How to Avoid Mismanagement of Opioid Use Disorder in Clinical Settings
Opioid use disorder (OUD) is a chronic condition that affects millions of people worldwide. It is characterized by a problematic pattern of opioid use that causes significant impairment or distress. OUD can lead to serious health consequences, such as overdose, infectious diseases, and death.
Unfortunately, OUD is often overlooked or inadequately managed in clinical settings, especially during inpatient admissions. This can result in poor outcomes for patients, such as relapse, readmission, or mortality. Therefore, it is essential for clinicians to recognize and treat OUD appropriately and effectively.
How to Diagnose OUD
The diagnosis of OUD is based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). According to the DSM-5, OUD is diagnosed when a person meets at least two of the following criteria within a 12-month period:
Taking opioids in larger amounts or for longer than intended.
Having a persistent desire or unsuccessful efforts to cut down or control opioid use.
Spending a lot of time obtaining, using, or recovering from opioids.
Experiencing cravings or a strong desire to use opioids.
Failing to fulfill major role obligations at work, school, or home because of opioid use.
Continuing to use opioids despite having social or interpersonal problems caused or worsened by opioid use.
Giving up or reducing important social, occupational, or recreational activities because of opioid use.
Using opioids in situations where it is physically hazardous.
Continuing to use opioids despite knowing that they have a physical or psychological problem that is likely caused or exacerbated by opioid use.
Developing tolerance to opioids, meaning that they need more opioids to achieve the desired effect or that they have a reduced effect from the same amount of opioids.
Experiencing withdrawal symptoms when they stop or reduce opioid use, or using opioids to avoid or relieve withdrawal symptoms.
The severity of OUD is determined by the number of criteria met: mild (2-3 criteria), moderate (4-5 criteria), or severe (6 or more criteria).
How to Treat OUD
The most effective treatment for OUD is medication-assisted treatment (MAT), which combines the use of FDA-approved medications with behavioral therapies and psychosocial support. MAT can help reduce opioid cravings, prevent withdrawal symptoms, block the effects of opioids, and improve functioning and quality of life. The three main types of medications used for MAT are:
Methadone: a synthetic opioid agonist that activates the same receptors as opioids but has a longer duration of action. Methadone can only be dispensed through specialized clinics that are regulated by federal and state laws.
Buprenorphine: a partial opioid agonist that binds to the same receptors as opioids but has a lower level of activation. Buprenorphine can be prescribed by qualified physicians who have obtained a waiver from the Drug Enforcement Administration (DEA).
Naltrexone: an opioid antagonist that blocks the effects of opioids by preventing them from binding to the receptors. Naltrexone can be prescribed by any licensed physician and is available in oral or injectable forms.
The choice of medication depends on several factors, such as patient preference, medical history, availability, cost, and potential drug interactions. The dose and duration of medication should be individualized and adjusted according to the patient's response and goals. MAT should be initiated as soon as possible after diagnosis and continued for as long as needed.
How to Avoid Mismanagement of OUD
Mismanagement of OUD can occur when clinicians fail to recognize, diagnose, treat, or follow up with patients who have OUD. Some common barriers to optimal management of OUD include:
Lack of knowledge or training on OUD and MAT among clinicians.
Lack of screening or assessment tools for OUD in clinical settings.
Lack of access or referral to MAT providers or programs.
Lack of coordination or communication between different levels of care (e.g., primary care, specialty care, emergency care). ec8f644aee