Pathways To Safer Opioid Use

Opioid use disorder (OUD) is a substance use disorder relating to the use of an opioid. Any such disorder causes significant impairment or distress.^[3] Signs of the disorder include a strong desire to use opioids, increased tolerance to opioids, difficulty fulfilling obligations, trouble reducing use, and withdrawal symptoms with discontinuation.^[4][5] Opioid withdrawal symptoms may include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood.^[5] Addiction and dependence are components of a substance use disorder.^[13] Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems at school, work, or home.^[4][5]

Opioids include substances such as heroin, morphine, fentanyl, codeine, dihydrocodeine, oxycodone, and hydrocodone.^[5][6] In the United States, a majority of heroin users begin by using prescription opioids, that may also be bought illegally.^[14][15] Risk factors for misuse include a history of substance use, substance use among family and friends, mental illness, low socioeconomic status, and race.^[16][17] Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5.^[4] If more than two of eleven criteria are present during a year, the diagnosis is said to be present.^[4] If a person is appropriately taking opioids for a medical condition, issues of tolerance and withdrawal do not apply.^[4]

Individuals with an opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine.^[7] Being on such treatment reduces the risk of death.^[7] Additionally, individuals 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.^[8] The medication naltrexone may also be useful to prevent relapse.^[10] Naloxone is useful for treating an opioid overdose and giving those at risk naloxone to take home is beneficial.^[9]

In 2013, opioid use disorders affected about 0.4% of people.^[4] As of 2016, about 27 million people are affected.^[11] Long term opioid use occurs in about 4% of people following their use for trauma or surgery related pain.^[18] Onset is often in young adulthood.^[4] Males are affected more often than females.^[4] It resulted in 122,000 deaths worldwide in 2015,^[12] up from 18,000 deaths in 1990.^[19] In the United States during 2016, there were more than 42,000 deaths due to opioid overdose, of which more than 15,000 were the result of heroin use.^[20]