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Opioid Use Disorder

Opioid Use Disorder (OUD) is a medical condition characterized by a problematic pattern of opioid use that leads to significant impairment or distress. Opioids are a class of drugs that include prescription pain relievers like oxycodone, hydrocodone, morphine, and illegal drugs like heroin.

Individuals with OUD often exhibit symptoms such as:

Strong cravings for opioids.
Difficulty controlling opioid use.
Continued use of opioids despite negative consequences, such as health problems or relationship issues.
Tolerance, meaning they need higher doses of opioids to achieve the desired effects.
Withdrawal symptoms when not using opioids.

Opioid Use Disorder can have severe consequences, including overdose and death. Treatment typically involves a combination of medication (such as methadone, buprenorphine, or naltrexone) and behavioral therapies to help individuals manage cravings, avoid relapse, and address underlying issues contributing to their substance use.

Websites

SAMHSA’s National Helpline

SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish). Call 1-800-662-HELP (4357) or visit the website.

Get the Facts on Opioid Use Disorder

Johns Hopkins Medicine

This website contains Opioid Use Disorder information provided by Johns Hopkins Medicine.

Good Samaritan Law

The Good Samaritan Drug Overdose Act of 2015 prevents punitive actions against health professionals and any person who administers naloxone or calls 911 to assist someone who may be overdosing on opiates. It also provides immunity to persons seeking medical treatment for an opioid overdose for themselves or someone else.

American Psychiatric Association

This website includes opioid use disorder information and resources for patients and families from the American Psychiatric Association (APA).

Tools & Resources

Medications for Addiction Treatment (MAT) Resource Library

The MAT Resource Library is supported by the Los Angeles County Health Agency and Department of Public Health, Substance Abuse Prevention and Control. The site provides practical information on Medications for Addiction Treatment (MAT) for providers across health systems (e.g., physical health, mental health, and substance use disorder systems), as well as for patients.

SAMHSA’s National Helpline

The Opioid Guide: A Resource Guide for Practicing Psychologists

A guide from the American Psychological Society with information for practicing psychologists on opioids, their use, and effective treatments.

Wound Care & Medical Triage for People Who Use Drugs and the Programs That Serve Them

This comprehensive guide provides information and recommendations regarding general health, safer use practices, common viral, fungal, parasitic, and other injection-related infections, overdose and overamp, tapering, withdrawal, medications for opioid use disorder, and seeking medical care.

Screening Tools

There are a number of screening tools available that can be self-administered via pen and paper, computer and tablet, or conducted by an interviewer. Each screening tool has pros and cons and a program should decide which screening tool is best for their agency based on population served with consideration to which substances are being used as well as state/regional billable terms for utilization of specific screening forms. Adopt SBIRT offers training and technical assistance on the use of screening assessments.

Never Use Alone

Toll-free national overdose prevention, detection, life-saving crisis response and medical intervention services for people who use drugs while alone. Never Use Alone’s peer operators are available 24-hours a day, 7 days a week, 365 days a year.

Medication for Opioid Use Disorder (MOUD) Tool Kit for Peer Recovery Specialists

This toolkit is a resource for Peer Recovery Specialists (PRSs) to feel equipped to discuss MOUD with providers, people seeking recovery, and others with questions about this treatment option.

Northern Nevada HOPES (HOPES)

The mission of Northern Nevada HOPES (HOPES) is to provide affordable, high-quality medical, behavioral health, and support services for all. The Medication Assisted Treatment (MAT) program at Northern Nevada HOPES offers caring, team-based treatment to give you hope and improve your life as you work toward recovery. HOPES accepts Medicaid, most major health plans, and, for those without insurance, has a sliding fee scale that adjusts cost based on what you can afford. If you’re interested in receiving medication-assisted treatment, the first step is to become a HOPES patient by calling 775-786-4673.

Publications

Fast Facts About Substance Use Disorders: What Every Nurse, APRN, and PA Needs to Know (Book)

This resource is the first to provide evidence-based information and strategies for APRNs and PAs who work with individuals with substance use disorders (SUDs). Written in a concise, bulleted style for easy access to critical information, the reference addresses often-undiagnosed medical and psychiatric conditions which may accompany SUDs and the ethical considerations of working with affected patients and families.

