Opioid use disorder is a problematic pattern of opioid use leading to clinically significant impairment or distress. Heroin and prescription opioid misuse is a major health concern.
From a diagnostic perspective, it is imperative that the physician understands the criteria for opioid use disorder.
Comorbid medical and psychiatric illnesses, as well as other substance use disorders, should be assessed.
Physicians should be aware of methods for screening and detection of opioid use in clinical settings.
Evidence-based treatments include detoxification, maintenance therapy with a relapse prevention medication, and psychosocial treatment.
Treatment requires a multidisciplinary approach, is long term, and involves modifying deeply ingrained behaviors through the use of medications and psychosocial treatments.
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 abused because of their euphoric effects. Naturally derived opiates are commonly abused 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.
History and exam
Key diagnostic factors
- maladaptive pattern of opioid use
- high Addiction Severity Index (ASI) score
- blunting of pleasurable opioid effects
- dilated pupils
- shallow/slow respirations or apnea
- needle marks, scars, or necrosis on skin near veins
- pulse <40 bpm
Other diagnostic factors
- chronic constipation
- weight loss
- restless sleep/insomnia
- memory impairment
- abdominal cramps
- backache/muscle spasms
- hot and cold flashes
- slurred speech
- aggressive behavior
- excess perspiration or lacrimation
- young age
- history of a mental health disorder
- history of substance use
- long-term opioid therapy
- childhood trauma
- family history of substance use
1st investigations to order
- urine or saliva drug screen
- gas chromatography-mass spectroscopy (GC-MS)
- serum electrolytes
- hepatitis serology
- HIV serology
- purified protein derivative (PPD) skin test
Investigations to consider
- rapid plasma reagin
- blood cultures
- beta human chorionic gonadotropin (beta-hCG)
nonpregnant adults in inpatient/outpatient detoxification program
nonpregnant adolescents in inpatient/outpatient detoxification program
pregnant women in inpatient/outpatient detoxification program
nonpregnant adults after detoxification program
nonpregnant adolescents after detoxification program
pregnant women after detoxification program
- Alcohol intoxication
- Sedative intoxication
- Anticholinergic intoxication
- 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
Opioid-use disorderMore Patient leaflets
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