“Opioid” is a term for a number of natural substances (originally derived from the opium poppy) and their semisynthetic and synthetic analogs that bind to specific opioid receptors. Opioids are potent analgesics that are also common drugs of abuse because of their wide availability and euphoriant properties. See also Opioid Analgesics and Opioid Toxicity and Withdrawal.
chronic pain requiring long-term use should not be routinely labeled addicts, although they commonly have tolerance and physical dependence. People who take opioids parenterally are at risk of all the complications of injection drug use.
The problem of opioid use is a global concern, and in the US specifically, opioid use and deaths from overdose have increased significantly over recent years.
Opioid use disorder
Opioid use disorder involves compulsive, long-term self-administration of opioids for nonmedical purposes. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) considers opioid use disorder to be present if the pattern of use causes clinically significant impairment or distress as manifested by the presence of ≥ 2 of the following over a 12-month period:
Taking opioids in larger amounts or for a longer time than intended
Persistently desiring or unsuccessfully attempting to decrease opioid use
Spending a great deal of time obtaining, using, or recovering from opioids
Craving opioids
Failing repeatedly to meet obligations at work, home, or school because of opioids
Continuing to use opioids despite having recurrent social or interpersonal problems because of opioids
Giving up important social, work, or recreational activities because of opioids
Using opioids in physically hazardous situations
Continuing to use opioids despite having a physical or mental disorder caused or worsened by opioids
Having tolerance to opioids (not a criterion when use is medically appropriate)
Having opioid withdrawal symptoms or taking opioids because of withdrawal
Treatment and Rehabilitation for Opioid Use Disorder
For severe, relapsing dependence, maintenance preferred to opioid withdrawal and detoxification
Ongoing counseling and support
Physicians must be fully aware of federal, state, and local regulations concerning use of an opioid drug to treat someone with a substance use disorder. To comply, physicians must establish the existence of physical opioid dependence. In the US, treatment is further complicated by negative societal attitudes toward people who have substance use disorders (including the attitudes of some law enforcement officers, physicians, and other health care practitioners) and toward treatment programs. Physicians should refer opioid-dependent patients to specialized treatment centers. If trained to do so, physicians may provide office-based treatment for selected patients.
Maintenance
Eligibility criteria include the following:
A positive drug screen for opioids
Physical dependence for > 1 year of continuous opioid use or intermittent use for even longer
Evidence of withdrawal or physical findings confirming drug use
Clinicians and patients need to decide whether a withdrawal (detoxification) or opioid maintenance approach is indicated. Generally, patients with severe, chronic, relapsing dependence do much better with opioid maintenance. Withdrawal and detoxification, although effective in the short term, have poor outcomes in patients with severe opioid dependence. Whichever course is chosen, it must be accompanied by ongoing counseling and supportive measures.
methadone
The US Substance Abuse and Mental Health Services Administration (SAMHSA)US Department of Health and Human Services.
Support
Most treatment of opioid dependence occurs in outpatient settings, typically in licensed opioid maintenance programs but increasingly in physician’s offices.
The therapeutic community concept, pioneered by such centers as Samaritan Daytop Village and Phoenix House, involves nondrug treatment in communal residential centers, where drug users receive training, education, and redirection to help them build new lives. Residency is usually 15 months. These communities have helped, even transformed, some users. However, initial dropout rates are extremely high. Questions of how well these communities work, how many will be opened, and how much funding society will give remain unanswered.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Phoenix House: Residential therapeutic community in which drug users learn to build new lives.
US Substance Abuse and Mental Health Services Administration (SAMHSA): Includes information on evidence-based practices, and patient and practitioner support. resources
Findtreatment.gov: Listing of licensed US providers of treatment for substance use disorders.
Providers Clinical Support System: Evidence-based training for primary practitioners on prevention and treatment of opioid use disorder.
