Opioid use disorder: Clinical sciences

Opioid use disorder is a medical condition characterized by the inability to control the use of opioids, despite adverse health and social consequences. The cause of opioid use disorder is multifactorial, including psychological, biological, social, and environmental factors. Based on criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, or DSM-5, you can categorize opioid use disorder as mild, moderate, or severe.

Keep in mind that the terms opiates and opioids are sometimes used interchangeably, but they actually refer to different entities. Opiates refer to only naturally occurring compounds derived from the poppy plant like heroin, morphine, and codeine, all of which have agonistic effects on the opiate receptor.

On the flip side, opioids refer to synthetic and semisynthetic compounds that resemble opiates in structure and their effects on the opioid receptor.

Okay, if a patient presents with a chief concern suggesting opioid use disorder, first perform an ABCDE assessment to determine if the patient is unstable or stable. If your patient is unstable, stabilize the airway, breathing, and circulation, which might require endotracheal intubation with mechanical ventilation. Next, obtain IV access and put your patient on continuous vital sign monitoring including blood pressure, heart rate, pulse oximetry, and cardiac telemetry. In severe cases, opioid overdose can result in CNS depression, coma, and even death. In these patients, immediately administer the opioid antagonist naloxone to reverse the effects of an opioid overdose!

Here’s a clinical pearl to keep in mind! Severe withdrawal can lead to unstable vital signs, and even lethal electrolyte abnormalities from vomiting.