Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis
- Eric Strain, MD
Eric Strain, MD
- Director, Johns Hopkins Center for Substance Abuse Treatment and Research
- Medical Director, Behavioral Pharmacology Research Unit
- Johns Hopkins University School of Medicine
Opioids, used medically for pain relief, have analgesic and central nervous system (CNS) depressant effects as well as the potential to cause euphoria. Opioid use disorder (OUD) can involve misuse of prescribed opioid medications, use of diverted opioid medications, or use of illicitly obtained heroin. OUD is typically a chronic, relapsing illness, associated with significantly increased rates of morbidity and mortality.
In patients with OUD who have achieved abstinence through medically supervised withdrawal or by other means, maintenance treatment aims to prevent relapse. Options for long-term maintenance treatment include an opioid agonist (ie, methadone or buprenorphine), an opioid antagonist (naltrexone), or nonmedication, abstinence-based treatment.
The psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) opioid abuse and opioid dependence were replaced by one diagnosis, opioid use disorder, in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) .
This topic describes the epidemiology, pharmacology, screening, assessment, and diagnosis of opioid use disorder. Treatment of the disorder is discussed separately. Management of intoxication and withdrawal from opioids is discussed separately. Addiction in impaired clinicians and abuse of prescription drugs are also discussed separately. (See "Pharmacotherapy for opioid use disorder" and "Acute opioid intoxication in adults" and "Opioid withdrawal in the emergency setting" and "Medically supervised opioid withdrawal during treatment for addiction" and "Substance use disorders in physicians: Epidemiology, clinical manifestations, identification, and engagement" and "Substance use disorders in physicians: Assessment and treatment" and "Prescription drug misuse: Epidemiology, prevention, identification, and management".)
●Opioid – The term opioid refers to natural and synthetic substances that act at one of the three main opioid receptor systems (mu, kappa, delta). Opioids can have analgesic and central nervous system (CNS) depressant effects as well as the potential to cause euphoria.
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- Mechanism of action
- Genetic polymorphisms and drug interactions
- CLINICAL MANIFESTATIONS
- HEALTH CONSEQUENCES
- Narcotic bowel syndrome
- Overdose and mortality
- Substance use history
- - Consumption
- - Route of administration
- - Tolerance
- - Last use
- - Treatment history
- Physical examination
- Laboratory evaluation
- - Opioid detection
- - Health risks
- Prescription monitoring programs
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS