Diagnosis and Pharmacologic Management of Opioid Dependency

Hospital Physician October 2007 15 O pioid dependency is a common problem that remains underdiagnosed and undertreated in the United States. The National Survey on Drug Use and Health estimated that in 2002 approximately 2.5 million Americans used pain relievers, mostly opioid agonists (eg, oxycodone, hydrocodone, morphine, methadone), for nonmedical use. Approximately 3.7 million Americans have reported using heroin at some time in their lives, with 314,000 reporting heroin use in the past year.1 Other sources estimate that the problem of opioid dependency is much larger. The Office of National Drug Control Policy reports that there are between 750,000 and 1 million regular users of heroin in the United States.2 Worldwide, approximately 16 million individuals (0.4% of the adult population) abuse opiates, but only 7.8% of these individuals receive treatment.3 Opioid abuse is a significant problem among hospital patients in the United Statess. In 2004, there were 162,137 emergency department visits due to heroin use and an additional 158,281 visits due to the nonmedical use of opioid pharmaceuticals.4 In 2003, there were 324,000 admissions for opiate abuse treatment.1 Still, only 20% of heroin users receive treatment, despite the availability of effective pharmacologic agents.5 Pharmacologic treatments, such as opioid agonists, are effective at reducing drug use among opioid-dependent patients, but access to these medications is limited. New officebased treatments for opioid dependency are available and provide alternatives for providers and patients. Given their frequent contact with patients who use opioids, hospital physicians and generalists can play an important role in identifying and managing opiate abuse. This article reviews the context of opioid dependence and treatment in the United States, outlines important aspects of assessing opioid dependency, and provides a guide to available treatment options.