Caring for Patients With Opioid Use Disorder: What Clinicians Should Know About Comorbid Medical Conditions

Abstract

Opioid use disorder (OUD) is a growing problem, with opioid‐involved overdose deaths quadrupling since 1999 in the United States. This article reviews comorbid medical conditions related to OUD, starting with complications of behaviors associated with opioid use (e.g., injection drug use), followed by conditions stemming from the direct effects of opioids (e.g., hypogonadism). HIV and hepatitis C virus (HCV) are common infections in people with OUD, and treatment for these conditions can be safely provided regardless of ongoing substance use. Complications of drug injection, such as HIV, HCV, skin and soft tissue infections, and infective endocarditis, may be prevented through provision of sterile syringes and supervised injection facilities. Rare, life‐threatening bacterial infections may present with signs and symptoms that mimic intoxication, such as malaise or stupor, and should be assessed in patients with fever or positive blood cultures. In addition, chronic opioid exposure can lead to hypogonadism, opioid‐induced hyperalgesia, sleep‐disordered breathing, and potentially increased risk of cardiovascular disease and neurocognitive impairment. Pharmacotherapies for OUD (buprenorphine, methadone, and naltrexone) are safe and effective and their adverse opioid effects can be managed in clinical practice. Awareness of OUD‐associated medical conditions and their treatments is an important step in improving the health and wellness of people with OUD.

Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System

“…We also observed elevated rates of physical and mental health comorbidities in OUD patients relative to non-OUD patients. Accumulating evidence has supported the positive association between opioid use and physical or psychiatric comorbidities, which presents considerable management challenges in clinical practice and contributes to mortality risk 24,25 …”

“…Accumulating evidence has supported the positive association between opioid use and physical or psychiatric comorbidities, which presents considerable management challenges in clinical practice and contributes to mortality risk. 24,25…”

Asymptomatic Screening of Clients on Opioid Substitution Therapy for Tuberculosis: An Experience from India

“…Considering these factors, clients on OST could be at higher risk of TB as many do not present with general TB symptoms like cough ≥ 2 weeks, for the very nature of opioids [5]. As a result, client may remain undiagnosed and continue to spread TB infection that would jeopardise the mission to End TB.…”

The Opioid Crisis: Filling in the Picture

“…In this first issue of Psychiatric Research and Clinical Practice , we focus on the opioid crisis, covering topics that are likely useful for behavioral health and addiction medicine clinicians. These topics include pharmacological and behavioral treatments of opioid use disorder (OUD) and general medical and psychiatric comorbidities ( 1 , 2 ). In this special issue, we also present less frequently addressed topics, including strategies for treatment engagement of pregnant women with OUD ( 3 ) and opioid use in Latin America ( 4 ).…”

“…General medical comorbidities are common as well, and psychiatrists can benefit from the review of these conditions by Slawek and colleagues ( 2 ). Whereas many medical complications arise from infections related to injection of substances, other complications can occur directly from opioid use, including hypogonadism and sleep‐disordered breathing.…”