What is opioid use disorder?
Opioid use disorder (OUD) is a mental health condition marked by problematic opioid use that leads to significant distress or impairment. It involves craving opioids, taking them in larger amounts or over longer periods than intended, developing tolerance, and experiencing withdrawal symptoms when use is reduced or stopped. Although opioids can be prescribed for pain relief, both prescription and illicit opioids may lead to OUD. In the U.S., more than 800,000 people died from drug overdoses between 1999 and 2020, and many more suffer social, occupational, and legal harms. OUD is a chronic but treatable condition through medications and behavioral therapies.
What are opioids?
Opioids are natural or synthetic substances that bind to opioid receptors in the brain to relieve pain and produce euphoria. Commonly used for acute pain after surgery or injury, they can also be prescribed for chronic pain. Long-term use can lead to tolerance (needing higher doses for the same effect) and physical dependence.
Examples of opioids and opiates include:
- Oxycodone
- Fentanyl
- Hydrocodone
- Methadone
- Morphine
- Codeine
- Hydromorphone
What causes opioid use disorder?
Risk factors for developing OUD include:
- Using more medication than prescribed or taking it by injection or snorting
- Longer duration of opioid use
- Personal or family history of substance use disorders
- High stress, anxiety, depression, or PTSD
- History of physical or sexual abuse
- Heavy alcohol or tobacco use
- Easy access to opioids
- Unemployment, low income, or limited healthcare access
Signs of opioid use disorder
Physical signs
- Drowsiness or nodding off
- Weight loss
- Constricted pupils
- Slurred speech
- Poor coordination
- Slow or shallow breathing
- Track marks from injections
- Poor hygiene
Behavioral signs
- Increased secrecy about activities
- Social withdrawal
- New peer group of known drug users
- Neglecting work, school, or home responsibilities
- Risky behaviors, such as driving under the influence
- Financial problems or borrowing money
- Doctor shopping for opioid prescriptions
- Changes in eating or sleeping habits
Psychological signs
- Mood swings from euphoria to irritability or depression
- Anxiety when opioids are unavailable
- Paranoia or distrust of others
- Lack of motivation for previously enjoyed activities
- Persistent depression during withdrawal
Signs of opioid withdrawal
- Restlessness and agitation
- Muscle and bone aches
- Insomnia
- Diarrhea
- Cold flashes and goosebumps
- Nausea and vomiting
- Excessive sweating
How is opioid use disorder diagnosed?
Diagnosis involves:
Clinical interview
- Detailed opioid use history, including source and route
- Behavioral patterns: cravings, failed attempts to cut down, time spent obtaining opioids
- Impact on work, school, home, and social life
Physical examination
- Signs of use or withdrawal, such as track marks and constricted pupils
- Assessment of health complications from opioid use
Diagnostic criteria (DSM-5)
At least two of the following within 12 months:
- Opioids taken in larger amounts or over longer periods than intended
- Persistent desire or unsuccessful efforts to cut down
- Time spent obtaining, using, or recovering from opioids
- Cravings or strong desire to use
- Failure to fulfill major role obligations
- Continued use despite social or interpersonal problems
- Important activities given up or reduced
- Use in physically hazardous situations
- Continued use despite physical or psychological problems
- Tolerance (needing more for same effect)
- Withdrawal or use to relieve withdrawal
Severity is graded as mild (2–3 criteria), moderate (4–5), or severe (6 or more).
How is opioid use disorder treated?
Treatment combines medications and behavioral therapies, often on an outpatient basis:
Medication-assisted treatment (MAT)
- Methadone: long-acting opioid agonist given in specialized clinics
- Buprenorphine: partial opioid agonist, available from certified prescribers
- Naltrexone: opioid antagonist, available as oral or injectable forms
Behavioral therapies
- Cognitive-behavioral therapy (CBT) to change thoughts and behaviors
- Contingency management with positive reinforcement
- Family therapy to improve communication and support
- Support groups such as Narcotics Anonymous
Detoxification
Medically supervised withdrawal management to relieve acute withdrawal symptoms.
Other supports
- Exercise programs for physical and mental well-being
- Mindfulness, meditation, and yoga for stress reduction
- Nutritional counseling to support overall health
Sources
- National Institute on Drug Abuse. Drug Misuse and Addiction. Accessed May 29, 2024.
- SAMHSA. Opioid Overdose Prevention. Accessed May 29, 2024.
- Centers for Disease Control and Prevention. Prescription Opioids. Accessed May 29, 2024.
- MedlinePlus. Opioid Misuse and Addiction Treatment. Accessed May 29, 2024.
- Stockings E, et al. Prevention and Treatment of Substance Use in Young People. Lancet Psychiatry. 2016. Accessed May 29, 2024.