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Opioid use disorder (OUD)

Opioids in this article are the drugs (e.g. painkillers) which contain such substances as morphine, heroin, codeine and oxycodone. They can be bought illegally or prescribed.

Opioid use disorder (OUD) is the repeated administration of opioids which continues despite the obvious negative consequences related to health and social interrelations. The most severe form of OUD is called addiction. OUD is characterized by two or more symptoms from the following list.

  1. Opioids are taken not as prescribed but in a larger amount or over a longer period of time.
  2. Craving or a strong desire to use opioids.
  3. All efforts to stop taking opioids or put it under control fail.
  4. A lot of time and effort is devoted to obtaining opioids and using them.
  5. Recovering from the consequences of taking opioid drugs takes more and more time.
  6. Frequent use of opioids results in failure to fulfil usual activity at work or at school.
  7. Some important social or personal activities are given up because of opioid use.
  8. Recurrent social or interpersonal problems caused by the use of opioids.
  9. Opioids are used even when taking them is likely to cause serious problems in what is to be done in the near future. For example, before an important meeting.
  10. The amount of opioid needed to achieve desired effect gradually increases. The usual amount of opioid ceases to produce desired effect. These are symptoms of tolerance or dependence.
  11. Opioids are taken to relieve or avoid withdrawal symptoms.
  12. When opioids are abruptly discontinued, the symptoms of withdrawal appear, such as the following:
  1. Depression
  2. Nausea or vomiting
  3. Muscle aches
  4. Lacrimation or rhinorrhea
  5. Pupillary dilation, piloerection, or sweating
  6. Diarrhea
  7. Yawning
  8. Fever
  9. Insomnia

Diagnosis of Opioid Use Disorder

If a patient frankly tells the doctor about his or her problems, diagnosis is not difficult. In case of dissimulation, diagnosis becomes complicated and should be based on a complex of laboratory and clinical data. The information from the patient's relatives may also be useful.

Typically, abuse of opioids is characterized by significant changes in the appearance and mental state of patients. The inevitable decrease in the level of physical health from systematic intoxication also leaves an imprint on the appearance of drug users.

In rare cases OUD is not accompanied by pronounced external manifestations, so that relatives of opioid users may know nothing about their dependence for years.

Diagnosis of OUD can be based on the following criteria:

  • Rapidly growing disorder in the psyche and behavior (causeless mood swings, aggressiveness, secrecy, deceit).
  • A marked decrease in success in studies and professional activities; the narrowing of the range of interests.
  • Changes in the circle of communication.
  • Alienation from relatives and friends.
  • Eating disorders, a marked decrease in body weight.
  • Sleep disorders, changes in daily rhythms of sleep and wakefulness.
  • Detection of drugs and their metabolites in the urine.

Treatment

Drug dependence caused by opioids is very difficult to treat. OUD is usually treated with opioid replacement therapy using methadone or buprenorphine. The main goal of the treatment is to reduce the risk of possible death. Treatment with medication only is not sufficient; patients should take part in social support programs like anonymous alcoholics, and individual or group psychotherapy. Naloxone is useful for preventing relapses.