Opioid use disorder

Opioid use disorder
Other namesOpioid addiction,[1] problematic opioid use,[1] opioid abuse,[2] opioid dependence[3]
Molecular structure of morphine
SpecialtyAddiction medicine, psychiatry
SymptomsStrong desire to use opioids, increased tolerance to opioids, failure to meet obligations, trouble with reducing use, withdrawal syndrome with discontinuation[4][5]
ComplicationsOpioid overdose, hepatitis C, marriage problems, unemployment, poverty[4][5]
DurationLong term[6]
CausesOpioids[3]
Diagnostic methodBased on criteria in the DSM-5[4]
Differential diagnosisAlcoholism
TreatmentOpioid replacement therapy, behavioral therapy, twelve-step programs, take home naloxone[7][8][9]
MedicationBuprenorphine, methadone, naltrexone[7][10]
Frequency16 million[11]
Deaths120,000[11]

Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood.[12] Addiction and dependence are important components of opioid use disorder.[13]

Risk factors include a history of opioid misuse, current opioid misuse, young age, socioeconomic status, race, untreated psychiatric disorders, and environments that promote misuse (social, family, professional, etc.).[14][15] Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems meeting social or professional responsibilities.[16][17] Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5.[17]

Opioids include substances such as heroin, morphine, fentanyl, codeine, dihydrocodeine, oxycodone, and hydrocodone.[5][6] A useful standard for the relative strength of different opioids is morphine milligram equivalents (MME).[18] It is recommended for clinicians to refer to daily MMEs when prescribing opioids to decrease the risk of misuse and adverse effects.[19] Long-term opioid use occurs in about 4% of people following their use for trauma or surgery-related pain.[20] In the United States, most heroin users begin by using prescription opioids that may also be bought illegally.[21][22]

People with opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine.[23] Such treatment reduces the risk of death.[23] Additionally, they may benefit from cognitive behavioral therapy, other forms of support from mental health professionals such as individual or group therapy, twelve-step programs, and other peer support programs.[24] The medication naltrexone may also be useful to prevent relapse.[10][8] Naloxone is useful for treating an opioid overdose and giving those at risk naloxone to take home is beneficial.[25]

This disorder is much more prevalent than first realized.[26] In 2020, the CDC estimated that nearly 3 million people in the U.S. were living with OUD and more than 65,000 people died by opioid overdose, of whom more than 15,000 overdosed on heroin.[27][28] In 2022, the U.S. reported 81,806 deaths caused by opioid-related overdoses. Canada reported 32,632 opioid-related deaths between January 2016 and June 2022.[29][30]

