User:Gbush2116/Opioid use disorder

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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. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.

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.). Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems meeting social or professional responsibilities. Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5.

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

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

People with an opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine. Such treatment reduces the risk of death. 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. The medication naltrexone may also be useful to prevent relapse. Naloxone is useful for treating an opioid overdose and giving those at risk naloxone to take home is beneficial. 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.

Signs and symptoms

[edit]

Opioid intoxication

[edit] Signs and symptoms of opioid intoxication include:

• Decreased perception of pain
• Euphoria
• Confusion
• Desire to sleep
• Nausea
• Constipation
• Miosis (pupil constriction)
• Bradycardia (slow heart rate)
• Hypotension (low blood pressure)
• Hypokinesis (slowed movement)
• Head nodding
• Slurred speech
• Hypothermia (low body temperature)

Opioid overdose

[edit] Main article: Opioid overdose

Signs and symptoms of opioid overdose include, but are not limited to:

• Pin-point pupils may occur. Patient presenting with dilated pupils may still be experiencing an opioid overdose.
• Decreased heart rate
• Decreased body temperature
• Decreased breathing
• Altered level of consciousness. People may be unresponsive or unconscious.
• Pulmonary edema (fluid accumulation in the lungs)
• Shock
• Death

Withdrawal

[edit] Main article: Opioid withdrawal

Opioid withdrawal can occur with a sudden decrease in, or cessation of, opioids after prolonged use. Onset of withdrawal depends on the half-life of the opioid that was used last. With heroin this typically occurs five hours after use; with methadone, it may take two days. The length of time that major symptoms occur also depends on the opioid used. For heroin withdrawal, symptoms are typically greatest at two to four days and can last up to two weeks. Less significant symptoms may remain for an even longer period, in which case the withdrawal is known as post-acute-withdrawal syndrome.

• Agitation
• Anxiety
• Muscle pains
• Increased tearing
• Trouble sleeping
• Runny nose
• Sweating
• Yawning
• Goose bumps
• Dilated pupils
• Diarrhea
• Fast heart rate
• High blood pressure
• Abdominal cramps
• Shakiness
• Cravings
• Sneezing
• Bone pain
• Increased body temperature
• Hyperalgesia
• Ptosis (drooping eyelids)
• Teeth chattering
• Emotional pain
• Stress
• Weakness
• Malaise
• Alexithymia
• Dysphoria

Treatment of withdrawal may include methadone and buprenorphine. Medications for nausea or diarrhea may also be used.

Diagnosis

[edit] The DSM-5 guidelines for the diagnosis of opioid use disorder require that the individual has a significant impairment or distress related to opioid uses. To make the diagnosis two or more of 11 criteria must be present in a given year:

1. More opioids are taken than intended
2. The individual is unable to decrease the number of opioids used
3. Large amounts of time are spent trying to obtain opioids, use opioids, or recover from taking them
4. The individual has cravings for opioids
5. Difficulty fulfilling professional duties at work or school
6. Continued use of opioids leading to social and interpersonal consequences
7. Decreased social or recreational activities
8. Using opioids despite being in physically dangerous settings
9. Continued use despite opioids worsening physical or psychological health (i.e. depression, constipation)
10. Tolerance
11. Withdrawal

The severity can be classified as mild, moderate, or severe based on the number of criteria present. The tolerance and withdrawal criteria are not considered to be met for individuals taking opioids solely under appropriate medical supervision. Addiction and dependence are components of a substance use disorder; addiction is the more severe form.

Cause

[edit] Opioid use disorder can develop as a result of self-medication. Scoring systems have been derived to assess the likelihood of opiate addiction in chronic pain patients. Healthcare practitioners have long been aware that despite the effective use of opioids for managing pain, empirical evidence supporting long-term opioid use is minimal. Many studies of patients with chronic pain have failed to show any sustained improvement in their pain or ability to function with long-term opioid use.

According to position papers on the treatment of opioid dependence published by the United Nations Office on Drugs and Crime and the World Health Organization, care providers should not treat opioid use disorder as the result of a weak moral character or will but as a medical condition. Some evidence suggests the possibility that opioid use disorders occur due to genetic or other chemical mechanisms that may be difficult to identify or change, such as dysregulation of brain circuitry involving reward and volition. Research using rodents as test subjects suggest that exposure to ongoing psychological stress during gestation, could have an effect on opioid reward systems. But the exact mechanisms involved are unclear, leading to debate over the influence of biology and free will.

Article body

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. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.

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.). Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems meeting social or professional responsibilities. Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5.

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

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

People with an opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine. Such treatment reduces the risk of death. 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. The medication naltrexone may also be useful to prevent relapse. Naloxone is useful for treating an opioid overdose and giving those at risk naloxone to take home is beneficial. 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. In 2022 the United states reported 81,806 deaths caused by opioid related overdoses, Canada reports 32,632 opioid related deaths between January 2016 and June 2022.

The stigma surrounding addiction can heavily influence opioid addicts not to seek help. Many people view addiction as a moral failing rather than a medical condition, which can lead to feelings of shame and isolation. This stigma can also affect family members, making it difficult for them to support their loved ones effectively.

Accessing appropriate treatment is often a significant barrier. Factors include:

• Availability of services: In many areas, especially rural regions, there is a lack of treatment facilities or qualified healthcare providers who specialize in opioid use disorder.
• Insurance coverage: People without insurance or those whose plans do not cover substance use disorder treatment may struggle to find affordable care.
• Transportation: For many, getting to treatment facilities can be challenging due to a lack of transportation options.
• Public stigma: Many communities may advocate against establishing treatment programs in their area due to stigma and perceptions of individuals with substance use disorders.

The Comprehensive Addiction and Recovery Act (CARA) was passed in 2016, with the aim of removing treatment barriers by allocating federal funds to increase accessibility to Medication Opioid Use Disorder (MOUD) treatment in rural areas. Telehealth could be a beneficial treatment alternative, especially to individuals in rural areas with limited access MOUD treatment.

The variety of treatment modalities available for OUD—such as medication-assisted treatment (MAT), counseling, and residential programs—can be overwhelming. Patients may have difficulty understanding which option best suits them, leading to confusion and potential disengagement from the treatment process. Withdrawal symptoms can be severe and uncomfortable, leading many people to relapse before they complete detoxification or engage fully in recovery programs. The fear of withdrawal often prevents people from seeking help altogether.

References

Instructor Feedback:

I have made suggested edits below. You will need to verify that usage of the term lifelong is justified. If not, please adjust. You have cited an example of appropriate, peer-reviewed secondary literature published in the last 10 years. There is a citation error you will need to fix. Click on the citation and when the popup box appears, click edit. You will need to manually adjust the date. The platform wants dd-mo-yr. You may have to put "01" for the date if the journal didn't indicate the exact day of publication. I do encourage you to review the final assignment rubric as you continue to work on edits to ensure you are meeting all of the assignment requirements.

Research using preclinical animal models suggests that exposure to ongoing psychological stress during gestation, could have a lifelong (true?) effect on opioid reward systems.