Opioid Use Disorders

Abstract

Opioid use and addiction in adolescents and young adults, including heroin and non-medical use of prescription opioids, is a serious and growing health problem of epidemic proportions. Opioid use has devastating consequences for youth and their families, including: progression to full addiction, severe psychosocial impairment, HCV and HIV transmission with injection use, exacerbation of co-occurring psychiatric disorders, overdose, and death. This chapter will provide an overview of opioid use disorders (OUDs) in youth, including: etiologic factors, epidemiology, consequences, clinical presentation and course, assessment and diagnosis, overdose, detoxification, and treatment. Opioid overdose is a life-threatening emergency. Respiratory depression should be treated with naloxone, and respiratory support if necessary. Overdose should always be utilized as an opportunity to initiate addiction treatment. Opioid withdrawal management (detoxification) is often a necessary, but never sufficient, component of treatment for OUDs. Medications used in the treatment of withdrawal may include buprenorphine, clonidine and others for relief of symptoms. Treatment for OUDs is effective but treatment capacity is alarmingly limited and under-developed. Although there is a limited evidence base for youth specific treatment, emerging consensus supports the incorporation of relapse prevention medications such as buprenorphine and extended release naltrexone into comprehensive psychosocial treatment including counseling and family involvement.

Characterization and Management of Patients with Heroin versus Nonheroin Opioid Overdoses: Experience at an Academic Medical Center

“…It should also be noted that 14.8% of patients presenting with heroin overdose were also documented to have prescriptions for oral opioid narcotics (Table ) or have a history of prescription opioid abuse (21.9%) (Table ). These findings support prior studies demonstrating that those who abuse prescription opioids have a higher chance of transitioning to heroin abuse …”

“…Illicit use of opioids in the United States has risen to an epidemic level and continues to grow, particularly with regard to nonprescription opioid exposures including heroin . Heroin is an opioid drug synthesized from morphine, a naturally occurring substance.…”

“…Heroin is an opioid drug synthesized from morphine, a naturally occurring substance. It exhibits a higher lipid solubility and higher potency compared with prescription opioids that makes users highly susceptible to accidental overdose and death necessitating urgent intervention . Although heroin has a notably higher incidence of death immediately following overdose, opioids, as a class, exhibit respiratory depression in addition to various adverse effects such as cardiopulmonary arrest, pulmonary edema, hypothermia, aspiration, rhabdomyolysis, and pneumonia …”

Association between state Medicaid expansion status and naloxone prescription dispensing

“…Therefore, we hypothesize that state Medicaid expansion may also have important life-saving implications with respect to individuals' access to naloxone, as those with OUD have a greater risk of opioid overdose. 25 As of September 2019, 37 states (including District of Columbia) have expanded Medicaid coverage, resulting in Medicaid eligibility for low-income adults up to 138 percent of the FPL. 26 Under the Affordable Care Act (ACA), the coverage for behavioral health services, including mental health care and substance use disorder treatments, is mandated for most expansion enrollees.…”

Playing with Fire: The Relationship between Mental Disorders and Prescription Opioid Abuse in a Rural Juvenile Court Sample

“…Aside from the well-documented link to the eventual initiation of heroin use, there are other aspects of prescription opioid abuse among adolescents that are troubling (see Sharma, Bruner, Barnett, & Fishman, 2016). For example, an overdose does not require an addiction.…”