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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 69, Opioid Use Disorder.



  • imageIllicit drug use, including the misuse of prescription medications, affects the health and well-being of millions of Americans. Addressing the impact of substance use alone is estimated to cost Americans more than $740 billion each year.

  • imageBetween 1999 and 2016, the number of drug overdose deaths in the United States more than tripled, and the Centers for Disease Control and Prevention (CDC) now estimates that each day at least 115 people in the United States die from an opioid overdose.

  • imageOpioid overdoses involving prescription opioids, synthetic opioids, and heroin have continued to increase while healthcare professionals, legislators, and the community as a whole continue to work together to focus on prevention, treatment, recovery, and enforcement to reverse this trend.

  • imageDefined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), substance use disorders (SUD) are diagnosed based on evidence of impaired control, social impairment, risky use, and pharmacological criteria. Severity of disorder can range from mild to moderate to severe.

  • imageSubstance use disorders are chronic illnesses for which there are no cures. The focus of treatment is to develop a holistic treatment plan that provides a recovery that allows the patient to live a full life as they manage the symptoms and decrease risk of relapse.

  • imageProblems related to abuse of chemical substances can occur acutely (eg, respiratory arrest from using heroin) or after some length of time (eg, dependence or withdrawal from continued use of an opioid). The treatment approach is distinctly different depending on the chronicity of the problem.

  • imageDeaths attributed to counterfeit opioid or benzodiazepine pills that include illicitly manufactured fentanyl have drastically increased during recent years. Additionally, reports of heroin, cocaine, and other products tainted with fentanyl and related analogues have contributed to the increase in overdoses.

  • imageOpioid use disorder (OUD) is a chronic often relapsing condition. Viewing OUD as a disorder, providing medication-assisted therapy, patient education, and support has been shown to decrease the risk of accidental overdose or full relapse into opioid use.

  • imageBehavioral therapy should not be required as a condition for receiving OUD medication unless required through an opioid-treatment program (OTP). The goal is to focus on the patient’s individual treatment plan to identify what is best for the patient at the time of therapy and to introduce behavioral therapy if and when the patient is ready.

  • imageThere are currently three Food and Drug Administration (FDA)-approved medications used in OUD including buprenorphine, methadone, and naltrexone. All three medications have demonstrated superiority at reducing illicit opioid use over no treatment. Pharmacotherapy in combination with psychosocial therapy has been found to be more effective than either treatment alone.

  • imageNaloxone is a mu-opioid receptor antagonist that can be used in the reversal of an opioid overdose. ...

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