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 Respond to  your colleagues who were  assigned a different disorder than you. Compare the differential  diagnostic features of the disorder you were assigned to the diagnostic  features of the disorder your colleagues were assigned. What are their  similarities and differences? How might you differentiate the two  diagnoses? 

       

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Opioid Use Disorder 

Substance  use disorder is a major public health problem in the United States.  This is a problem that is associated with increased morbidity,  mortality, and cost of care. It suffices to say that the health care  delivery system is significantly burdened by issues that are associated  with substance use disorder. Data from 1995 to 2018 shows that there has  been an increase in the prevalence rate the use of cannabis as well as  other illegal drugs and analgesics (Seitz et al., 2019). This shows how  substance abuse presents a serious problem for the health care system.  when discussing substance abuse and related disorders, it is very hard  to ignore the opioid epidemic in the country. The opioid epidemic is a  crisis that has taken millions of lives over the last few decades. This  crisis was initially worsened by an augmented use of pharmaceutical  opioids. Currently, most deaths due to opioid are caused by overdosing  on heroin as well as the illegally manufactured synthetic opioid that is  referred to as fentanyl (Lyden & Binswanger, 2019). Death is not  the only negative outcome of the crisis. Opioid use is also associated  with disorders. Opioid use disorder shall form the description of this  paper where the diagnostic criteria shall be presented first. The paper  shall then discuss the treatment of opioid use disorder using  psychotherapy and psychopharmacologic interventions. Finally, the  clinical features of the disorder shall be discussed with reference to  the DSM-5 criteria.

Diagnostic Criteria 

Opioid  use disorder is described as a pattern of opioid use that is  problematic, leading to clinically significant distress or impairment.  The distress or impairment should be manifested by at least two symptoms  from a list that is provided in the DSM-5. This manifestation should  last at least 12 months to make a correct diagnosis (APA, 2013).  Notably, if a person exhibits 2-3 symptoms, this is considered a mild  case. If there are 4-5 symptoms, this is considered moderate, and 6 or  more symptoms demonstrate a severe case. The symptoms as provided in the  DSM-5  list include taking opioids in larger amounts or longer period  than intended, persistent desire or uncontrolled effort to moderate or  stop using opioids, spending so much time using, acquiring and  recovering from the use, craving for opioids, failing to fulfill  important obligations in life due to opioid use, continued use  regardless of social and interpersonal problems that are worsened by the  use of opioids, giving up social, occupational and recreational  activities due to opioid use, using opioids in situations that are  hazardous, and continued use of opioids with the knowledge that it is  causing or exacerbating physical or psychological problems. Notably,  having a high tolerance for opioids in order to achieve the desire to  consume as well as suffering from withdrawals are also symptoms to  include in the list but do not apply in cases where opioids are used  solely for medication purposes (APA, 2013).  

Psychotherapy 

The  most effective psychotherapeutic approach in the treatment of opioid  use disorder is cognitive behavioral therapy. In one study, the  accessibility, feasibility, and efficacy of cognitive behavioral therapy  in the treatment of opioid use disorder was confirmed (Barry et al.,  2019). This approach is effective in preventing relapse and it is also  known to work in preventing those that are taking opioid medications for  pain from starting to use other illicit opioid substances. The use of  psychotherapy as discussed entails rehabilitation as well as  maintenance. While rehabilitation focuses on the use of cognitive  behavioral therapy, maintenance includes psychological support and  patients are always encouraged to join support groups such as an  anonymous program. Education and reward cooperation can be the benefits  of these support groups (Dydyk, Jain & Gupta, 2020). In addition,  when group approaches are used, patients get to benefit from therapeutic  factors such as universality and guidance. The maintenance phase may  also require the use of medications. 

Psychopharmacologic Treatment 

When  cognitive behavioral therapy is used in combination with medication, it  is said to be most effective in the treatment of opioid use disorder  (Dydyk, Jain & Gupta, 2020). Drugs are used for opioid replacement,  maintenance, and substitution therapy. Thus, the drugs that are commonly  used include Methadone and Buprenorphine. They are always provided  under supervision. These drugs are longer acting though they are not as  addictive and euphoric as the illicit opioid drugs. The mentioned drugs  are mu opioid receptor agonists, and they are used as opioid  substitutions even though they have dissimilar pharmacodynamic and  pharmacokinetic properties (Noble & Marie, 2019). Other medications  that are used include Naltrexone that helps in reducing the urge to use,  hence maintaining abstinence and Lofexidine which may be used to treat  side effects associated with withdrawal.

Clinical Features 

 In  a person that presents to the clinic and is diagnosed with opioid use  disorder, they may have slurred speech, pinpoint pupils as well as  sedation. On of the criterion for the disorder is tolerance. This is  requiring high amounts to quench the desire. In such cases, patients may  not present with acute symptoms. This may also be true in cases where  the patient has used a dose that is typical for them. Most acute cases  are emergencies due to overdosing (Strain, Saxon & Hermann, 2015).  It is therefore very important for any health worker to be keen in  identifying the acute symptoms, especially emergency cases in order to  prevent deaths due to overdosing of opioids, something that is very  common.

References

Barry,  D. T., Beitel, M., Cutter, C. J., Fiellin, D. A., Kerns, R. D., Moore,  B. A., … & Schottenfeld, R. S. (2019). An evaluation of the  feasibility, acceptability, and preliminary efficacy of  cognitive-behavioral therapy for opioid use disorder and chronic pain. Drug and alcohol dependence, 194, 460-467

Dydyk, A. M., Jain, N. K., & Gupta, M. (2020). Opioid Use Disorder. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK553166/#article-42233.s6

Lyden, J., & Binswanger, I. A. (2019, April). The United States opioid epidemic. In Seminars in perinatology (Vol. 43, No. 3, pp. 123-131). WB Saunders

Noble,  F., & Marie, N. (2019). Management of opioid addiction with opioid  substitution treatments: beyond methadone and buprenorphine. Frontiers in Psychiatry, 9, 742

Seitz,  N. N., Lochbühler, K., Atzendorf, J., Rauschert, C., Pfeiffer-Gerschel,  T., & Kraus, L. (2019). Trends in substance use and related  disorders: Analysis of the epidemiological survey of substance abuse 1995 to 2018. Deutsches Ärzteblatt International, 116(35-36), 585.

Strain,  E., Saxon, A. J., & Hermann, R. (2015). Opioid use disorder:  Epidemiology, pharmacology, clinical manifestations, course, screening,  assessment, and diagnosis. UpToDate, Post, TW, editor. UpToDate. Waltham, MA [cited 2018 Apr 1]