Opioid Use and Addictive Disorder

This chapter discusses epidemiologic, pathophysiology and diagnostic issues associated with opioid use disorders. Differentiation of the recreational user and the user who was prescribed narcotics for a diagnosed pain issue is an important variable in the approach to management. Absolute sobriety from opiates/opioids is difficult to achieve and a multifaceted approach is a necessity. This chapter also describes nondrug therapies used in the management of opioid use disorders, including narcotics anonymous, cognitive behavioral therapies and others. For many patients, substitution therapy may be necessary for the short or long term to prevent further issues with opioid use and a better outcome. Buprenorphine substitution therapy requires special provider training while methadone must be dispensed by a licensed opiate treatment program. Withdrawal from opioids is not life threatening but is subjectively very distressing. Management of opioid withdrawal can include treatment with buprenorphine or methadone resulting in relief of withdrawal symptoms and then slowly tapering off the medication. Alternatively non-opiate agents such as clonidine and other medications for symptom relief are used to ameliorate withdrawal. The chapter includes key points and a case vignette to assist the learner. A patient education sheet and further resources are included.

Keywords: Buprenorphine, Clonidine, Methadone, Naloxone, Naltrexone, Suboxone, Substitution therapy, Subutex.