Opioid use disorder

Last reviewed: 24 Feb 2023
Last updated: 28 Feb 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • maladaptive pattern of opioid use
  • high Addiction Severity Index (ASI) score
  • blunting of pleasurable opioid effects
  • miosis
  • dilated pupils
  • shallow/slow respirations or apnoea
  • needle marks, scars, or necrosis on skin near veins
  • unconsciousness
  • pulse <40 bpm
More key diagnostic factors

Other diagnostic factors

  • chronic constipation
  • weight loss
  • nausea/vomiting
  • sedation
  • restless sleep/insomnia
  • memory impairment
  • sneezing
  • yawning
  • abdominal cramps
  • diarrhoea
  • backache/muscle spasms
  • hot and cold flashes
  • hypotension
  • sedation
  • confusion
  • slurred speech
  • aggressive behaviour
  • excess perspiration or lacrimation
  • rhinorrhoea
  • restlessness
  • piloerection
  • tachypnoea
  • hypertension
  • arrhythmias
  • seizures
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • urine or saliva drug screen
  • gas chromatography-mass spectroscopy (GC-MS)
  • serum electrolytes
  • FBC
  • urea/creatinine
  • LFTs
  • hepatitis serology
  • HIV serology
  • purified protein derivative (PPD) skin test
More 1st investigations to order

Investigations to consider

  • rapid plasma reagin
  • blood cultures
  • beta human chorionic gonadotrophin (beta-hCG)
More investigations to consider

Treatment algorithm

ACUTE

non-pregnant adults in inpatient/outpatient detoxification programme

non-pregnant adolescents in inpatient/outpatient detoxification programme

pregnant women in inpatient/outpatient detoxification programme

ONGOING

non-pregnant adults after detoxification programme

non-pregnant adolescents after detoxification programme

pregnant women after detoxification programme

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

Disclosures

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

Disclosures

DMB declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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.

Peer reviewers

Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD

Consultant Psychiatrist and Honorary Senior Lecturer

Institute of Psychiatry

King's College London

London

UK

Disclosures

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

Disclosures

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

  • Opioid use disorder images
  • Differentials

    • Alcohol intoxication
    • Sedative intoxication
    • Anticholinergic intoxication
    More Differentials
  • Guidelines

    • Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient
    • Use of long-acting injectable buprenorphine for opioid substitution therapy
    More Guidelines
  • Patient leaflets

    Opioid-use disorder

    More Patient leaflets
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