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Opioid use disorder

Last reviewed: 21 Jul 2025
Last updated: 19 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • 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
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

  • young age
  • history of a mental health disorder
  • history of substance use
  • long-term opioid therapy
  • childhood trauma
  • family history of substance use
Full details

Diagnostic tests

1st tests to order

  • 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
Full details

Tests to consider

  • rapid plasma reagin
  • blood cultures
  • beta human chorionic gonadotropin (beta-hCG)
Full details

Treatment algorithm

ACUTE

nonpregnant adults in inpatient/outpatient detoxification program

nonpregnant adolescents in inpatient/outpatient detoxification program

pregnant women in inpatient/outpatient detoxification program

ONGOING

nonpregnant adults after detoxification program

nonpregnant adolescents after detoxification program

pregnant women after detoxification program

Contributors

Authors

Ashwin A. Patkar, MD, MRCPsych

Associate Professor

Medical Director

Duke Addictions Program

Department of Psychiatry and Behavioral Sciences

Duke University Medical Center

Durham

NC

Disclosures

AAP has received payments for being Consultant to Radeas Labs that performs drug testing and is a member of the Speakers Bureau for Janssen Pharmaceuticals, manufacturer of Spravato, and Otsuka Pharmaceuticals, manufacturer of Rexulti. AP is a stockholder in Generys Biopharmaceuticals that has compounds in development for drug addiction.

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

Declarações

JCL declares that he has no competing interests.

Douglas M. Burgess, MD

Assistant Professor

Department of Psychiatry

University of Missouri - Kansas City

Medical Director

Outpatient Behavioral Health

Truman Medical Centers

Kansas City

MO

Declarações

DMB declares that he has no competing interests.

Agradecimentos

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

Declarações

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.

Revisores

Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD

Consultant Psychiatrist and Honorary Senior Lecturer

Institute of Psychiatry

King's College London

London

UK

Declarações

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

Declarações

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

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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

World Health Organization. International statistical classification of diseases and health related problems (ICD). 11th revision. Jan 2022 [Internet publication].Texto completo

Substance Abuse and Mental Health Services Administration. Federal guidelines for opioid treatment programs. Mar 2015 [internet publication].Texto completo

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

Gowing L, Ali R, White JM, et al. Buprenorphine for managing opioid withdrawal. Cochrane Database Syst Rev. 2017 Feb 21;2(2):CD002025.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Opioid use disorder images
  • Diagnósticos diferenciais

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  • Diretrizes

    • Diagnostic and statistical manual of mental disorders, 5th edition, text revision
    • Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Opioid-use disorder

    Mais Folhetos informativos para os pacientes
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