Talk:Opioid use disorder

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The article is well-structured overall, but is not comprehensive in its coverage of important sub-topics, such as OUD mitigation and OUD induction strategies.

I will reorganize the diagnosis section to appear with “Signs and symptoms” since these sections repeat the same information. I will also reorganize portions of the current “signs and symptoms” section so it flows logically from use to withdrawal to potential long-term sequelae. For readers not familiar with medical terminology, I plan to add descriptions for the medical bullets in the "opioid intoxication" and "opioid withdrawal" section. Lastly, where possible, I will shorten the "management" section to improve readability.

Student editor(s): 

User:Kalij94.

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WikiProject Medicine: MUSC College of Medicine

Hello,

I'm also a fourth-year medical student who will be editing this page as part of an elective rotation. I am planning to focus mainly on the Epidemiology, Prevention, and Treatment sections of the body. I've outlined the aspects of the editing process we've been told to focus on and how I plan to do so below. Please let me know if you have thoughts or suggestions. Looking forward to working with you all!

1. What resources do I intend to look up, and when? -This week, until 11/25, I will be solidifying resources -Meta-analyses from reputable journals -Book chapters from reputable, yet recent sources

2. How will I decide what things (signs, symptoms, side-effects, etc.) to explicitly include/exclude? -Expand upon information presented in terms of the types of populations in which opioid use disorder is most prevalent and why (e.g., discussing barriers to care in certain populations) -Update and summarize prevention and treatment sections as appropriate based on secondary research studies

3. Will I also embed additional links to other Wiki pages? -Yes — Preceding unsigned comment added by RedStorm1 (talk • contribs) 20:21, 18 November 2019 (UTC)

Article start

This was one of the first articles I edited on Wikipedia when I finally got round to signing up for a user account; it's got a little bigger, but is still quite unloved. For something which affects probably millions of people around the world, you'd think something more can be written. Does the article need to be deleted? Or merged into Opioid#Dependence_and_withdrawal_issues?

Hence addition of the {{attention}} tag.

Richard W.M. Jones 14:46, 1 November 2005 (UTC)

I agree the article does need some more work, perhaps as someone going through these issues I will attempt to add some more useful text later when I have some time (although I have never really made major page edits before and worry my personal experience of the issue may cause inadvertent POV issues) MttJocy 21:39, 11 March 2007 (UTC)

Requested name change

I think that the name of this page should be opioid dependency rather than opiate, because it then encompasses the full range of opioids rather than simply morphine and codeine

--javsav (cbf logging in)

Agreed, dependency to opioid drugs and true natural opiates functions in much the same way with similar effects, thus Opioid would be more suitable, I do suggest a redirect is left as well though due to the common erronious perception in the general public that opiate refers to all the opioid drugs, such as heroin, hydrocodone, oxycodone etc are often mistakenly termed opiates. MttJocy 21:39, 11 March 2007 (UTC)

I've moved the article, per the request and discussion here. -GTBacchus^(talk) 00:43, 20 March 2007 (UTC)

Effects on the brain

Prescription pain killers are widely used and for most people who use them, especially those who suffer with chronic pain, they are extremely effective and necessary for them to live a pain free and productive life. It is when these narcotics are abused and used for non-medical purposes that it creates a problem. The effects on the brain from long term use of opioids range from acute sensory effects such as blurred vision or impaired judgement, to extreme effects such as respiratory depression or cardiac arrest. The brain controls the addiction by becoming dependant on the drugs and also by creating a tolerance to the drugs which forces the addict to increase drug usage. Even after the addict has stopped using the opioids, the brain can still create urges and cravings making it hard for the addict to stay away from the drugs. —Preceding unsigned comment added by Gigi1123 (talk • contribs) 02:14, 25 April 2008 (UTC)

I removed an uncited section saying that opioid use causes no long term brain damage, as this is completely false in the case of some opioids, and unproven in others. In any case it is dangerous and encourages uninformed drug use.Fireemblem555 (talk) 05:48, 8 January 2010 (UTC) I don't think anyone about to take opiates thinks 'I'll just check with Wikipedia first' PetePassword (talk) 20:50, 19 June 2018 (UTC)

Opioid use does not cause brain damage, nor damage to any of the organ systems in the body.

http://www.promotingexcellence.org/downloads/jacs_0203.pdf "Opioids at any dose do not cause visceral organ damage."