Opioid Use and Opioid Use Disorder in Pregnancy: A Joint Opinion of the ACOG’s Committee on Obstetric Practice and ASAM

The Society of Maternal–Fetal Medicine endorses this document. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice in collaboration with committee members Maria A. Mascola, MD, MPH; Ann E. Borders, MD, MSc, MPH; and the American Society of Addiction Medicine member Mishka Terplan, MD, MPH.

Opioid Use Disorder

Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder. [Updated 2024 Jan]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.

This activity focuses on the critical evaluation and management of opioid use disorder (OUD), a pervasive condition significantly diminishing patients’ quality of life and contributing to a widespread epidemic in the United States.

Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States

There are strategies that can assist community leaders, local and regional organizers, non-profit groups, law enforcement, public health, and members of the public in understanding and navigating effective ways to prevent opioid overdose in their communities. Use this information as a reference for evidence-based practices that have been successfully implemented in the U.S.

Heroin, Fentanyl, & Other Opioids: A Comprehensive Resource for Families with a Teen or Young Adult Struggling with Opioid Use

Fueled by drugs like heroin, fentanyl and the misuse of prescription pain pills, the opioid epidemic in our country has impacted countless families. To help address this, the Partnership for Drug-Free Kids created a new eBook — Heroin, Fentanyl & Other Opioids: A Comprehensive Resource for Families with a Teen or Young Adult Struggling with Opioid Use. Parents and families need to be prepared with the knowledge and skills to identify opioids, spot early use and take action effectively.

Posters & Infographics

Opioid Trifold Brochures

Opioid Information Brochures for Providers or Consumers help educate on opioids and opioid use, including effects of opioid use, pregnancy and opioid use, medications for opioid use including opioid overdose reversal medications, and treatment options for persons using opioids.

Download or request free hard copies

Take Action to Prevent Addiction Learn how to reduce risk. Know the Facts About Opioids Talk With Your Doctor Your doctor may talk to you about prescription opioids for pain treatment. Ask about the risks and benefits so that you can work together to decide what is best. You can also ask your doctor to help you find other safer ways to manage pain. Every day in the United States, 41 people lose their lives to prescription opioid overdose. Prescription opioids—like hydrocodone, oxycodone, and morphine—can be prescribed by doctors to treat moderate to severe pain but can have serious risks and side effects. PEOPLE DIE 41EVERY DAY Opioids are highly addictive. Research shows that if you use opioids regularly, you may become dependent on them. That’s because opioids change how the brain and nervous system function. You can’t know how your brain will react to opioids before taking them. ANYONE CAN BECOME ADDICTED It Only Takes a Little to Lose a Lot Opioids affect the part of the brain that controls breathing. If you take too high a dose, it can slow your breathing and cause death. Opioids can be addictive and dangerous. Risks include misuse, addiction, and overdose. Combining opioids with alcohol and other drugs— like sleeping pills or cough medication —increases your chances of death.1 1 fda.gov/Drugs/DrugSafety/ucm518473.htm For those who might have an opioid use disorder, call SAMHSA’s National Helpline at 1-800-662-HELP. Start the Conversation Protect yourself and others by talking about your questions and concerns. Ask about nonopioid pain management options, addiction, and overdose risks. Talk with your doctor. Let them know that you care about them, and be patient and open when listening so that they feel heard and valued. Talk with your loved ones if you’re concerned about opioid misuse or addiction. Encourage your loved ones to get help if they need it. Help them look for treatment, and offer to go with them to their first appointment. Your support can make a difference. Treatment Support Learn the signs of a quality treatment center at goo.gl/X1FCGW. Find opioid treatment options in your state at goo.gl/Gtkv9C. Follow these tips to protect yourself and those you care about. Tips to Reduce Risk Only take prescription medication that is prescribed to you. Don’t share medication with others. Take the medicine as prescribed. Don’t use medications in greater amounts, more often, or longer than directed by your doctor. Keep medicines in a safe place. It’s best to store prescription opioids in a place that can be locked—like a keyed medicine cabinet—to keep them secure from children and visitors. Dispose of expired or unused prescription opioids. Remove them from your home as soon as possible to reduce the chance that others will misuse them. To get rid of prescription opioids and other medications safely: • Check with your pharmacist to see if you can return them to the pharmacy. • Find a medicine take-back option near you at takebackday.dea.gov. Hear real stories about recovery from prescription opioids at cdc.gov/RxAwareness.

