Back اضطراب تعاطي المواد الأفيونية Arabic অ’পিঅইড আসক্তি AS Разстройства, свързани с употребата на опиоиди Bulgarian Addicció als opioides Catalan Trastorno por consumo de opioides Spanish Opioidivieroitusoireyhtymä Finnish התמכרות לאופיואידים HE オピオイド使用障害 Japanese ଓପିଅଏଡ ବ୍ୟବ‌ହାର ବେମାରୀ OR Dependência de opioides Portuguese

Opioid use disorder

Opioid use disorder
Other namesOpioid addiction,[1] problematic opioid use,[1] opioid abuse,[2] opioid dependence[3]
Molecular structure of morphine
SpecialtyAddiction medicine, psychiatry
SymptomsStrong desire to use opioids, increased tolerance to opioids, failure to meet obligations, trouble with reducing use, withdrawal syndrome with discontinuation[4][5]
ComplicationsOpioid overdose, hepatitis C, marriage problems, unemployment, poverty[4][5]
DurationLong term[6]
CausesOpioids[3]
Diagnostic methodBased on criteria in the DSM-5[4]
Differential diagnosisAlcoholism
TreatmentOpioid replacement therapy, behavioral therapy, twelve-step programs, take home naloxone[7][8][9]
MedicationBuprenorphine, methadone, naltrexone[7][10]
Frequency16 million[11]
Deaths120,000[11]

Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids.[12] Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood.[5] Addiction and dependence are important components of opioid use disorder.[13]

Risk factors include a history of opioid misuse, current opioid misuse, young age, socioeconomic status, race, untreated psychiatric disorders, and environments that promote misuse (social, family, professional, etc.).[14][15] Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems meeting social or professional responsibilities.[5][4] Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5.[4]

Opioids include substances such as heroin, morphine, fentanyl, codeine, dihydrocodeine, oxycodone, and hydrocodone.[5][6] A useful standard for the relative strength of different opioids is morphine milligram equivalents (MME).[16] It is recommended for clinicians to refer to daily MMEs when prescribing opioids to decrease the risk of misuse and adverse effects.[17]

Long-term opioid use occurs in about 4% of people following their use for trauma or surgery-related pain.[18] In the United States, most heroin users begin by using prescription opioids that may also be bought illegally.[19][20]

People with an opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine.[21] Such treatment reduces the risk of death.[21] Additionally, they may benefit from cognitive behavioral therapy, other forms of support from mental health professionals such as individual or group therapy, twelve-step programs, and other peer support programs.[22] The medication naltrexone may also be useful to prevent relapse.[10][8] Naloxone is useful for treating an opioid overdose and giving those at risk naloxone to take home is beneficial.[23] In 2020, the CDC estimated that nearly 3 million people in the U.S. were living with OUD and more than 65,000 people died by opioid overdose, of whom more than 15,000 were heroin overdoses.[24][25]

  1. ^ a b "FDA approves first buprenorphine implant for treatment of opioid dependence". U.S. Food and Drug Administration (FDA) (Press release). 26 May 2016. Retrieved 16 March 2017.
  2. ^ "3 Patient Assessment". Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). 2004.
  3. ^ a b "Commonly Used Terms". www.cdc.gov. 29 August 2017. Retrieved 16 July 2018.
  4. ^ a b c d e American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 540–546, ISBN 978-0-89042-555-8
  5. ^ a b c d e Substance Use and Mental Health Services Administration (30 September 2014). "Substance Use Disorders".
  6. ^ a b "Opioid Use and Opioid Use Disorder in Pregnancy". ACOG. August 2017. Retrieved 16 July 2018.
  7. ^ a b Cite error: The named reference BMJ2017Re2 was invoked but never defined (see the help page).
  8. ^ a b "Treatment for Substance Use Disorders". Substance Abuse and Mental Health Services Administration. October 2014.
  9. ^ McDonald R, Strang J (July 2016). "Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria". Addiction. 111 (7): 1177–87. doi:10.1111/add.13326. PMC 5071734. PMID 27028542.
  10. ^ a b Sharma B, Bruner A, Barnett G, Fishman M (July 2016). "Opioid Use Disorders". Child and Adolescent Psychiatric Clinics of North America. 25 (3): 473–87. doi:10.1016/j.chc.2016.03.002. PMC 4920977. PMID 27338968.
  11. ^ a b Dydyk AM, Jain NK, Gupta M (2022), "Opioid Use Disorder", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 31985959, NCBI NBK553166, retrieved 16 November 2022
  12. ^ Diagnostic and statistical manual of mental disorders : DSM-5. Arlington, VA : American Psychiatric Association. 2013. ISBN 978-0-89042-554-1.
  13. ^ Cite error: The named reference Brain disease was invoked but never defined (see the help page).
  14. ^ Webster LR (November 2017). "Risk Factors for Opioid-Use Disorder and Overdose". Anesthesia and Analgesia. 125 (5): 1741–1748. doi:10.1213/ANE.0000000000002496. PMID 29049118. S2CID 19635834.
  15. ^ Santoro TN, Santoro JD (2018). "Racial Bias in the US Opioid Epidemic: A Review of the History of Systemic Bias and Implications for Care". Cureus. 10 (12): e3733. doi:10.7759/cureus.3733. PMC 6384031. PMID 30800543.
  16. ^ Cite error: The named reference pmid36327391 was invoked but never defined (see the help page).
  17. ^ "A Prescriber's Guide to Medicare Prescription Drug (Part D) Opioid Policies" (PDF).
  18. ^ Mohamadi A, Chan JJ, Lian J, Wright CL, Marin AM, Rodriguez EK, von Keudell A, Nazarian A (August 2018). "Risk Factors and Pooled Rate of Prolonged Opioid Use Following Trauma or Surgery: A Systematic Review and Meta-(Regression) Analysis". The Journal of Bone and Joint Surgery. American Volume. 100 (15): 1332–1340. doi:10.2106/JBJS.17.01239. PMID 30063596. S2CID 51891341.
  19. ^ "Prescription opioid use is a risk factor for heroin use". National Institute on Drug Abuse. October 2015. Retrieved 16 July 2018.
  20. ^ Hughes E (2 May 2018). "The Pain Hustlers". New York Times. Retrieved 3 May 2018.
  21. ^ a b "Trends in the Use of Methadone, Buprenorphine, and Extended-release Naltrexone at Substance Abuse Treatment Facilities: 2003–2015 (Update)". www.samhsa.gov. Retrieved 16 November 2022.
  22. ^ Donovan DM, Ingalsbe MH, Benbow J, Daley DC (2013). "12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview". Social Work in Public Health. 28 (3–4): 313–332. doi:10.1080/19371918.2013.774663. PMC 3753023. PMID 23731422.
  23. ^ "Opioid Overdose Prevention Programs Providing Naloxone to Laypersons — United States, 2014". www.cdc.gov. Retrieved 16 November 2022.
  24. ^ CDC (30 August 2022). "Disease of the Week – Opioid Use Disorder". Centers for Disease Control and Prevention. Retrieved 16 November 2022.
  25. ^ "Data Brief 294. Drug Overdose Deaths in the United States, 1999–2016" (PDF). CDC. Retrieved 18 May 2018.