"Unlike alcohol or tobacco, heroin causes no ongoing toxicity to the tissues or organs of the body. Apart from causing some constipation, it appears to have no side effects in most who take it. When administered safely, its use may be consistent with a long and productive life. The principal harm comes from the risk of overdose, problems with injecting, drug impurities and adverse legal or financial consequences." Source: Byrne, Andrew, MD, "Addict in the Family: How to Cope with the Long Haul" (Redfern, NSW, Australia: Tosca Press, 1996), pp. 33-34, available on the web at http://www.csdp.org/addict/.

Heroin is not inherently toxic to the organ systems of the body. Whereas a 200-400mg dose of heroin could kill a novice, a chronic user may take 1800mg without ill-effects. http://www.opioids.com/heroin.html

The scientific consensus seems to be that pure opiates do not cause damage to the body, but rather, various things that street drugs are cut with can do so. Maybe we can compromise and include this in the article. As a recovering addict, I'm not advocating for or supporting recreational/irresponsible opiate use, but I do believe in the truth being out there. Realistically, if you are abusing oxycontin for years, you will not have brain damage afterwards (unless you OD and get it from oxygen deprivation, but that's still a whole different issue than the possibility of damage being implicit in long-term use). However, you will have more severe problems like daily cravings for life, long-term severe restlessness/anxiety/depression, etc. 74.47.149.67 (talk) 16:48, 25 April 2010 (UTC)

Opioid/opiate related effects on the physical aspects of the brain, eg brain damage, are a subject of much confusion and debate. People who argue that opiods are less dangerous and detrimental than we are culturally indoctrinated to believe will often cite the claim that "opiods do not possess any inherent detrimental effects on the brain or body, and that all such effects stem from impurities in street drugs or develop as a result of unsafe routes of ingestion." Such proponents will similarly cite claims like "if this was not the case, then opiods would not constitute the largest single class of prescription drugs in the world, and in the US, based either on the total number of prescriptions, renewals, or quantity of doses prescribed, because all opiods belong to the same class and cannot be counted separately." The downside is that there are, indeed, some genuine negative effects on brain cell biochemistry that stem from long term opiod dependence. To be sure, some of this comes from differing ideas of the "definition" of brain damage. For example, some medical researchers, often those in fields like psychology, psychiatry, and psychoanalysis, identify "mental illness" as a form of brain damage, and because substance abuse is often identified as a mental illness, we get this association. Similarly, the very fact of physical/chemical dependence is often defined as "damage" with respect to the normal biochemical function of the brain. However, with respect to actual direct damage to the cells of the body: opiates/opiods do not produce any direct cellular damage. The ABSOLUTE ONLY negative associate with human biochemistry that derives from long term opiod dependence is a belief (theory, assumption, nowhere near consensus; one of many theories used to explain behavioral effects in long term opiod users) that Opiods affect the rate at which new nerve cells are produced by the body, which theoretically changes the balance of a differential equation that represents the equilibrium between normal/natural/regular cell death and normal/natural/regular cell growth. The effect is that some believe that Opiod abuse produces something similar to "aging" in the sense that the rate at which those new cells are grown slows down, as would be seen in a rapid aging process. Cell death does occur as a result of non-competitive opiods that bind irreversibly to the opiod recepters, which causes the body to target them for early cell death. This is only the case for extremely potent opiods (Bentley opiods like fentanyl and large animal tranquilizers) and irreversibly binding morphinan derivatives that include an alkylating group near the component of the ligand that binds. Short half life opiods of moderate strength, which includes those that are commonly abused, do not possess sufficient agonist properties to cause the body to target the cells for early death. The same CANNOT BE SAID for methadone and buprenorphine, the latter of which possesses potency of ~10-30x that of morphine (Eg 1 mg of buprenorphine is equivalent to 10-30 mg of morphine; buprenorphine for pain is prescribed in 250 microgram-500 microgram doses). Buprenorphine's extremely long half life (~30 hours or so) also contributes to the effect of chronic activation of the opiod receptor. Note: Everything I have said thus far is true ONLY for adult brains. long term opiod effects are much more pronounced in the brains of adolescents and teenagers because their brain cells are still growing, and by slowing down the rate of cell growth it prevents the eventual formation of the maximum possible number of brain cells, which effectively limits the potential of such a person's brain.184.189.220.114 (talk) 20:26, 10 September 2013 (UTC)

