Opioid use disorder is a pattern of opioid use with loss of control, craving and continued use despite harm, involving pain pills, heroin or fentanyl. Medications such as buprenorphine and methadone cut overdose deaths sharply and are the core of treatment.
Key symptoms
- Using more than intended and failed attempts to quit
- Craving and much time spent getting or using opioids
- Withdrawal: yawning, sweating, runny nose, diarrhea, aches
- Problems at work, home or with the law
- Past overdoses
What you find on exam
- Pupils: small when intoxicated, large in withdrawal
- Breathing rate and oxygen saturation
- Injection marks, skin abscesses, heart murmurs
- COWS score to rate withdrawal severity
Tests
- Urine drug screen, with specific testing for fentanyl
- HIV, hepatitis B and C tests
- Liver tests and pregnancy test
- Blood cultures and echocardiogram if fever in someone who injects
Treatment basics
- Buprenorphine started when withdrawal begins, or methadone in a program
- Extended-release naltrexone after full detox
- Naloxone kit and overdose education for every patient
- Counseling and harm reduction: sterile needles, fentanyl test strips
- Vaccines for hepatitis and treatment of infections
Red flags
- Slow or stopped breathing, pinpoint pupils, unresponsive
- Fever with a new heart murmur in someone who injects
- Suicidal thoughts
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.