Opioid use disorder (OUD): restarting treatment after a relapse

There are several ways to think about opioid use disorder (OUD).

OUD is a chronic brain disease, where exposure to opioid drugs have caused physical and chemical changes to the brain that result in a physical and psychological dependence on opioid drugs.

OUD is a disease that impacts nearly every aspect of a person’s life, including physical health, mental health, relationships, education, work, finances, and many others.

OUD is also a disease that is treatable. There are effective treatments for OUD. While treatment will vary from person to person, treatment typically includes a combination of medications, counseling, and psychosocial support. Treatment can help a person achieve and maintain remission and regain function in the parts of their life affected by OUD.

Under ideal circumstances, once a person achieves recovery and remission, recovery and remission will continue uninterrupted. However, circumstances are often not ideal. Relapses happen.

While a person should take every step possible to avoid relapse, relapse can be a part of the treatment process. A relapse does not mean that treatment has failed.

If you or a loved one has experienced a relapse, it’s important to restart treatment. Here, we look at three questions to answer when restarting treatment for OUD.

Do you need a different healthcare provider?

Your first step should be working with a healthcare provider. You may want to continue working with a healthcare provider who has been a part of your treatment in the past, or you may decide to work with a different healthcare provider.

Some people have negative experiences with the healthcare system or with specific healthcare providers. Feeling judged or stigmatized by a healthcare provider can make a person reluctant to ask questions or bring up concerns—and this can impact success with treatment.

Trust in your healthcare provider is critical. Spend some time thinking about what you want and need from a healthcare provider. If you've had negative experiences with the healthcare system or specific healthcare providers, restarting treatment can be an opportunity to find providers who you can build a better working relationship with.

Another way to frame this is what types of care and support you need. In some cases, it may not be working with a different healthcare provider, but adding another type of support, such as a different type of therapy or participating in a support group.

Have your medication needs changed?

Medications for opioid use disorder (MOUD) are a mainstay of treatment. This can include medications to address withdrawal symptoms during the detoxification process, long-term maintenance therapy to reduce cravings and help maintain recovery, and emergency treatments to be administered in case of an overdose (which are recommended for many people treating OUD).

As you restart treatment, you and your healthcare provider should discuss your medication needs. Expect to discuss relapse and recent use of opioids, withdrawal symptoms, your current physical and mental health, and your medical history.

While a healthcare provider will be your best source of information about treatment, it also helps to know what treatment options are available. Treatment for OUD continues to evolve. Spend some time learning about what treatment options are available.

Newer treatment options for OUD are designed to help prevent relapse.

What contributed to the relapse?

It’s also important to think about what contributed to the relapse. Understanding what contributed to a relapse can help you avoid relapses in the future. Relapses happen for many different reasons, and everyone’s experience is different. Some common contributing factors include:

• Treatment was difficult to access or difficult to adhere to. For example, problems with insurance, the cost of treatment, medication side effects, or difficulty attending appointments.
• Stressful life events, such as the loss of employment or housing, family responsibilities, or medical emergencies.
• Symptoms of a mental health disorder, such as depression, anxiety, or trauma, which are common among people with OUD.
• Social pressures, such as friends who use opioids or social situations associated with opioid use.
• Inadequate healthcare, support, or mental health resources.
• Stigma or negative experiences, including stigma in healthcare settings.
• Positive moods or life events, which can also increase the desire to take opioids.
• Pain due to injuries, medical procedures, or health issues.

Spend some time thinking about the reason or reasons for the relapse. In some cases, the answer might be straightforward. In other cases, it may be a combination of different factors. This is an important topic to discuss with a counselor or mental health professional.

While it’s important to think about and evaluate a relapse, try to avoid feelings of guilt and self-blame. Try to think of the relapse as a learning experience and part of the treatment process.