Opioid Dependence
Opioid dependence is adaptation to repeated opioid use with tolerance and withdrawal, sometimes occurring within opioid use disorder marked by impaired control and harm.
Key points
- Reduced tolerance after abstinence sharply increases overdose risk if a previous dose is resumed.
- Buprenorphine or methadone maintenance reduces withdrawal, illicit use and mortality more effectively than repeated detoxification alone.
- Naloxone access, safer-use education and assessment of sedatives, alcohol and mental health are essential parts of care.
The listings below are not for unsupervised induction; opioid type, last use, withdrawal state and other sedatives affect safety.
Starting treatment safely
Buprenorphine can precipitate severe withdrawal if started too soon after a full opioid agonist, while methadone can accumulate and affect heart rhythm. Clinical protocols assess withdrawal, tolerance, pregnancy, liver function and interacting medicines before induction.
Recovery and overdose prevention
Maintenance duration is individual and should not be ended by arbitrary deadlines. Psychological, housing and pain support address drivers of harm. Naloxone should be available to the person and close contacts, especially after detoxification, hospital discharge or release from custody.
When to seek urgent care
Call emergency services for slow or stopped breathing, blue lips, inability to wake or pinpoint pupils; give naloxone if available. Urgent help is also needed for suicidal intent or severe withdrawal with dehydration.