Copyright problems with diagnostic criteria

The American Psychiatric Association has not released its Diagnostic and Statistical Manual of Mental Disorders into public domain, but claims copyright. The Wikimedia Foundation has received a letter of complaint (Ticket:2010030910040817, for those with access) about the use of their diagnostic criteria in this and a number of other articles. Currently, this content is blanked pending investigation, which will last approximately one week. Please feel free to provide input at the copyright problems board listing during that time. Individuals with access to the books would be particularly welcome in helping to conduct the investigation. Assistance developing a plan to prevent misuse of the APA's material on Wikipedia projects would also be welcome. Thank you. Moonriddengirl ^(talk) 14:24, 11 March 2010 (UTC)

I am curious about what the outcome is/was of this "ticket"/complaint, as of today. Although I have never used a DSM to gain material for an article on Wikipedia I am one of those who has access to a DSM. I guess I want to be clear about what this is meaning. Does this mean that someone used the information and did not give proper credit to the publisher of the DSM or does this mean that even with proper credit no one is allowed to use any of the information in the DSM? Just curious. Thank you. TattØØdẄaitre§ 23:59, 10 June 2013 (UTC)

Hmmm, perfect example of i should research before I ask a question. I followed the link and I do see that all issues have been resolved changed reworded etc however I do still have a question as to exactly what the violation was. Can we use the info from a DSM if we credit right? TattØØdẄaitre§ 00:36, 11 June 2013 (UTC)

Put it in your own words, adding some variant of "According to the DSM [insert current version here]...". I dream of horses (T) @ 04:13, 11 June 2013 (UTC)

Ok Thank You TattØØdẄaitre§ 04:34, 11 June 2013 (UTC)TattØØdẄaitre§ 04:39, 11 June 2013 (UTC)

Refs

The below refs were listed in reference section but not as inline citations in the article body, so it is not clear which were simply dumped random and which if any were used to write article content. So I have moved them here. If anyone wants to take the time to reference them that would be great.

• Volkow N. What do we know and what don't we know about opiate analgesic abuse? Keynote address, Wednesday, March 30, 2005. Program and abstracts of the 24th Annual Scientific Meeting of the American Pain Society; March 30-April 2, 2005; Boston, Massachusetts.
• Fishbain DA, Rosomoff HL, Rosomoff RS (1992). "Drug abuse, dependence, and addiction in chronic pain patients". Clin J Pain. 8 (2): 77–85. PMID 1633386. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Hoffmann NG, Olofsson O, Salen B, Wickstrom L (1995). "Prevalence of abuse and dependency in chronic pain patients". Int J Addict. 30 (8): 919–27. PMID 7558484. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Chabal C, Erjavec MK, Jacobson L, Mariano A, Chaney E (1997). "Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors". Clin J Pain. 13 (2): 150–5. doi:10.1097/00002508-199706000-00009. PMID 9186022. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Kouyanou K, Pither CE, Wessely S (1997). "Medication misuse, abuse and dependence in chronic pain patients". J Psychosom Res. 43 (5): 497–504. doi:10.1016/S0022-3999(97)00171-2. PMID 9394266. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Reid MC, Engles-Horton LL, Weber MB, Kerns RD, Rogers EL, O'Connor PG (2002). "Use of opioid medications for chronic noncancer pain syndromes in primary care". J Gen Intern Med. 17 (3): 173–9. doi:10.1046/j.1525-1497.2002.10435.x. PMC 1495018. PMID 11929502. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Narcotic & Psychotropic Drugs: Achieving Balance in National Opioids Control Policy © World Health Organization, 2000.
• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision 2002.
• WHO Expert Committee on Addiction-Producing Drugs, Thirteenth Report, World Health Organization Technical Report Series No. 273. Geneva: World Health Organization, 1964.
• WHO. 5th Review of Psychoactive Substances for International Control. Geneva: World Health Organization, November 16-20, 1981.
• NIDA. Trends in Prescription Drug Abuse 2006.
• "Contents". American Pain Society (APS) Bulletin. 9 (5). 1999. {{cite journal}}: Unknown parameter |month= ignored (help)
• Mahowald ML, Singh JA, Majeski P (2005). "Opioid use by patients in an orthopedics spine clinic". Arthritis Rheum. 52 (1): 312–21. doi:10.1002/art.20784. PMID 15641058. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Use of Essential Narcotic Drugs to Treat Pain is Inadequate, Especially in Developing Countries. International Narcotics Control Board (INCB), Annual Report, 3 March 2004.
• Walid MS, Hyer L, Ajjan M, Barth AC, Robinson JS (2007). "Prevalence of opioid dependence in spine surgery patients and correlation with length of stay". J Opioid Manag. 3 (3): 127–8, 130–2. PMID 18027538.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• {{cite journal |author=Walid MS, Hyer LA, Ajjan M, Robinson JS |title=Predicting Opioid-Dependence Using Pain Intensity and Length of Pain Suffering in Pre-Spine-Surgery Patients |journal=Internet J Pain, Symptom Control and Palliative Care |volume=5 |issue=2 |year=2007 |url=http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijpsp/vol5n2/suffering.xml}}

