Opioid Use Disorder

Basics

Opioid use disorder (OUD) is a chronic, relapsing condition characterized by repeated opioid use despite serious adverse consequences
Diagnosis is made using criteria stated in the Diagnostic and Statistical Manual of Mental Disorders and can be further described as mild, moderate, or severe
Complications include overdose, particularly with dangerous adulterants in drug supply, other health consequences of hazardous use including death, as well as other socioeconomic factors
OUD is responsible for significant morbidity and mortality and is highly treatable with medications
Multiple studies have shown benefit in initiating medications for OUD from the emergency department

Exact etiology is unknown, and OUD routinely affects individuals without clear risk factors
Vulnerability to addiction is thought to be 40–60% inherited
Environmental factors increasing propensity to addiction include low socioeconomic class, low parental support, peer group deviancy, and drug availability

Mechanism: Addicted individuals develop progressive structural changes of brain regions responsible for reward, motivation, inhibitory control, and self-awareness
Opioid use interferes with the dopamine mesolimbic system, particularly the ventral striatum, nucleus accumbens, and ventral tegmental areas of the brain
Drug seeking and use becomes more driven by emotion and instinct rather than logic

Substance use in adolescence significantly increases the likelihood of developing substance use disorder
Buprenorphine is safe and effective in adolescent patient population

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