Prevent Addiction Fact Sheet

This face sheet contains information for patients about preventing opioid addiction.

Download the fact sheet.

What You Need to Know About Treatment and Recovery There is hope. Recovery is possible. Addiction Is A Disease Opioids are highly addictive, and they change how the brain works. Anyone can become addicted, even when opioids are prescribed by a doctor and taken as directed. In fact, millions of people in the United States suffer from opioid addiction. Signs of Opioid Addiction A major warning sign of addiction is if a person keeps using opioids even though taking them has caused problems—like trouble keeping a job, relationship turmoil, or run-ins with law enforcement. Other signs can include:1 Opioid Use Disorder Sometimes referred to as “opioid addiction,” opioid use disorder is a chronic and relapsing disease that affects the body and brain. It can cause difficulties with tasks at work, school, or home, and can affect someone’s ability to maintain healthy relationships. It can even lead to overdose and death. Trying to stop or cut down on drug use, but not being able to. Taking one drug to get over the effects of another. Using drugs because of being angry or upset with other people. Being scared at the thought of running out of drugs. Stealing drugs or money to pay for drugs. Overdosing on drugs. To learn more about opioid misuse, go to cdc.gov/RxAwareness. 1 findtreatment.gov/content /understanding-addiction/addiction-can-affect-anyone Recovery Is Possible Recovery does not happen overnight. Asking for help from family, friends, co-workers, and others can make a big difference. Tell them your reasons for quitting and ask them to check in with you about how things are going. If you know or suspect someone is struggling, ask if you can help. Treatment Can Help Treatment can help people get their lives back before it is too late. No single treatment method is right for everyone, but research shows that combining behavioral therapy with medication is the most effective approach for overcoming opioid addiction. Addiction is a disease that for many involves long-term follow-up and repeated care to be effective and prevent relapse. When people make a recovery plan that includes medication for opioid use disorder, their chances of success increase. Medications can help normalize brain chemistry, relieve cravings, and in some cases prevent withdrawal symptoms. Medication-Assisted Treatment Options Talk with your doctor to find out what types of medication are available in your area and what options are best for you. Be sure to ask about the risk of relapse and overdose. Behavioral Health Treatment Services Locator: findtreatment.samhsa.gov Opioid Treatment Program Directory by State: dpt2.samhsa.gov/treatment/ directory.aspx Health Center Locator: findahealthcenter.hrsa.gov Mental Health and Addiction Insurance Help: hhs.gov/programs/topic-sites/ mental-health-parity/mentalhealth-and-addiction-insurancehelp/index.html Find Treatment Services Use these resources to find services that fit your needs: Methadone • Available as daily liquid • Can only be used in a certified opioid treatment program setting Buprenorphine • Available as dissolving tablet, cheek film, or 6-month implant under the skin • Can be prescribed by a doctor for use outside of a clinic Naltrexone • Can be prescribed by any healthcare provider who can legally prescribe medication • Only used for people who have not used opioids for at least 7–10 days Additional resources to access help: • Medication-Assisted Treatment (MAT) • Decisions in Recovery: Treatment for Opioid Use Disorder • Facing Addiction in America | The Surgeon General’s Report on Alcohol, Drugs, and Health

Opioid Use Disorder Treatment and Recovery Fact Sheet

This fact sheet contains important information about treatment and recovery of opioid use disorder for patients, families and friends.