Thanks.--Literaturegeek | T@1k? 23:42, 31 May 2010 (UTC)

Possible Reason for the Un-Love

Many sources I have run across in general research indicate that there is a significant effort to get the general public to distinguish between physical dependency, characterised by physical symptoms when use is discontinued, and addiction, characterized by drug-seeking behaviors and continued use despite negative consequences. Advocacy groups for both recovering addicts and patients who use medications known to cause physical dependency have both done a great deal of work to separate the two in the minds of the general populace, but this entry (and possibly the diagnostic criteria it discusses) conflates the two. This may be why the article is not getting much love. My vote would be to absorb it into the larger article as a specific reference to a particular diagnosis associated with the larger problem. Nightsmaiden (talk) 10:19, 30 July 2010 (UTC) Well you'll dismiss me as someone who's resistant then, but I don't know where you get the idea that addiction is somehow different to what this page is about, I wondered if the word addiction was suddenly non politically correct like junky, even though the preferred term by junkies, viz William Burroughs novel 'Junky'. In my experience those who are susceptible to addiction can be addicted very quickly. The effects halve with each subsequent dose, figure it out, it doesn't take months if the supply is there. Physical dependancy and addiction are the same, why are you splitting hairs? Whether you're talking about the state sponsored addiction to Oxycontin or the street junky's heroin, the only difference in addicts is some can cope and others can't, that's to do with character not a different kind of dependency. I've known both, I don't get it from books of theory. Methadone is massively more addictive than heroin, junkies sell it and buy heroin, and so more become addicted to a Nazi pharma addiction than were ever addicted to heroin. PetePassword (talk) 21:05, 19 June 2018 (UTC)

opioid dependence 2 factors

I am curious about the section titled 12 step support groups. I am going to attempt to add more sources... but I am wondering if this section should really be here. There are other articles that specifically talk about addiction and what the 12 step programs are used for.

Dependence (on any drug not just Opioid) has two factors and is the progressive need for the drug that results from the use of that drug

1. The need creates psychological and physical changes

A. Psychological dependence occurs when a user needs the substance to feel normal or to function adequately in normal daily activities

B. Physical dependence occurs when the body adapts to the substance and needs increasing amounts to ward off the effects of withdrawal

The "addiction" part and therefore the need for a 12-step program to stop using the drug is a separate issue. Someone can use the drug and be dependent on it but not be addicted to it. Am I making sense? Just because a person suffers from withdrawals (which is the physical factor) when they stop using the drug, does not make them an addict (Psychological and Physical factors).

