How Do Craving And Withdrawal Affect Opioid Relapse Rates?

Most people recovering from an addiction to an opioid drug or medication will experience a relapse fairly early in the treatment process. Two key factors in the onset of a relapse are the presence of continuing cravings or urges for opioid use and the onset of withdrawal symptoms after initial opioid detoxification.

In a study slated for publication in February 2015 in the journal Addictive Behaviors, a team of American researchers looked at the ways in which cravings and withdrawal symptoms impact the relapse risks for any given person recovering from prescription opioid addiction.

Opioid Cravings

All people dealing with opioid drug or medication addiction have longstanding chemical changes in their brain function that make them physically dependent on the continued intake of some form of opioid substance.

Opioid cravings are essentially unconscious and conscious signals sent by the brain as a reminder of the established need to maintain at least a minimum level of opioid intake. Conscious cravings may manifest as clearly articulated thoughts supporting immediate opioid consumption or opioid consumption in the near future.

Conversely, unconscious cravings may manifest as unarticulated urges for opioid intake. Conscious and unconscious cravings for the use of opioids or any other substance commonly stem from exposure to drug cues.

These cues are reminders of the actions commonly undertaken during episodes of substance use, the thoughts or feelings associated with substance use or the circumstances in which substance use typically occurs.

A strong drug cue can support a rapid escalation of drug cravings, and thereby steeply boost the short-term odds of drug use. The presence of opioid cravings is a diagnosable symptom of opioid use disorder (opioid abuse/addiction).

Opioid Withdrawal

Withdrawal is a second reinforcer used by the dependent/addicted brain to ensure the continued consumption of any given substance. It occurs when the levels of that substance fall below the levels required by the currently established conditions of addiction.

Opioid Withdrawal Symptoms

Specific symptoms of opioid withdrawal include:

• sleeplessness
• achy muscles
• an unusually anxious or agitated mental state
• excessive sweat production
• nausea
• vomiting
• pupil dilation
• diarrhea
• cramping in the stomach or abdomen

Unlike some forms of withdrawal (e.g., alcohol withdrawal), opioid withdrawal has no potential to trigger fatal changes in body function. However, affected individuals commonly feel uncomfortable enough to resume opioid intake. Withdrawal symptoms are usually most prominent during initial opioid detoxification. Along with opioid cravings and a range of other symptoms, doctors use the presence of withdrawal symptoms to help diagnose the presence of opioid use disorder.

Impact On Opioid Relapse Rates statistics

In the study scheduled for publication in Addictive Behaviors, researchers from the University of Texas Medical School at Houston, the University of Texas Health Science Center, the University of Texas Southwestern Medical Center and Harvard-affiliated McLean Hospital used information from a project called the Prescription Opioid Addiction Treatment Study to help determine exactly how opioid cravings and opioid withdrawal work together to increase the odds that any given person in recovery will relapse back into uncontrolled opioid use.

A total of 653 people dependent on or addicted to opioid medications took part in the study. All of these people received a commonly used medication, called buprenorphine/naloxone, that’s specifically designed to reduce the risks for relapse in people affected by opioid addiction.

The researchers concluded that there were four distinct groups of people in the larger pool of study participants: people with high levels of opioid craving and opioid withdrawal, people with moderate or intermediate levels of opioid craving and opioid withdrawal, people who transitioned from high levels of craving and withdrawal to low levels of craving and withdrawal, and people who maintained low levels of craving and withdrawal.

The researchers also concluded that three groups of participants were least likely to relapse back into uncontrolled opioid use: people who experienced a reduction in their craving and withdrawal levels over time, people who initially experienced low levels of craving and withdrawal, and people who responded well to the craving- and withdrawal-reducing effects of buprenorphine/naloxone.

The study’s authors believe that their work increases the level of understanding about those individuals most likely to rapidly relapse after entering treatment for prescription opioid dependence/addiction. They also believe that their work underscores the importance of paying close attention to changing craving and withdrawal symptoms during the recovery process.

Finally, the authors believe their work may increase the future ability to identify individualized treatment patterns that decrease each affected person’s chances of experiencing an early opioid relapse.