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Kerkkoh

Opioid use disorder and addiction

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Kerkkoh    44

Disclaimer:

1. I do not support using any sorts of drugs, and I am always in the favor of stopping. If you have a drug problem, please contact a professional in your country.

2. I have never used drugs nor do I plan on doing so. This information isn't from real life experience at all.

3. All the information is from hours and hours of research I've done to provide enjoyable roleplay experiences for everyone else around my character(s).

4. I do not wish to offend anyone with this guide. If you find something in this tutorial offensive, please contact me immediately and I will edit it accordingly.

5. Information in this guide is not accurate medical information, and you should never adapt any of it to real life. Information in this tutorial has been picked mainly from the internet and is in no way trustworthy.

6. If you wish to contribute or have suggestions, please contact me either in this thread, in TeamSpeak or by sending me a private message.

7. If you notice a typo or something wrong with the guide, please contact me about it.

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To start with,

I have had a character that had a severe case of opioid use disorder. I did tons of research on the subject since it is horrible to see someone playing a character like this wrong. I wanted to write this guide to give some basic instructions on what to do and what not to do. I was going to write one about drug addiction in general, but the subject is overly broad, and these tips can be adapted to fit other substance abuse disorders easily.

Another thing worth mentioning is that I list a lot of symptoms and effects here, but these effects have been just taken from the internet and are most likely the most common effects or symptoms. Effects and symptoms can vary a lot among individuals so these are not the only effects or symptoms you could have.

I. What is it, how it happens & basics

II. Different kinds of opioids and their effects

IV. Withdrawal

V. Overdose

 

I. What is it, how it happens & basics

Most of us are familiar with addiction and the definition of it already, but if you would like to read the actual definition of an opioid use disorder, you can find one from Wikipedia. To put it bluntly, it's a medical condition where a person continuously uses opioids despite the consequences and effects of it. Opioid use disorder always involves addiction to opiates. The addiction usually involves psychological and physical dependence which make it hard to stop.

Opioid use disorder can develop over time when using a prescribed opiate based medication or it could simply start from an individual "trying" a drug. Some people are more prone to becoming addicts than others. Addicts don't often recognize the addiction themselves and often start to think about it only after someone tells them about it, but this may vary among individuals.

Users usually seek for other users to fit in better. They can feel out people's opinions about drugs by joking about it or making an excuse for taking the substance.

Something you also have to note is that using multiple kinds of drugs at once can cause a lot of different symptoms. For example, there is a total of 798 drugs (4428 brand and generic names) that are known to interact with morphine. You can check the huge list of them over at https://www.drugs.com/drug-interactions/morphine.html

Most of these might not be relevant to you, but you should at least remember that if your character has used morphine or other opioids for a longer time, he or she probably knows not to use alcohol and morphine at the same time.

What to do:

  • Use a drug and then leave it for a while. If your character is addicted, opioid use disorder has relatively strong physical withdrawal symptoms that will appear if your character is becoming addicted to it.
  • Emote taking the drug and withdrawal symptoms. (More about withdrawal symptoms in Chapter IV)
  • If the drug is intravenous, like morphine auto-injector, emote pulling your sleeve up and finding a vein before using it.
  • Keep in mind the general knowledge about drugs and opioids

What not to do:

  • Use an opioid and instantly take more within five minutes and tell that you are addicted now. (Believe me, this happens)
  • Inject intravenous drug through your clothes
  • Drink alcohol and take opioids at the same time (No, it's not a party now; the effects include fainting and even death)

II. Different kinds of opioids

Some terms quickly:

  • Immediate-release: The substance will affect immediately
  • Controlled or slow-release: The drug will be released slowly or controllably in your body to ensure longer lasting effects

Since modding hasn't been introduced to DayZ yet, we only have one opioid item in the game at this point. In the future, I wish that we can get more medicine and an actual addiction system. Right now, your best bet is to emote a lot of things. For example, we already have syringes in the game, and you could emote having morphine or heroin in them and injecting it. We also have vitamin bottles which can be easily emoted to be things like Vicodin, Zohydro ER or Oxycontin in them.

*Takes out a white medicine bottle that has a Vicodin label on it*

What are some of the most common opioids that you could be using?

 

Morphine is probably the easiest one to start with at this point since it has its item in the game. Morphine auto-injectors that are in DayZ contain a 10mg dose of morphine that gets injected upon pressing the needle down. Autoinjectors are probably the easiest way of administering morphine, but they only have a relatively small amount of morphine in them since highly tolerant addicts can use up to 2000-3000mg per day. Note that the minimal lethal dose of morphine is around 200mg for nontolerant users, but in the case of hypersensitivity, even 60mg can cause sudden death.

The best way to roleplay a tolerant morphine addict is to emote out larger amounts of morphine in syringes, saline-like IV administered bags full of liquid morphine or otherwise.

