SHM's Clinical Quick Talks-Opioid Use Disorder

Pdf Summary

This teaching script by Dr. Talía Bernal focuses on Opioid Use Disorder (OUD), emphasizing its diagnosis, withdrawal symptoms, treatment, and stigma reduction. OUD is defined as a pattern of opioid use resulting in clinically significant impairment or distress within 12 months, diagnosed by meeting at least two of 11 criteria such as tolerance, withdrawal, using opioids inappropriately, and experiencing negative life consequences. Importantly, tolerance and withdrawal alone do not confirm OUD if opioids are taken as prescribed.<br /><br />Clinicians should ask patients and families how opioids have impacted their lives to identify OUD. Opioid withdrawal symptoms typically start within hours to days after last use and include nausea, vomiting, diarrhea, myalgias, diaphoresis, yawning, chills, tachycardia, tremor, abdominal cramping, rhinorrhea, lacrimation, anxiety, pupil dilation, and visible restlessness. The Clinical Opiate Withdrawal Scale (COWS) assists in assessing severity. Differential diagnoses include infections, other intoxications or withdrawals, medication side effects, and hypoglycemia. Certain symptoms like yawning, lacrimation, and mydriasis are more specific to opioid withdrawal.<br /><br />Treatment involves FDA-approved medications for OUD (MOUD): methadone (long-acting full agonist), buprenorphine (partial agonist), and naltrexone (antagonist). Methadone and buprenorphine reduce mortality and are preferred, whereas naltrexone prevents overdose but does not alleviate withdrawal. Detoxification without MOUD has high relapse rates and is not recommended. Adjunctive symptom-based treatments can help manage withdrawal symptoms. Patients’ overdose risk is highest post-withdrawal due to lowered tolerance; naloxone (Narcan) should be provided with counseling.<br /><br />The script highlights combating stigma by using person-centered, nonjudgmental language (e.g., “person who uses IV drugs” instead of “IV drug abuser”). Clinicians are urged to offer evidence-based OUD treatment, differentiate withdrawal from other medical issues, and communicate respectfully to engage patients effectively. Useful resources include SAMHSA and Bridge to Treatment websites.

Asset Subtitle

Talia Bernal

Keywords

Opioid Use Disorder

OUD diagnosis

Opioid withdrawal symptoms

Clinical Opiate Withdrawal Scale

MOUD medications

Methadone treatment

Buprenorphine therapy

Naltrexone use

Stigma reduction

Naloxone overdose prevention