Any thoughts would be appreciated. TattØØdẄaitre§ 23:47, 10 June 2013 (UTC)

Yes, I pretty much agree with you on all of that. It's always seemed a little strange to me to have that section on 12 steps here. Perhaps we should shorten it according to WP:Summary style, and if so, I'd be happy to help doing that. Someone can be physically dependent (as someone on methadone would be), and still be able to function constructively in society, so it becomes a matter of opinion whether one would want to call such a person "addicted" in the same way that someone on heroin (for example) might be. --Tryptofish (talk) 20:07, 11 June 2013 (UTC)

Hmmm, so I wonder what we do now? Since we both agree maybe there are others that would think so too? I am rather new at all this stuff so not sure what the next step would be for us to request to have that section removed or shortened as you suggest. Or do we just do it? I thank you for your input for sure. TattØØdẄaitre§ 04:31, 12 June 2013 (UTC)

I've been at this a long time, and it's pretty much a matter of WP:BEBOLD. I'd like to give it another day or so, just in case someone else drops by and has a different view, and then either you or I can go ahead and do it. (If someone complains later, which is highly improbable, it can always be undone.) --Tryptofish (talk) 19:16, 12 June 2013 (UTC)

Thank you sounds good. TattØØdẄaitre§ 20:22, 12 June 2013 (UTC)

 Done. --Tryptofish (talk) 20:07, 18 June 2013 (UTC)

Opiod Withdrawal Timeframes and remove trigger image

As much as we like to think professionals don't look to wikipedia for factual information, they do. For methadone the length of typical withdrawal is about 30days same for bupe. Spreading misinformation (be it cited or not from a professional source) is going to seriously hurt some people. Typical time frames for short acting opiods can be as short as 2 or 3 days (especially if a taper is involved) to 7 to 10 days and even beyond depending on a lot of factors. Actually from your own source "Methadone, for example, has a half-life of anywhere from 15 to as long as 60 hours, with an average half-life of approximately 24 hours. For a daily user of methadone, withdrawal symptoms will begin to be felt within 24-48 hours of last methadone exposure. The physical withdrawal for methadone can last up to 4 weeks or longer, with symptoms of withdrawal reaching their peak around the 7-10 day mark. ". One other thing, change the image on the page, for those going through withdrawal that's a trigger image. This one is just saying "guys be respectful" more then anything else. — Preceding unsigned comment added by 71.199.64.166 (talk) 10:56, 31 October 2014 (UTC)

As far as I can tell, the website cited as a source for that information does not meet the WP:MEDRS criteria. Regarding the image: please see WP:NOTCENSORED. -- The Anome (talk) 23:29, 31 October 2014 (UTC)

Please see also a discussion that I started at WT:PHARM#"Trigger image" at Opioid dependence. --Tryptofish (talk) 23:31, 31 October 2014 (UTC)

Agree the source clearly does not meet standards for medical information sources. It needs to stay out unless a better source can be found, e.g. a meta analysis, professional medical association treatment guideline, or review.Formerly 98 (talk) 23:34, 31 October 2014 (UTC)

Merge/redirect of Opioid replacement therapy

Back at the start of April, I boldly redirected the Opioid replacement therapy (ORT) article after having merged it here in the Management section. You can see this in the history; it was part of a larger effort to consolidate and synchronize the various bits of content we had on this that were scattered across several WP articles.

Am opening this now as User:Bpmcneilly has left a very civil message on my talk page suggesting that the ORT article be recreated. I don't see much use in that, as the content all seems to fit very comfortably here, but am happy to discuss to hear what advantages there are in a re-split of ORT (or undoing the merge, as it were). And of course get others' take on this. Jytdog (talk) 03:38, 2 May 2016 (UTC)

NB: should have originally noted that the ORT article looked like this before the merger. Jytdog (talk) 04:23, 2 May 2016 (UTC)

I honestly don't think the management section is long enough to merit making an independent article for ORT. Seppi333 (Insert 2¢) 03:48, 2 May 2016 (UTC)

