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.).^[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]

Cause[edit]

Opioid use disorder can develop as a result of self-medication.^[33] Scoring systems have been derived to assess the likelihood of opiate addiction in chronic pain patients.^[34] 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.^{[35][36][37][38][39]} 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.^{[36][40][41][42][39]}


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.^[15][43][44] 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. But the exact mechanisms involved are unclear, leading to debate over the influence of biology and free will.^[45][46]