Opioid use disorder

Opioid use disorder
Other names	Opioid addiction,[1] problematic opioid use,[1] opioid abuse,[2] opioid dependence[3]
Molecular structure of morphine
Specialty	Addiction medicine, psychiatry
Symptoms	Strong desire to use opioids, increased tolerance to opioids, failure to meet obligations, trouble with reducing use, withdrawal syndrome with discontinuation[4][5]
Complications	Opioid overdose, hepatitis C, marriage problems, unemployment, poverty[4][5]
Duration	Long term[6]
Causes	Opioids[3]
Diagnostic method	Based on criteria in the DSM-5[4]
Differential diagnosis	Alcoholism
Treatment	Opioid replacement therapy, behavioral therapy, twelve-step programs, take home naloxone[7][8][9]
Medication	Buprenorphine, methadone, naltrexone[7][10]
Frequency	16 million[11]
Deaths	120,000[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. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood.^[12] 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.^[16][17] Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5.^[17]

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).^[18] It is recommended for clinicians to refer to daily MMEs when prescribing opioids to decrease the risk of misuse and adverse effects.^[19] Long-term opioid use occurs in about 4% of people following their use for trauma or surgery-related pain.^[20] In the United States, most heroin users begin by using prescription opioids that may also be bought illegally.^[21][22]

People with opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine.^[23] Such treatment reduces the risk of death.^[23] 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.^[24] 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.^[25]

This disorder is much more prevalent than first realized.^[26] 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 overdosed on heroin.^[27][28] In 2022, the U.S. reported 81,806 deaths caused by opioid-related overdoses. Canada reported 32,632 opioid-related deaths between January 2016 and June 2022.^[29][30]