So, my argument for re-adding the ORT article is that the space in this article deals specifically with medications as an option for those dealing with opioid use. The ORT article would serve as a space to both discuss what is mentioned here (the physical options for drugs used) as well as legal differences across jurisdictions and academic / clinical arguments in favor of or against the use of this method of treatment. I think the latter two are out of scope the way the current article is structured. the former ORT article included data about effectiveness from the WHO, various examples of where ORT is practiced and the differences between them, thigns of that nature. Bpmcneilly (talk) 04:10, 2 May 2016 (UTC)

That's interesting. Some of that content was already in the former article and indeed came over here (like the WHO recommendation and discussion of effectiveness, and where it is done; that stuff is not gone). The detail on legal/jurisdictional stuff as well as the philosophical debates could well go into a Society and Culture section here, which is now lacking. If that gets too big we could discuss at that time what WP:SPLIT would be appropriate... Jytdog (talk) 04:23, 2 May 2016 (UTC)

agree could go into Society and Culture section --Ozzie10aaaa (talk) 13:18, 2 May 2016 (UTC)

Agree improve and expand here. If it becomes to big than split. Doc James (talk · contribs · email) 20:16, 2 May 2016 (UTC)

Agree that split should only occur if/when size permits. Yobol (talk) 14:20, 3 May 2016 (UTC)

Copyright Problems

I just ran Earwig's Copyvio Detector([3]) on this article and it scores 51.9% against http://whqlibdoc.who.int/unaids/2004/9241591153_eng.pdf and 47.6% against http://www.who.int/substance_abuse/activities/treatment_opioid_dependence/en/index.html [4]. I see paragraphs in common with only minor differences. Do we have a problem here? --DanielRigal (talk) 17:34, 28 August 2016 (UTC)

Thanks for pointing that out. I did some better paraphrasing and reduced those numbers. Jytdog (talk) 09:10, 29 August 2016 (UTC)

Scoping review

... of primary care based models. doi:10.7326/M16-2149 JFW | T@lk 22:50, 5 December 2016 (UTC)

WikiProject Medicine

Hi All,

I am a 4th year medical student at the University of California, San Francisco. As part of an elective I will be editing this article over the next few weeks.

Focussing predominantly on the lead page followed by symptoms of withdrawal, diagnosis, and management: - Ensure readability, break down jargon, shorten sentences if need be - Add links to other Wikipedia articles - Review/add citations - If time permits, I would like to add a section about opioid intoxication and a brief note on causes of opioid related deaths

Happy for any feedback. — Preceding unsigned comment added by Chey.snav (talk • contribs) 19:48, 2 March 2017 (UTC)

Please do not focus primarily on the lead. The lead just summarizes the body. Please focus first on the body, and once that is well sourced and NPOV and covers the sections described in WP:MEDMOS, then - and only then - consider the lead, revising it as necessary per WP:LEAD. Please note that the Translation task force often just translates the lead, so please make sure the complete citation for each ref used in the lead, is in the lead. Thanks. Jytdog (talk) 20:31, 2 March 2017 (UTC)

Welcome, we'll be happy to see your contributions! If you can better summarize the article please do improve the lead. But Jytdog is right that effort might be better placed on improving the body. If you're adding content it should be first added to the body and then (possibly) summarized in the lead. Sizeofint (talk) 03:51, 3 March 2017 (UTC)

Hi all,

Happy others are contributing and editing this page as well. However, I'm wondering if we can come to some sort of agreement regarding deleting large chunks of text. Perhaps posting first to ask intended purpose and discuss? Obviously for time reasons that doesn't make sense for a sentence here and there but I'm hoping for large amounts of text or new sections we could discuss first.

Thanks for everyones contributions! — Preceding unsigned comment added by Chey.snav (talk • contribs) 21:32, 13 March 2017 (UTC)

There is always WP:BRD but if you think a change is likely going warrant discussion it certainly does not hurt to open a discussion here first. Sizeofint (talk) 19:40, 15 March 2017 (UTC)

Incidentally, you can sign your comments using four tildes after your post like ~~~~. Sizeofint (talk) 19:41, 15 March 2017 (UTC)

Peer Review: Hi Chey.snav, here are my comments for your work Lede: “ despite adverse consequences from continued use.[3]” -Perhaps you could elaborate or be more specific such as “impaired social, physical functioning”

Diagnosis: Maybe add a sentence about who makes the diagnosis and in what setting i.e. doctors? counselors? Can you self-diagnose?

