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Opioid use disorder

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  • Обзор
  • Теория
  • Диагноз
  • Лечение
  • Последующее наблюдение
  • Источники
Последний просмотренный: 15 Nov 2025
Last updated: 12 Nov 2025

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • maladaptive pattern of opioid use
  • high Addiction Severity Index (ASI) score
  • blunting of pleasurable opioid effects
  • miosis
  • dilated pupils
  • shallow/slow respirations or apnea
  • needle marks, scars, or necrosis on skin near veins
  • unconsciousness
  • pulse <40 bpm
Полная информация

Другие диагностические факторы

  • chronic constipation
  • weight loss
  • nausea/vomiting
  • sedation
  • restless sleep/insomnia
  • memory impairment
  • sneezing
  • yawning
  • abdominal cramps
  • diarrhea
  • backache/muscle spasms
  • hot and cold flashes
  • hypotension
  • sedation
  • confusion
  • slurred speech
  • aggressive behavior
  • excess perspiration or lacrimation
  • rhinorrhea
  • restlessness
  • piloerection
  • tachypnea
  • hypertension
  • arrhythmias
  • seizures
Полная информация

Факторы риска

  • young age
  • history of a mental health disorder
  • history of substance use
  • long-term opioid therapy
  • childhood trauma
  • homelessness/housing instability
  • family history of substance use
  • criminal justice system involvement
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • Addiction Severity Index (ASI)
  • clinical opiate withdrawal scale (COWS)
  • urine or saliva drug screen
  • gas chromatography-mass spectroscopy (GC-MS)
  • serum electrolytes
  • CBC
  • BUN/creatinine
  • LFTs
  • hepatitis serology
  • HIV serology
  • purified protein derivative (PPD) skin test
Полная информация

Исследования, проведение которых нужно рассмотреть

  • rapid plasma reagin
  • blood cultures
  • beta human chorionic gonadotropin (beta-hCG)
Полная информация

Алгоритм лечения

Острый

nonpregnant adults in inpatient/outpatient medically supervised withdrawal program

nonpregnant adolescents in inpatient/outpatient medically supervised withdrawal program

pregnant women in inpatient/outpatient medically supervised withdrawal program

nonpregnant adults after medically supervised withdrawal or suitable for initial or early maintenance therapy

nonpregnant adolescents after medically supervised withdrawal or suitable for initial or early maintenance therapy

pregnant women after medically supervised withdrawal or suitable for initial or early maintenance therapy

Составители

Авторы

Ashwin A. Patkar, MD, MRCPsych

Associate Professor

Medical Director

Duke Addictions Program

Department of Psychiatry and Behavioral Sciences

Duke University Medical Center

Durham

NC

Раскрытие информации

AAP is a stockholder in Generys Biopharmaceuticals that has compounds in development for drug addiction (for stimulant use disorder). AAP provides expert testimony for United States Federal Agencies and is an expert reviewer for North Carolina Medical Board. AAP is the author of references cited in this topic.

Jonathan C. Lee, MD

Medical Director

The Farley Center at Williamsburg Place

Williamsburg

Community Assistant Professor

Department of Family Medicine

Eastern Virginia Medical School

Norfolk

Assistant Clinical Professor

Department of Psychiatry

Virginia Commonwealth University

Richmond

VA

Affiliate Assistant Professor

Department of Psychiatric Medicine

East Carolina University

Greenville

NC

Раскрытие информации

JCL declares that he has no competing interests.

Isabel Patton, B.S, B.A

Medical Assistant

Department of Psychology

Emory University

Atlanta

Georgia

Раскрытие информации

IP declares being an employee of AAP who has declared interests above. IP has co-authored a manuscript with AAP which has not yet been published.

Выражение благодарностей

Dr Ashwin A. Patkar, Dr Jonathan C. Lee, and Isabel Patton would like to gratefully acknowledge Dr Douglas M. Burgess, Dr Kamal Bhatia and Dr Srilakshmi Musham, previous contributors to this topic.

Раскрытие информации

DMB declares that he has no competing interests. KB declares that he has received grant support from National Institutes of Health, Lundbeck, Pfizer, and Titan Pharmaceuticals. SM declares that she has received grant support from Pfizer, Titan Pharmaceuticals, Shire, and the Forest Research Institute.

Рецензенты

Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD

Consultant Psychiatrist and Honorary Senior Lecturer

Institute of Psychiatry

King's College London

London

UK

Раскрытие информации

CK declares that he has no competing interests.

George E. Woody, MD

Emeritus Professor

Department of Psychiatry

Perelman School of Medicine

University of Pennsylvania

Philadelphia

PA

Раскрытие информации

GEW declares that he has no competing interests. GEW is an author of a number of references cited in this topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.Полный текст

World Health Organization. WHO releases 2025 update to the International Classification of Diseases (ICD-11). Feb 2025 [Internet publication].Полный текст

American Society of Addiction Medicine. The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update. 2020 Mar/Apr;14(2S suppl 1):1-91.Полный текст  Аннотация

Substance Abuse and Mental Health Services Administration. TIP 63: medications for opioid use disorder. Jul 2021 [internet publication].Полный текст

National Institute for Health and Care Excellence. Drug misuse in over 16s: opioid detoxification. Jul 2007 (reaffirmed 2019) [internet publication].Полный текст

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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