Opioid Use Disorder

Basics

Description

  • 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

Etiology

  • 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

Pathophysiology

  • 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

Pediatric Considerations

  • 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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