{'fraction_non_alphanumeric': 0.027932960893854747, 'fraction_numerical': 0.016171714201705382, 'mean_word_length': 5.2536764705882355, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Treatment of Opioid-Use Disorders.

Copyright © 2016 Massachusetts Medical Society. This article provides an overview of the current treatment of opioid-related conditions, including treatments provided by general practitioners and by specialists in substance-use disorders. The recent dramatic increase in misuse of prescription analgesics, the easy accessibility of opioids such as heroin on the streets, and the epidemic of opioid overdoses underscore how important it is for physicians to understand more about these drugs and to be able to tell patients about available treatments for substance-use disorders. Opioids include most prescription analgesics as well as products of the poppy plant (e.g., opium, morphine, and codeine).1 Although opioids usually are prescribed to control pain, diminish cough, or relieve diarrhea, they also produce feelings of euphoria, tranquility, and sedation that may lead the patient to continue to take these drugs despite the development of serious related problems. These problems include the need to escalate doses in order to achieve these desired effects; such levels of opioids can overwhelm respiratory drive and lead to death.1,2 Opioid-use disorders are seen in persons from all educational and socioeconomic backgrounds. Recognition of such disorders has contributed to efforts to change physicians’ prescribing practices and to train first responders regarding the parenteral administration of naloxone (Narcan or Evzio), a mu-opioid receptor antagonist.2 In the United States, an estimated 400,000 persons have used heroin in the past month and 4 million have reported nonmedical use of prescription pain relievers.3-5 By some estimates, almost 17,000 deaths per year are related to opioids; drug poisoning is one of the leading causes of accidental death in the United States. Approximately 3 million persons in the United States and almost 16 million worldwide have a current or past opioid-use disorder.6 The global burden of disease from opioid-related conditions approaches 11 million life-years lost from health problems, disabilities, and early death.7 In the 2013 Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (Table 1), an opioid-use disorder is defined as the repeated occurrence within a 12-month period of 2 or more of 11 problems, including withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids. A cluster of 6 or more items indicates a severe con dition.4,8 The clinical course of opioid-use disorders involves periods of exacerbation and remission, but the underlying vulnerability never disappears.1 This pattern is similar to that of other chronic relapsing conditions (e.g., diabetes and hypertension) in which perfect control of symptoms is difficult and patient adherence to treatment is often incomplete. Although persons with opioid problems are likely to have extended periods of abstinence from opioids and often do well,9 the risk of early death, primarily from an accidental overdose, trauma, suicide, or an infectious disease (e.g., human immunodeficiency virus [HIV] infection), is increased by a factor of 20.10-15 Legal problems are especially likely in persons with criminal records and high impulsivity.13 The risk of adverse outcomes decreases markedly with abstinence from opioids.9,16 Dan L. Longo, M.D., Editor