Effects

Common effects

Euphoria, Itch, Nausea, Vomiting, Constipation, Drowsiness, dry mouth

Other effects

Dizziness, Decreased sex drive, Reduced testosterone levels, Depression, Immunodeficiency, opioid-induced abnormal pain sensitivity, Increased risk of falls, Slowed breathing

All effects may vary among individuals, and this is not a complete list of effects.

---

Oxycodone (the Most common brand name is Oxycontin) is often taken in pill form as an immediate release or delayed/slow release. Oxycodone can be administered intravenously as well, but among addicts, pills are the most common way of taking it. A good way to of roleplaying oxycodone is emoting a pill bottle with a label saying Oxycontin or another oxycodone brand name on it. Using these pills can be done via consuming the pills from a vitamin bottle or just by emoting them. These tablets can also be crushed and administered intranasally.

 

Effects

Common effects

Euphoria, constipation, fatigue, somnolence, dizziness, nausea, vomiting, dry mouth, anxiety, itching, and sweating

Other effects

Loss of appetite, nervousness, abdominal pain, diarrhea, dyspnea, and hiccups

All effects may vary among individuals and this is not a complete list of effects.

---

Hydrocodone (common brand names are Zohydro ER and Norco) is usually used in the form of pills. These tablets can also be crushed and administered intranasally.

Effects

Common effects

Euphoria, Nausea, vomiting, constipation, drowsiness, dizziness, lightheadedness, anxiety, abnormally happy or sad mood, dry throat, itching, and narrowing of the pupils

All effects may vary among individuals, and this is not a complete list of effects.

---

Hydrocodone/paracetamol (the most common brand name is Vicodin) is just a mix of Hydrocodone and paracetamol which has mostly same effects as Hydrocodone. The most common brand name is Vicodin, and people often know it from the TV-series House M.D.

 

Effects

Common effects

Euphoria, Lightheadedness, Dizziness, Euphoria, Sedation, Nausea, and vomiting

All effects may vary among individuals, and this is not a complete list of effects.

---

Codeine like many other opioids is used for treating pain and cough. It's widely known for its syrup form's recreational use. It's commonly referred to as 'syrup', 'lean', or 'purple drank.'

Codeine does also appear in a pill form, but the syrup form has been the most commonly misused form of codeine lately.

Effects

Common effects

Drowsiness and constipation

Less common effects

Itching, Nausea, vomiting, dry mouth, miosis, orthostatic hypotension, urinary retention, euphoria, dysphoria, and coughing.

All effects may vary among individuals, and this is not a complete list of effects.

---

Heroin usually has the same effects as morphine and is most often injected intravenously. It's most easily roleplayed with syringes and emoting.

All effects may vary among individuals, and this is not a complete list of effects.

---

What to do:

  • Look at the effects listed here and on the internet and try to roleplay them as well as possible. Emoting and text chat is your friend when emoting the effects.
  • Usually, choose one drug to use at once to avoid interaction between the drugs and awkward roleplay when someone knows about the drug interactions better than you do
  • If you pick one drug, do some additional research about it
  • Add variety to the effects and emoting them, don't keep on scratching your leg the same way again and again.
  • Commit to the addiction. Drug addicts that are heavily addicted will value drugs over anything (Except your life because of the server rules of course)
  • Use brand names or nicknames for the substances for the most part. (Oxycontin or oxy instead of Oxycodone)

What not to do:

  • Emote the same *yawning* or *sneezing* again and again.

Top Tips:

Most of these opioids don't cause your character to go crazy or hallucinate (All effects may vary among individuals). If you do crazy running around "because you are on drugs", you just may look stupid. Euphoria can be roleplayed in many different ways since people experience it a bit differently.

For many addicts, it's not about the effects that they get from the drug anymore, but they have just formed a habit or try to keep away the physical withdrawal symptoms.

IV. Withdrawal

Since opioids have a lot in common, there are some general withdrawal effects. Opioid withdrawal effects can vary a lot among individuals, and the following progression of them might not apply to everyone.

The early symptoms can be noticed after 16 to 24 hours after the last dose. They include:

  • muscle aches
  • restlessness
  • anxiety
  • lacrimation (eyes tearing up)
  • runny nose
  • excessive sweating
  • inability to sleep
  • yawning very often
  • drug craving

After the first day passes without using any opioids, the effects usually get worse, and they include:

  • diarrhea
  • abdominal cramping
  • goose bumps on the skin
  • nausea and vomiting
  • dilated pupils and possibly blurry vision
  • rapid heartbeat
  • high blood pressure
  • involuntary leg movements (restless leg syndrome)
  • fetal position
  • weight loss

After about 72 hours from the last dose, the effects should start to go away and at that point, the addict has gone through the physical withdrawal effects. Even though the physical withdrawal effects disappear, addicts usually have a psychological need for the drug for a long time after. This psychological need can be noticed as thinking and talking about the drug and craving for it.

Knowing at least some of these withdrawal effects should help you to roleplay withdrawal correctly.

