Opioid use disorder

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Synopsis

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Opioid drugs are derived from poppy plants, or they may be semi-synthetic or synthetic. Opioid analgesics have commonly been prescribed to provide relief from moderate to severe pain (which may be acute or chronic) from trauma, cancer, and other diseases that are unresponsive to other medications; they also have euphoric effects. Since they carry a high potential for dependence and abuse, most opioids are classified as Schedule II substances according to the Controlled Substances Act. 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 (semi-synthetic 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 in a group of opioid 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.)

Some patients may physically harm themselves in an attempt to obtain prescription opiates. 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. 

A 2019 CDC report characterizes drug use (methamphetamine, injection drug, and heroin use) and heterosexual syphilis transmission as connected and interrelated epidemics in the United States. Consider syphilis screening in patients with substance abuse disorders.

Opioid toxicity can be life-threatening. Opioid users who are experiencing withdrawal or detoxification are most prone to overdose and death if they take their usual dosage.

Drugs approved by the US Food and Drug Administration (FDA) for medication-assisted treatment for opioid addiction include methadone, buprenorphine, naltrexone, and lofexidine.

Devices with cranial nerve stimulation may help reduce symptoms of acute opioid withdrawal.

Note: Children of parents with opioid use disorder are at increased risk for neglect and/or abuse.

Codes

ICD10CM:
F11.20 – Opioid dependence, uncomplicated

SNOMEDCT:
5602001 – Opioid abuse

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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