Opioid use disorder

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Última revisão: 13 Sep 2025

Última atualização: 25 Sep 2025

Opioid use disorder is a significant and rapidly evolving public health concern worldwide, with increasing use of synthetic opioids such as fentanyl driving increases in opioid use disorder and in overdose deaths.

Opioid use disorder is a problematic pattern of opioid use leading to clinically significant impairment or distress.

It is important to assess comorbid medical and psychiatric illnesses, as well as other substance use disorders.

Physicians should be aware of methods for screening and detection of opioid use in clinical settings.

Opioid use disorder is a treatable, chronic disease. Evidence-based treatments include medically supervised withdrawal, maintenance therapy with relapse prevention pharmacotherapy, and psychosocial treatment.

Treatment requires a multidisciplinary approach, is long term, and involves modifying deeply ingrained behaviors through the use of pharmacotherapy and psychosocial treatments.

Definição

An opioid is a synthetic or natural agent that stimulates opioid receptors and produces opium-like effects. Opiates are a type of opioid that are naturally derived from the opium poppy (e.g., codeine, morphine, opium). They are used to treat pain but may also be misused because of their euphoric effects. Naturally derived opiates are commonly misused alongside semisynthetic and synthetic opioids such as fentanyl, heroin (diamorphine), methadone, oxycodone, and hydrocodone. The Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR) defines opioid use disorder as a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least 2 out of 11 criteria within a 12-month period.[1]

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Algoritmo de tratamento

AGUDA

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

Colaboradores

Autores

Ashwin A. Patkar, MD, MRCPsych

Associate Professor

Medical Director

Duke Addictions Program

Department of Psychiatry and Behavioral Sciences

Duke University Medical Center

Durham

Declarações

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

Affiliate Assistant Professor

Department of Psychiatric Medicine

East Carolina University

Greenville

Declarações

JCL declares that he has no competing interests.

Isabel Patton, B.S, B.A

Medical Assistant

Department of Psychology

Emory University

Atlanta

Georgia

Declarações

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.

Agradecimentos

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.

Declarações

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.

Revisores

Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD

Consultant Psychiatrist and Honorary Senior Lecturer

Institute of Psychiatry

King's College London

London

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

Declarações

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.

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.Texto completo

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

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.Texto completo Resumo

Substance Abuse and Mental Health Services Administration. TIP 63: medications for opioid use disorder. Jul 2021 [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

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Alcohol intoxication
- Sedative intoxication
- Anticholinergic intoxication
Mais Diagnósticos diferenciais
Diretrizes
- Management of opioid use disorder: 2024 update to the national clinical practice guideline
- Comprehensive, evidence-based, consensus guidelines for prescription of opioids for chronic non-cancer pain
Mais Diretrizes
Folhetos informativos para os pacientes
Opioid-use disorder
Mais Folhetos informativos para os pacientes
Calculadoras
Clinical Opioid Withdrawal Scale (COWS) for adults and adolescents
Mais Calculadoras
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O uso deste conteúdo está sujeito ao nosso aviso legal

Opioid use disorder

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

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

Colaboradores

Autores

Ashwin A. Patkar, MD, MRCPsych

Declarações

Jonathan C. Lee, MD

Declarações

Isabel Patton, B.S, B.A

Declarações

Agradecimentos

Declarações

Revisores

Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD

Declarações

George E. Woody, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Calculadoras

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice