This chapter discusses epidemiologic, pathophysiology and diagnostic issues
associated with opioid use disorders. Differentiation of the recreational user and the
user who was prescribed narcotics for a diagnosed pain issue is an important variable in
the approach to management. Absolute sobriety from opiates/opioids is difficult to
achieve and a multifaceted approach is a necessity. This chapter also describes nondrug
therapies used in the management of opioid use disorders, including narcotics
anonymous, cognitive behavioral therapies and others. For many patients, substitution
therapy may be necessary for the short or long term to prevent further issues with
opioid use and a better outcome. Buprenorphine substitution therapy requires special
provider training while methadone must be dispensed by a licensed opiate treatment
program. Withdrawal from opioids is not life threatening but is subjectively very
distressing. Management of opioid withdrawal can include treatment with
buprenorphine or methadone resulting in relief of withdrawal symptoms and then
slowly tapering off the medication. Alternatively non-opiate agents such as clonidine
and other medications for symptom relief are used to ameliorate withdrawal. The
chapter includes key points and a case vignette to assist the learner. A patient education
sheet and further resources are included.
Keywords: Buprenorphine, Clonidine, Methadone, Naloxone, Naltrexone, Suboxone,
Substitution therapy, Subutex.