  1. ^ a b "FDA approves first buprenorphine implant for treatment of opioid dependence". U.S. Food and Drug Administration (FDA) (Press release). 26 May 2016. Retrieved 16 March 2017.
  2. ^ "3 Patient Assessment". Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). 2004.
  3. ^ a b "Commonly Used Terms". www.cdc.gov. 29 August 2017. Retrieved 16 July 2018.
  4. ^ a b c Cite error: The named reference DSM5 was invoked but never defined (see the help page).
  5. ^ a b c Substance Use and Mental Health Services Administration (30 September 2014). "Substance Use Disorders".
  6. ^ a b "Opioid Use and Opioid Use Disorder in Pregnancy". ACOG. August 2017. Retrieved 16 July 2018.
  7. ^ a b Cite error: The named reference BMJ2017Re2 was invoked but never defined (see the help page).
  8. ^ a b "Treatment for Substance Use Disorders". Substance Abuse and Mental Health Services Administration. October 2014.
  9. ^ McDonald R, Strang J (July 2016). "Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria". Addiction. 111 (7): 1177–1187. doi:10.1111/add.13326. PMC 5071734. PMID 27028542.
  10. ^ a b Sharma B, Bruner A, Barnett G, Fishman M (July 2016). "Opioid Use Disorders". Child and Adolescent Psychiatric Clinics of North America. 25 (3): 473–487. doi:10.1016/j.chc.2016.03.002. PMC 4920977. PMID 27338968.
  11. ^ a b Dydyk AM, Jain NK, Gupta M (2022). "Opioid Use Disorder". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 31985959. NCBI NBK553166. Retrieved 16 November 2022.
  12. ^ Substance Use and Mental Health Services Administration (30 September 2014). "Substance Use Disorders".
  13. ^ Volkow ND, Koob GF, McLellan AT (January 2016). "Neurobiologic Advances from the Brain Disease Model of Addiction". The New England Journal of Medicine. 374 (4): 363–371. doi:10.1056/NEJMra1511480. PMC 6135257. PMID 26816013. Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder.
  14. ^ Webster LR (November 2017). "Risk Factors for Opioid-Use Disorder and Overdose". Anesthesia and Analgesia. 125 (5): 1741–1748. doi:10.1213/ANE.0000000000002496. PMID 29049118. S2CID 19635834.
  15. ^ Santoro TN, Santoro JD (December 2018). "Racial Bias in the US Opioid Epidemic: A Review of the History of Systemic Bias and Implications for Care". Cureus. 10 (12): e3733. doi:10.7759/cureus.3733. PMC 6384031. PMID 30800543.
  16. ^ Substance Use and Mental Health Services Administration (30 September 2014). "Substance Use Disorders".
  17. ^ a b American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 540–546, ISBN 978-0-89042-555-8
  18. ^ Cite error: The named reference pmid36327391 was invoked but never defined (see the help page).
  19. ^ "A Prescriber's Guide to Medicare Prescription Drug (Part D) Opioid Policies" (PDF).
  20. ^ Mohamadi A, Chan JJ, Lian J, Wright CL, Marin AM, Rodriguez EK, et al. (August 2018). "Risk Factors and Pooled Rate of Prolonged Opioid Use Following Trauma or Surgery: A Systematic Review and Meta-(Regression) Analysis". The Journal of Bone and Joint Surgery. American Volume. 100 (15): 1332–1340. doi:10.2106/JBJS.17.01239. PMID 30063596. S2CID 51891341.
  21. ^ "Prescription opioid use is a risk factor for heroin use". National Institute on Drug Abuse. October 2015. Retrieved 16 July 2018.
  22. ^ Hughes E (2 May 2018). "The Pain Hustlers". New York Times. Retrieved 3 May 2018.
  23. ^ a b "Trends in the Use of Methadone, Buprenorphine, and Extended-release Naltrexone at Substance Abuse Treatment Facilities: 2003–2015 (Update)". www.samhsa.gov. Retrieved 16 November 2022.
  24. ^ Donovan DM, Ingalsbe MH, Benbow J, Daley DC (2013). "12-step interventions and mutual support programs for substance use disorders: an overview". Social Work in Public Health. 28 (3–4): 313–332. doi:10.1080/19371918.2013.774663. PMC 3753023. PMID 23731422.
  25. ^ "Opioid Overdose Prevention Programs Providing Naloxone to Laypersons — United States, 2014". www.cdc.gov. Retrieved 16 November 2022.
  26. ^ Diagnostic and statistical manual of mental disorders : DSM-5. Arlington, VA : American Psychiatric Association. 2013. ISBN 978-0-89042-554-1.
  27. ^ CDC (30 August 2022). "Disease of the Week – Opioid Use Disorder". Centers for Disease Control and Prevention. Retrieved 16 November 2022.
  28. ^ "Data Brief 294. Drug Overdose Deaths in the United States, 1999–2016" (PDF). CDC. Retrieved 18 May 2018.
  29. ^ Malden DE, Hong V, Lewin BJ, Ackerson BK, Lipsitch M, Lewnard JA, et al. (24 June 2022). "Hospitalization and Emergency Department Encounters for COVID-19 After Paxlovid Treatment — California, December 2021–May 2022". MMWR. Morbidity and Mortality Weekly Report. 71 (25): 830–833. doi:10.15585/mmwr.mm7125e2. ISSN 0149-2195. PMID 35737591.
  30. ^ Statistics Canada (2023). "Exploring the intersectionality of characteristics among those who experienced opioid overdoses: A cluster analysis". Health Reports. 34 (3). Government of Canada: 3–14. doi:10.25318/82-003-X202300300001-ENG. PMID 36921072.