risk factors in opioid use disorders In general, individuals take substances for a variety of reasons, in- cluding (1) pleasure; (2) an escape from social anxiety, stress, and depression; (3) to increase performance; (4) curiosity and social pressure (National Institute on Drug Abuse [NIDA], 2020). There- fore, no single factor determines whether an individual becomes addicted to drugs, whether biological or environmental (NIDA, 2020). Biological influences include genetics, gender, and mental dis - orders, while environmental impacts include chaotic home situa- tions, parental use and attitudes, peer influences, community at - titudes, and low academic achievement (NIDA, 2020). Risk factors for substance abuse include (1) aggressive behavior in childhood, (2) lack of parental supervision, (3) peer refusal skills, (4) drug ex- perimentation, (5) availability of drugs at school, and (6) communi- ty poverty (NIDA, 2020). Protective factors reduce an individual’s risk of substance use and include (1) self-efficacy affected by per - sonal and home situations, (2) parental monitoring and support, (3) positive relationships, (4) extracurricular activities, (5) anti-drug policies at school, and (6) neighborhood resources (NIDA, 2020). One of the most significant changes during development in ado - lescence is the maturing prefrontal cortex, which is responsible for assessment of situations, making sound decisions, and keeping emotions and desires under control (NIDA, 2020). These changes place the adolescent at a greater risk of substance abuse. In addi- tion, introducing substance use during this time can interrupt the
development of neuronal connections, which are affected by en- vironmental forces that determine how these connections operate as individuals age (NIDA, 2020). Root causes of opioid use disorder It appears likely that there are several root causes of the current opioid epidemic (Blumenthal & Seervai, 2017). Prescribers At the root of the opioid epidemic is the pain epidemic. It has been acknowledged that during the mid-1990s, to treat pain bet- ter, physicians overprescribed opioid medications in the absence of adequate attention to negative consequences. This may have responded to several experts at the time contending that pain was being undertreated in routine medical practice (Blumenthal & Seervai, 2017). Pharmaceutical companies Many have implicated the sales practices of opioid manufactur- ers and marketers. Investigations have established that drug makers may have partially fueled the epidemic by their efforts to enhance the sales of their opioid medications (Blumenthal & Seervai, 2017). In a current example, federal prosecutors have leveled racketeering charges against several executives of INSYS Therapeutics, alleging that they were part of a scheme involving aggressive sales of fentanyl. More specifically, the indictment sug - gests that prescribers offered bribes and kickbacks in exchange for higher prescribing rates for their product SUBSYS, a spray form of fentanyl (Thomas, 2016). Health insurance Although receiving less attention in the media, recent examina- tions have suggested that in some cases, insurance practices pro- vide easy access to opioid medications while restricting access to less addictive but more expensive pain medication. In addition, in some cases, access to addiction treatment may also be curtailed (Blumenthal & Seervai, 2017). Socioeconomics An association can be established between opioid misuse/abuse and unemployment, lack of health insurance, and poverty among adults. Unfortunately, it is difficult to confirm that financial disad - vantage is a cause. Rather, this condition could result from the epidemic (Blumenthal & Seervai, 2017). Nonetheless, it remains probable that feelings of hopelessness and social trauma are at least somewhat to blame. Further, the geographic distribution of the opioid problem is revealing. Racial and ethnic minorities in cities have historically had high addiction rates. Some of the highest addiction rates in the United States occur where social dislocation is found, includ- ing densely populated urban regions and Appalachia. Since the 1970s, rural communities have suffered from employment de- clines. As a result of higher unemployment rates, financial prob - lems, and limited upward mobility, the stage was set for increases in substance use and abuse (Blumenthal & Seervai, 2017). The drive for opioids combined with poverty often results in criminal activity. In 2012, a total of 259 million opioid prescriptions were written. This is adequate to provide each American adult with a medica- tion bottle. It is estimated that of each five new heroin users, four got their start with painkillers. A 2014 survey of people suffering from opioid addiction showed that 94% of respondents chose to use heroin because of the costs; prescription opioids are more expensive and difficult to obtain (ASAM, 2017).
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