Prevention: “Naloxone kits are recommended for laypersons who may witness an opioid overdose, individuals in substance use treatment programs, individuals recently released from incarceration and individuals with large prescriptions for opioids.[8]” -This sentence got kind of long. Split in two maybe?

“Opioid replacement therapy (ORT) (also called opioid substitution therapy or opioid maintenance therapy) involves replacing an illegal opioid, such as heroin, with a longer acting but less euphoric opioid; methadone or buprenorphine are typically used and the drug is taken under medical supervision.[37]” - Also split this sentence into smaller ones.

“In practice, 40-65% of patients maintain complete abstinence from opioids while receiving opioid replacement therapy, and 70-95% are able to reduce their use significantly, while experiencing a concurrent elimination or reduction in medical (improper diluents, non-sterile injecting equipment), psychosocial (mental health, relationships), and legal (arrest and imprisonment) issues that can arise from the use of illegal opioids.[37] “- Same here

The rest of the section looks pretty tidy. --Haiphamalicious (talk) 04:56, 21 March 2017 (UTC)

@Haiphamalicious, thanks for your feedback, great suggestions! — Preceding unsigned comment added by Chey.snav (talk • contribs) 03:06, 22 March 2017 (UTC)

I hope all the action on this page hasn't scared you off :). Sizeofint (talk) 06:12, 30 March 2017 (UTC)

Order

@Doc James: It seems like you have missed out classification, which is supposed to be the first section. zzz (talk) 03:41, 15 March 2017 (UTC)

Sure. Is their a classification of OUD? Also I am "Doc James" not "DocJames" Doc James (talk · contribs · email) 04:08, 15 March 2017 (UTC)

What is this article about?

The definition is more than half-way down the page, and literally none of the article before that is actually about OUD. It seems like OUD is incidental to this article as written. See WP:COATRACK. zzz (talk) 03:48, 15 March 2017 (UTC)

@DocJames: "Opioid use disorders resulted in 122,000 deaths worldwide in 2015", does the (offline) ref state that, or are you simply counting all opioid related deaths as "Opiod use disorder"? zzz (talk) 03:58, 15 March 2017 (UTC)

The first sentence has the definition "Opioid use disorder is a medical condition characterized by the compulsive use of opioids despite adverse consequences from continued use" so not sure what you are referring to?

Ref says "All age deaths (thousands) Opioid use disorders 122·1 (109·5 to 129·7) 2015". So it specifically about OUD. You need to look at the table. User:Signedzzz Doc James (talk · contribs · email) 04:09, 15 March 2017 (UTC)

"is characterised by...", yes that is oddly vague for an encylopedia article, how about just "is"? No mention of the DSM definition "that these symptoms are present over a period of 12 months", until near the end of the page, why not? Do you draw a distiction between OUD and opioid addiction, etc etc? Because this article does not, in fact it seems to imply that any illicit opioid use is "opioid use disorder", since as I just stated, nearly all of the article is not about OUD. zzz (talk) 04:23, 15 March 2017 (UTC)

Agree the article needs lots of work.

I prefer the wording you suggest aswell "Opioid use disorder is the compulsive use of opioids despite adverse consequences from continued use" Doc James (talk · contribs · email) 04:27, 15 March 2017 (UTC)

DSM5 says "occuring within a 12 month period" not that symptoms need to be present for at least 12 months. Doc James (talk · contribs · email) 04:30, 15 March 2017 (UTC)

Thanks for clarifying. zzz (talk) 04:36, 15 March 2017 (UTC)

Have adjusted that lower wording as it was a little confusing. Doc James (talk · contribs · email) 04:38, 15 March 2017 (UTC)