Tips:

Addiction to opiates is usually very strong, and the withdrawal isn't pretty. Addict often needs a close friend to get him or her through it. It isn't an easy process, and it is bound to fail without proper supervision. Speaking to other addicts or anyone about it might help the recovering addict.

 

V. Overdose

Opioid overdose is the primary cause of death by opioids. An overdose happens by using too much of a drug. It can be because a person has taken a slow release pill of some opioid and then drank alcohol which speeds up the release. Overdose can also happen because addicts usually develop tolerance to the drug and have to take too much of the drug to get the same effects as before.

Opioid overdose effects vary a lot, and the information you get may be contradictory. I chose to trust the information from WHO (World Health Organization), and I picked some effects for you to roleplay. I'm going to quote their information sheet directly because it offers you the best information

Due to their effect on the part of the brain which regulates breathing, opioids in high doses can cause respiratory depression and death. An opioid overdose can be identified by a combination of three signs and symptoms referred to as the “opioid overdose triad”. The symptoms of the triad are:

  • pinpoint pupils
  • unconsciousness
  • respiratory depression

So the most lethal symptom is respiratory depression and finally a respiratory arrest. Opioids don't necessarily cause the airways to close, but the breathing and gas exchange may just slow down and stop due to the effect on the person's brain.

Some sources also indicate that there are a lot of other symptoms, but WHO doesn't recognize them in their information sheet. This contradiction could be because of varying symptoms among different kinds of overdoses and different mixtures of drugs that caused the overdose. These are some of the other possible symptoms:

  • Awake, but unable to talk
  • Body is very limp
  • Face is very pale or clammy
  • Fingernails and lips turn blue or purplish black
  • For lighter skinned people, the skin tone turns bluish purple, for darker skinned people, it turns grayish or ashen.
  • Breathing is very slow and shallow, erratic, or has stopped
  • Pulse (heartbeat) is slow, inconsistent, or not there at all
  • Choking sounds, or a snore-like gurgling noise (sometimes called the “death rattle”)
  • Vomiting
  • Loss of consciousness
  • Unresponsive to outside stimulus

In case a respiratory arrest doesn't happen, and the person is still breathing, they could go unconscious and choke on their vomit.

Roleplaying an overdose can cause your character to die without proper and immediate treatment. Minor overdose might not be fatal but requires as much immediate medical attention as a major overdose. A major overdose is fatal if you don't receive immediate care from a doctor that knows how to treat an opioid overdose.

Treating an opioid overdose is important to avoid death. Just providing basic life support and Naloxone to the patient can prevent the death of the patient. An opiate addict or their caretaker should always carry naloxone in the case of an overdose. Providing oxygen to the patient will help him or her to be able to breathe, but the administration of naloxone is necessary to counteract the effects of an opioid overdose.

Tips:

Since overdose is a touchy subject, it's important that you try to roleplay it as well as you can.

End

You can do additional reading about the subject on many sites. Wikipedia is usually not preferred in your college essays, but it saves you time regarding this kind of research as you don't have to skim through hundreds of books and websites about the subject.

I am still in no ways an expert, and I am not saying that all of this information is 100% accurate. I just thought that this might help someone improve their addiction RP.

Sources and additional reading:

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Grimnir    589

Nice guide, now I am nearly regretting that I tried to make you overdose yesterday. ;)

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Guest

Solid research, lets hope people take this on board so it's not a see of drug stereotypes knocking around.

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Castiel    1124

Great guide, I can see you put a lot of effort into your research. Good stuff!

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Guest

Impressive guide. I might use this for my next character.

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   20

This is awesome! Great job with the guide.

If you were looking for more information I would suggest looking into the DSM-V or DSM-5. The Diagnostic and Statistical Manual of Mental Disorders 5th edition is used by professionals to categorize and diagnose a wide variety of disorders. I know that different countries have different manuals, but in the US this is the one most commonly used. In the DSM-5, they differentiate between opiate use and opiate addiction and what they believe constitutes a diagnosis of either of the disorders. The differences in these disorders may provide from clarification for you or others attempting to RP this out.

Again, great job!

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It's obvious you've put a great deal of effort into this guide. This is the kind of research which leads to amazing IC experiences, well done! :)

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PurifieR    17

Enjoyed the little talk with your drug addict character, as well as this awesome guide! Too much research and effort, good shit.

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isocade    90

Having played a character who was a former heroin addict and multiple other characters who were opioid addicts in the past as well, I can safely say that this guide is truly reliable and accurate. I can also safely say that I roleplayed it all properly, which I had been worried about for a very long time.

I can see your name in lights kid, you're gonna be a star.

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Guest

I had been thinking about making a guide about drugs. I'm glad you did it though since it was needed! Hope to see you add even more types and work on the guide. Good job!

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Guest

I was so confused seeing the situation at the hospital in-camp.. now I guess you nearly overdosed that day

Good read, 10/10

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