Korean J Pain.  2022 Oct;35(4):361-382. 10.3344/kjp.2022.35.4.361.

Prevention, diagnosis, and treatment of opioid use disorder under the supervision of opioid stewardship programs: it’s time to act now

• Kim EJ
• Hwang EJ
• Yoo YM
• Kim KH

• KMID: 2533977
• DOI: http://doi.org/10.3344/kjp.2022.35.4.361

Abstract

The third opium war may have already started, not only due to illicit opioid trafficking from the Golden Crescent and Golden Triangle on the international front but also through indiscriminate opioid prescription and opioid diversion at home. Opioid use disorder (OUD), among unintentional injuries, has become one of the top 4 causes of death in the United States (U.S.). An OUD is defined as a problematic pattern of opioid use resulting in clinically significant impairment or distress, consisting of 2 or more of 11 problems within 1 year, as described by the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Observation of aberrant behaviors of OUD is also helpful for overworked clinicians. For the prevention of OUD, the Opioid Risk Tool and the Current Opioid Misuse Measure are appropriate screening tests before and during opioid administration, respectively. Treatment of OUD consists of 3 opioid-based U.S. Food and Drug Administration-approved medications, including methadone, buprenorphine, and naltrexone, and non-opioid-based symptomatic medications for reducing opioid withdrawal syndromes, such as α 2 agonists, β-blockers, antidiarrheals, antiemetics, non-steroidal anti-inflammatory drugs, and benzodiazepines. There are at least 6 recommendable guidelines and essential terms related to OUD. Opioid stewardship programs are now critical to promoting appropriate use of opioid medications, improving patient outcomes, and reducing misuse of opioids, influenced by the successful implementation of antimicrobial stewardship programs. Despite the lack of previous motivation, now is the critical time for trying to reduce the risk of OUD.

Keyword

Analgesics; Opioid; Antimicrobial Stewardship; Buprenorphine; Methadone; Naltrexone; Narcotic Antagonists; Opioid-Related Disorders; Opium; Prescriptions; Substance Withdrawal Syndrome; United States Food and Drug Administration

Figure

• 

  Fig. 1 Schematic illustration of prevention, diagnosis, and treatment of opioid use disorders (OUD). Under the supervision of opioid stewardship programs (roof), prevention, diagnosis and treatment of opioid use disorder (3 pillars) should be performed, based on the various recommendation guidelines (foundation). Prevention of OUD is recommended to use the screening tests, such as opioid risk tool (ORT) before opioid administration and current opioid misuse measure (COMM). Diagnosis of OUD is performed by the Diagnosis and Statistical Manual of Mental Disorders, fifth edition (DSM-5). OUD is suspected if patients have 2 or more among 11 items. For busy clinicians, aberrant opioid-taking behaviors, composed of clearly and potentially problematic behaviors, can be used for suspicion of OUD in a clinical field. Treatment of OUD consists of 3 the U.S. Food and Drug Administration (FDA)-approved medications, including methadone, buprenorphine, and naltrexone and non-opioid symptomatic medications for the treatment of opioid withdrawal syndrome, such as α2 agonists, β-blockers, antidiarrheals, antiemetics, non-steroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines. These methods for prevention, diagnosis, and treatment are based on the 6 recommendation guidelines from various societies and associations, under the supervision of opioid stewardship programs.

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