Download the fact sheet

Medications for opioid overdose, withdrawal, and addiction Medications for opioid overdose, withdrawal, and addiction are safe, effective, and save lives. The National Institute on Drug Abuse supports research to develop new medicines and delivery systems to treat opioid use disorder and other substance use disorders, as well as other complications of substance use (including withdrawal and overdose), to help people choose treatments that are right for them. Medications approved by the U.S. Food and Drug Administration for opioid addiction, overdose, and withdrawal work in various ways. Opioid Receptor Agonist: Medications attach to and activate opioid receptors in the brain to block withdrawal symptoms and cravings. Opioid Receptor Partial Agonist: Medications attach to and partially activate opioid receptors in the brain to ease withdrawal symptoms and cravings. Opioid Receptor Antagonist: Medications attach to and block activity of opioid receptors in the brain. Antagonist medications that treat substance use disorders do so by preventing euphoric effects (the high) of opioids and alcohol and by reducing cravings. Antagonist medications used to treat opioid overdoses do so by reversing dangerous drug effects like slowing or stopping breathing. Adrenergic Receptor Agonist: A medication that attaches to and activates adrenergic receptors in the brain and helps alleviate withdrawal symptoms. Four cards show medications prescribed to reduce opioid use and cravings. Methadone is available in daily liquid or tablets. Naltrexone is available in a monthly injection. Buprenorphine available in daily tablet and weekly or monthly injection. Buprenorphine/naloxone is available in daily film that dissolves under the tongue or tablet. One card shows medication prescribed to treat withdrawal symptoms. Lofexidine is available as a tablet taken as needed. Two cards show medication used to reverse overdose. Naloxone is available as an emergency nasal spray or injection. Nalmefene is available as an emergency nasal spray or injection.

Medications for Opioid Use Disorder (MOUD) Infographic

This infographic shows different types of medications approved by the U.S. Food and Drug Administration for opioid overdose, withdrawal, and addiction.

Download the infographic

Webinars & Online Learning

The Medicated Assisted Treatment recorded ECHO series focuses on supporting providers, staff, and administrators at facilities providing Medication-Assisted Treatment (MAT) services. By bringing together a team of MAT experts based at Northern Nevada HOPES and Center for Behavioral Health, the goal was to provide a platform for collaborative discussion and case review.

This recorded webinar from the PS ROTA-R provides an overview on the impact of stimulant use on non-metropolitan rural communities.

In this video, scientists from the National Institute on Drug Abuse answer common questions about drug use and addiction. The episode What Is Addiction? introduces viewers to the brain’s reward pathway, brain development and how addiction science continues to advance treatment and prevention of substance use disorder.

Current News & Research

Project AMPED

Drug overdoses involving methamphetamine increased 3.6-fold from 2011 to 2016 – surpassing the increase in heroin-related deaths during that period. Rates of cocaine-related deaths also doubled from 2011 to 2016. Methamphetamine use is largely concentrated in the Western US, and Nevada and New Mexico have been disproportionately burdened by the opioid epidemic and high rates of methamphetamine use. This is a multi-year, mixed methods study in Nevada and New Mexico is examining the patterns, reasons for, and health concerns related to methamphetamine use and opioid use.

Published Papers

Harding, R.W., Wagner, K.T., Fiuty, P., Smith, K.P., Page, K., Wagner, K.D., (2022) “”It’s called overamping”: Experiences of overdose among people who use methamphetamine”. Harm Reduction Journal. 19(1): 1-11. https://link.springer.com/article/10.1186/s12954-022-00588-7
*Rhed, B.D., Harding, R.W., *Marks, C., Wagner, K.T., §Fiuty, P., Page, K., Wagner, K.D. (2022) Patterns of and rationale for the co-use of methamphetamine and opioids: Findings from qualitative interviews in New Mexico and Nevada. Frontiers Psychiatry, 13. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.824940/full
Wagner, K.D., *Marks, C., §Fiuty, P., Harding, R.W., Page, K. (2023) A qualitative study of interest in and preferences for potential medications to treat methamphetamine use disorder. Addiction Science & Clinical Practice. 18:47 https://doi.org/10.1186/s13722-023-00401-1
Wagner, K.D., Fiuty, P., Page, K., Tracy, E.C., Nocera, M., Miller, C.W., Tarhuni, L.J., Dasgupta, N. (2023). Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services. Drug and Alcohol Dependence. 252: 110985 https://doi.org/10.1016/j.drugalcdep.2023.110985
*Erinoso, O., *Daugherty, R., *Kirk, M.R., Harding, R.W., Etchart, H., Reyes, A., Page, K., Fiuty, P., Wagner, K.D. (accepted 9 May 2024) Safety Strategies and Harm Reduction for Methamphetamine Users in the Era of Fentanyl Contamination: A Qualitative Analysis. International Journal of Drug Policy. (COMING SOON)

