2020 Nov 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.
ABSTRACT
Opioid use disorder is the chronic use of opioids that causes clinically significant distress or impairment. Opioid use disorders affect over 16 million people worldwide, over 2.1 million in the United States, and there are over 120,000 deaths worldwide annually attributed to opioids. There are as many patients using opioids regularly as there are patients diagnosed with obsessive-compulsive disorder, psoriatic arthritis, and epilepsy in the United States. Opioid use disorder diagnosis is based on the American Psychiatric Association DSM-5 and includes a desire to obtain and take opioids despite social and professional consequences. Examples of opioids include heroin, morphine, codeine, fentanyl, and synthetic opioids such as oxycodone. Opioid use disorder consists of an overpowering desire to use opioids, increased opioid tolerance, and withdrawal syndrome when discontinued. Opioid use disorder includes dependence and addiction with addiction representing the most severe form of the disorder. The disease is treated with opioid replacement therapy using buprenorphine or methadone, which reduces the risk of morbidity and mortality. Naltrexone may be useful to prevent relapse. Naloxone is used to treat opioid overdose. Nonpharmacologic behavioral therapy is also beneficial. Patients with opioid use disorder often benefit from twelve-step programs, peer support, and mental health professionals, individual and group therapy. The significant prevalence of opioid use disorder stresses the importance of clinicians to understand more about opioids and be able to refer patients to available treatment centers for substance use disorders, as well as be weaned from prescription opioids due to their addictive potential and significant side effect profile. The opioid-use disorder typically involves periods of exacerbation and remission, but the vulnerability to relapse never disappears. The pattern is similar to other chronic relapsing conditions; signs and symptoms can be severe, and long-term adherence to treatment is often intermittent. Patients with opioid problems may have extended periods of abstinence and usually do well. However, there is a chronic risk of accidental overdose, trauma, suicide, and infectious diseases. The risk decreases with abstinence from opioids.