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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

Vulnerability Factors

Several factors have been identified that make people vulnerable to substance use disorder, including OUD.16 These include genetics, the properties of the drug themselves, life experience, and the environment in which the patient lives.

Vulnerability Factor: Genetics

Genetics make up a significant portion of a person’s vulnerability.17 If there is a family history or a personal history of addiction, that is a strong predictor of future problems with substance use. There are many genetic markers that have been identified as potential predictors as well.

Vulnerability Factor: Environment Influences

The environment in which a person lives can not only influence his or her vulnerability for use and abuse but also the ability for rehabilitation.17 People may do well in a structured setting for rehabilitation, but once they are released into their previous environment where they have the same cues and pressures, they may have trouble maintaining sobriety. Certain social pressures can be profound and difficult for people to reduce, so they return to using.

Vulnerability Factor: Drug Properties

Properties of the drugs themselves pose a significant vulnerability factor.17 Certain substances, such as cocaine and methamphetamines, pose a greater threat than drugs such as cannabis. The effect relates to a more profound release of dopamine, making users of these drugs more susceptible to severe drug use disorders.

Vulnerability to Opioid Addiction

Vulnerability to opioid addiction is something that we’re struggling to understand. It is known that one individual may be exposed to opioids for the very first time and develop an addiction, whereas another person can be exposed for years and not develop an addiction.18 What is not quite understood is how all the vulnerability factors interact. Which is the most profound: the genetic component, environment, life stressors, life experience? It is really all quite individual.

Risk Factors for Opioid Misuse and OUD

There are certain risk factors for opioid misuse and the development of OUD.19 These include the following:

  • Personal or family history of substance use and OUD, in particular. These can be strongly predictive.
  • Self‑reported craving is also strongly predictive. Patients will often tell you that they “need” the drug. It may not have anything to do with pain or function, but merely feeling. Often, doses of medications for OUD are adjusted purely based on the level of craving that the patient is reporting.
  • Psychiatric history is a very compelling factor and can be predictive because of the mood‑altering properties of opioids, particularly if the psychiatric disease is uncontrolled.

  • Finally, we have become aware that certain demographic factors, such as younger age, gender, and so on, are more likely to be associated with OUD.

    Being aware of these risks is extremely important, and assessment of these risk factors should take place as part of treatment.

Which of the following is the strongest predictor of developing an opioid use disorder (OUD)?

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