Opioid Use Disorder Assessment Tools and Drug Screening

Ducharme J, Moore S. Opioid Use Disorder Assessment Tools and Drug Screening. Mo Med. 2019 Jul-Aug;116(4):318-324. PMID: 31527982; PMCID: PMC6699803.

Opioid use disorder risk assessment tools cannot be used in isolation. In combination with standardized clinical examination, and, when indicated, urine drug screening, a validated risk assessment tool, improves the ability to detect opioid misuse. Even though no single tool has been shown to have both high interobserver reliability and high sensitivity, the standardized approach has still been shown to be superior to subjective care giver assessment. This article will provide a global approach to risk assessment in addition to reviewing the available tools.

The Opioid Epidemic’s Toll on Children

This article from the Johns Hopkins Bloomberg School of Public Health discusses the opioid epidemic’s toll on children.

The Mobile Emergency Recovery Intervention Trial (MERIT)

The Mobile Emergency Recovery Intervention Trial (MERIT) is a grant-funded research study that is evaluating the effectiveness and long-term outcomes of an ER-based intervention for opioid overdose patients treated in Nevada’s Emergency Departments (EDs). The research is currently ongoing.

Published Papers:

Wagner, K.D., Oman, R.F., Smith, K.P., Harding, R., Dawkins, A.D., Lu, M., §Woodard, S., Berry, M.N., Roget, N.A. (2019). “Another tool for the tool box? I’ll take it!”: Feasibility and acceptability of mobile recovery outreach teams (MROT) for opioid overdose patients in the emergency room. Journal of Substance Abuse Treatment. 108:95-103 https://doi.org/10.1016/j.jsat.2019.04.011
McGuire, A., Ray, B., Watson, D., Carter, J., Wagner, K., Powell, K., Smith, K., Robinson, L., Cooperman, N., Treitler, P. (2019) Emergency department-based peer support for opioid use disorders: Emergent functions and forms. Journal of Substance Abuse Treatment. 108:82-87 https://doi.org/10.1016/j.jsat.2019.06.013
Wagner, K.D., *Mittal, M.L., Harding, R.W., Smith, K.P., Dawkins, A., Wei, X., §Woodard, S., Roget, N.A., Oman, R.F. (2020) “It’s gonna be a lifeline”: Findings from focus group research to investigate what people who use opioids want from peer-based post-overdose interventions in the emergency department. Annals of Emergency Medicine. 76(6): 717-727 https://doi.org/10.1016/j.annemergmed.2020.06.003
Smith, K.P., Oman, R.F., Lu, M., Dawkins, A.D., Harding, R.W., Hepworth, K., Wagner, K.D. (2021). The Mobile Emergency Recovery Intervention Trial (MERIT): Protocol for a 3-Year Mixed Methods Observational Study of Mobile Recovery Outreach Teams in Nevada’s Emergency Departments. Plos ONE. 16(10): e0258795. https://doi.org/10.1371/journal.pone.0258795
*Kirk, M.R., Dawkins, A.D., Wei, X., *Ajumobi, O., §Lee, L.C., Oman, R., §Woodard, S., Wagner, K.D. (2023) What makes a peer? Characteristics of certified peer recovery support specialists in an emergency department-based intervention. PlosOne (Accepted July 31, 2023, e-pub December 7, 2023). https://doi.org/10.1371/journal.pone.0289920