Course and Natural History of Opioid Dependence
Opioid dependence can begin at any age, but problems associ-ated with opioid use are most commonly first observed in the late teens or early twenties. Once dependence occurs it is usually con-tinuous over a period of many years even though periods of ab-stinence are frequent. Reoccurrence is common even after many years of forced abstinence, such as occurs during incarceration. Increasing age appears to be associated with a decrease in preva-lence. This tendency for dependence to remit generally begins after age 40 and has been called “maturing out”. However, many persons have remained opioid dependent for 50 years or longer. Thus, though spontaneous remission can and does occur, most cases of untreated opioid dependence follow a chronic, relapsing course for many years.