Opioid use disorder
Opioids posit a high potential for dependence and abuse. Most opioids are classified as Schedule II substances according to the US Controlled Substances Act. Physicians should exercise extreme caution before prescribing opioids for patients, given their significant abuse potential and adverse side-effect profile. Resources for opioid prescribing guidelines, as well as nonopioid alternatives, can be found here.
Opioid drugs include morphine and codeine (natural opiates); heroin, oxycodone, oxymorphone, hydrocodone, hydromorphone, and buprenorphine (semisynthetic opioids); and meperidine (Demerol), fentanyl and fentanyl analogs such as carfentanil, and methadone (synthetic opioids). Routes of drug administration include oral, inhalation (smoking), intranasal (snorting), subcutaneous ("skin popping"), and intravenous.
Opioid use disorder is the habitual use of any substances within the opioid class of drugs leading to a state of opioid intoxication and/or dysfunctional behavior, with significant long-term adverse effects. The disorder can range from mild to severe. The individual may experience a growing tolerance and onset of withdrawal symptoms. Opioid withdrawal syndrome may present with profuse sweating, hypertension, nausea, vomiting, fever, anxiety, and lacrimation. (For discussion of withdrawal symptoms in neonates due to maternal use of opioids during pregnancy, see Neonatal abstinence syndrome.)
Opioid use disorder is a growing epidemic in the United States, with rates of use and overdose rising significantly every year. In 2015, it was estimated that 2.6 million people over 12 years of age were addicted to opioids. Patients dependent on opioid pain medications who are unable to obtain prescriptions legally may pursue opioids through alternate means. Persons using diverted opioids or street drugs face a greater risk of overdose and death due to inconsistency of strength / dosage, drug interactions, or contamination of supply. Cases of lead poisoning from lead-contaminated opium are increasing, especially in the Middle East and also in Europe, Australia, and North America. Newer strains of synthetic opioids or contaminated street drugs are more resistant to naloxone (Narcan) rescue treatments, thus increasing the lethality of opioid overdose.
Patients with this disorder may have an increased risk of various general medical conditions.
Note: Children of parents with opioid use disorder are at increased risk for neglect and/or abuse.
F11.20 – Opioid dependence, uncomplicated
5602001 – Opioid abuse
Intoxication / overdose from other drugs or medications:
- Ethanol, methanol, ethylene glycol, etc
- Phencyclidine (PCP)
- Sedative-hypnotic drugs – zolpidem, zaleplon, eszopiclone, etc
- Antidepressants – selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclics, etc (see serotonin syndrome)
- Antihistamines (see anticholinergic syndrome)
Seizure – Consider as alternative cause of loss of consciousness.
Possible other causes of altered mental status / unresponsiveness – cerebrovascular accident, diabetic ketoacidosis, cardiac arrhythmia, myocardial infarction, hepatic encephalopathy, uremia, dementia, delirium, severe sepsis
Endocarditis – Opioid users are at increased risk for bloodborne infections, including MRSA, that may result in endocarditis.
HIV / AIDS, hepatitis B, hepatitis C, syphilis – Intravenous drug use puts individuals at risk for contracting bloodborne infections.