Opioid Dependence Course Of The Disorder Over Time Opioid

dependence is the modern diagnostic term for narcotic addiction, but the older term is still often used. This entry, however, uses the modern term. The term opioid refers to natural and synthetic substances that have morphine-like effects. The term opiate is generally used in a more restricted sense to refer to MORPHINE, HEROIN, CODEINE, and similar drugs derived from OPIUM. OPIOID dependence is defined as a cluster of symptoms related to continued use of an opioid drug. One of the prominent features of the disorder is the inability to stop using the drug. Persons with repeated periods of opioid dependence are often called narcotic addicts. Because they are not always dependent (that is, addicted), the term opioid users seems more suitable and therefore is used here. During the late nineteenth and early twentieth centuries the principal opioid drugs used were LAUDANUM (a solution of opium in alcohol, taken orally) and morphine (usually injected by needle). During the latter half of the twentieth century, heroin has been the principal drug of opioid users. It is usually taken by intravenous injection, but sometimes by insufflation, that is, by sniffing it into the nasal cavities.

The course of opioid dependence is affected by multiple interacting conditions in the person and in the environment. The combined conditions create thresholds for the onset, continuation, and relapse after remission of opioid dependence. Different methods of investigation (for example, pharmacological, psychological, sociological, psychiatric) have led to different theoretical conceptions of the causal conditions and processes in opioid dependence. These conceptions, however, tend to be compatible and supplementary rather than contradictory. In the following description of the course of opioid dependence, the principal conditions thought to affect its onset and course will be identified.

In the United States, legal and medical conditions affecting opioid use and dependence have changed since the nineteenth century. In the nineteenth century many persons regularly used laudanum or morphine that they obtained legally from physicians, retail drug stores, or other sources. Physicians often prescribed or recommended these drugs for treatment of chronic physical PAIN or psychological distress. Although daily use of an opioid drug with consequent dependence on it probably impaired the social performance of many persons, reports exist of persons—including some with distinguished careers—who acceptably filled social roles during years of opioid drug dependence. Though some antisocial persons used opioid drugs, such use itself did not lead to criminal behavior.

In the twentieth century, opioid dependence became closely associated with criminal behavior. Enactment and enforcement of federal and state laws to control the production and distribution of opioid drugs (mostly called narcotic drugs in the laws) became prominent features of the twentieth-century environment of opioid use. Physicians could no longer prescribe opioid drugs to maintain dependence, and opioid users now had to obtain their drugs from illicit sources. Furthermore, because the illicit opioid drugs were expensive, users often engaged in illegal moneymaking activities— especially theft, burglary, fraud, prostitution, and illicit drug traffic—to pay for their drugs. In addition, twentieth-century opioid users have often had histories of delinquent behavior that preceded their opioid use.

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