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OUD

CE / CME

Module 6: Opioid Use Disorder

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Optometrists: 1.00 COPE CE credit 

ABP MOC: maximum of 1.00 MOC point

ABS MOC: maximum of 1.00 Continuous Certification credit

ABOHNS MOC: maximum of 1.00 Part II Self-Assessment Credit

ABPath MOC: maximum of 1.00 Lifelong Learning point

Dental Professionals: 1.00 ADA CERP credit

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: May 31, 2023

Expiration: May 30, 2026

Timothy Atkinson
Timothy Atkinson, PharmD, BCPS, CPE
CME/CE Information

Activity

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Course Completed

Definitions

Definitions are important when it comes to substance use disorders because they are very often used interchangeably and inappropriately, even in research studies, making results very difficult to interpret.12-14

  • Misuse is any intentional therapeutic use of a substance in an inappropriate way.
  • Abuse is the intentional nontherapeutic use of a substance to try to achieve a psychological or  physiologic effect.
  • Addiction or OUD is a treatable chronic medical disease involving brain circuitry, genetics, environment, and experiences resulting in compulsive use.
  • The definition of dependence is very similar to addiction according to current International Statistical Classification of Diseases and Related Health Problems (ICD)‑10 codes. However, there is also the concept of physical dependence, which describes the body acclimation to the chemical such that abrupt discontinuation can cause withdrawal syndrome.
  • Tolerance is an acclimation to medicine, requiring a larger amount of the substance to maintain the same level of effect.
  • Aberrancy is behavior that is a departure from what is expected or prescribed.
  • Diversion is any intentional transfer of a drug product from a lawful to an unlawful distribution or possession. This may be simply giving it away, but it can also be selling it or obtaining it for the purpose of selling.

Opioid Use Disorder

OUD definitions have evolved over time. In an earlier version of the DSM, addiction was defined as symptomatic of a personality disorder. In addition, tolerance and withdrawal were sometimes used as criteria and considered an essential feature of addiction.

In the more recent guidelines, there is a recognition that tolerance and withdrawal are normal, natural, pharmacologic phenomena of opioids. Therefore, we cannot use these criteria as diagnostics in anyone that is prescribed an opioid for pain. Other criteria must be relied on to make a diagnosis.

Finally, we have also come to recognize that OUD is a spectrum disorder; there are mild, moderate, and severe forms of the disorder.

Diagnostic Criteria for Opioid Use Disorder

The criteria for the diagnosis of OUD include the following15:

  • Using drugs in large amounts or for longer than intended
  • Desire to decrease or stop using drugs but being unable to
  • Spending a great deal of time procuring, using, or recovering from use
  • Craving the next dose
  • Continuing to use drugs despite problems in relationships
  • Giving up important activities because of drug use

Any 2 criteria met within 12 months is diagnostic of a mild form of OUD, whereas if ≥6 are present, a severe form of OUD may be diagnosed. 

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