It seems like this is about the DSM designation but the lead attempts to make it a common use description. "Opiod Use Disorder is a DSM V diagnostic classification" would be a better intro. Without that type of lead in, it makes "adverse consequences" seem open ended when in fact, it's a specific criteria. Constipation is an "adverse consequence" but not the type of adverse consequence in the DSM (why we even mention it in this article is odd). Even a patient that exhibits tolerance, has withdrawal after cessation, etc, etc, may not meet the DSM criteria for a disorder. Finally, are we summing up all opioid overdose deaths as being a result of "Opioid Use Disorder?" --DHeyward (talk) 06:58, 15 March 2017 (UTC)

The term is wider than just the DSM5 clarification and I do not think we should tie it just to that. Doc James (talk · contribs ·email) 02:01, 16 March 2017 (UTC)

@Doc James: Where outside of DSM V has this term been used? I realize that after DSM V it gets used more frequently but it's an odd phrase to be an organic description. It sounds like a term of art created when the stigma of the previous term of art has achieved lay person ambiguity. This term seems to have arisen because "addiction" and "dependence" became common and conflated. When did "opioid use disorder" become a thing that needed differentiation from opioid addiction? There was a big push years ago to differentiate and educate the public and medical community about the difference between addiction and dependence but it seemingly failed and this term arose from those ashes. --DHeyward (talk) 05:57, 16 March 2017 (UTC)

There is "alcohol use disorder" which is the DSM 5 term for "alcoholism". Both terms go to the same article and we call that one alcoholism as it is the more common name. The ICD9 uses the term "Opioid type dependence" Doc James (talk · contribs · email) 14:20, 16 March 2017 (UTC)

are we summing up all opioid overdose deaths as being a result of "Opioid Use Disorder?": I think the point of that graph is to accompany the subsection on opioid overdoses. Not necessarily to attribute all deaths due to opioid overdose to OUD. Sizeofint (talk) 19:48, 15 March 2017 (UTC)

If RS's haven't made the connection, we shouldn't. How are overdoses related to the diagnoses (citation needed)? This article isn't about drug policy, or outcomes, it is about the diagnoses of a psychiatric condition. --DHeyward (talk) 20:40, 15 March 2017 (UTC)

Also, the statement I modified about "dependance" Most people who are opioid-dependent have at least one other psychiatric comorbidity. comes from this article "An Examination of Psychiatric Comorbidities as a Function of Gender and Substance Type within an Inpatient Substance Use Treatment Program." They are speaking about co-morbidity of inpatients, not in general. A person being treated with opiates for longer than 14 days begin to develop tolerance. They may experience withdrawal. They may also develop dependence. The source is only speaking about persons that have sought inpatient treatment for drug abuse. It is not an open-ended statement about those dependent on opiods which is far greater number than those that need treatment for abuse. As an example, Fentanyl is a powerful opiate that exists as prescription medication. Those that being treated for cancer are likely dependent on opiods. That source, however, does not apply to them as they are not inpatients seeking help for addiction. This article should not state they have "psychiatric comorbidity" because the source never says that. --DHeyward (talk) 05:42, 16 March 2017 (UTC)

This response is in regard to both what has been stated in this section and the #Synonyms subsection below.

The current revision of both major diagnostic manuals for mental health disorders (i.e., the DSM-5 and ICD-10) conflate addiction and dependence by grouping both disorders under 1 broad classification. The DSM-5 and ICD-10 both classify substance use disorders along a spectrum from mild to moderate/severe (see for reference). For opioid use disorders, the codes from the DSM-5 are 305.50 and 304.00 for mild and moderate/severe respectively, while the corresponding ICD-10 codes are F11.1 and F11.2 (see for reference).

I don't have access to the DSM-5 itself, but lists the DSM-5's diagnostic criteria for a substance use disorder on slides 9–13 and lists the same criteria for an opioid use disorder on page 1. The ICD-10 is freely accessible online, so I've quoted the three sections on the F11.1, F11.2, and F11.3 codes (note: I'm including F11.3 because it's referenced in F11.2) from the "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for 2016: Mental and behavioural disorders due to psychoactive substance use" webpage which contains diagnostic codes for these disorders:

Blockquote of the ICD-10's .1, .2, and .3 diagnostic code subdivisions for F10–F19 (i.e., including F11)

.1 Harmful use A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected psychoactive substances) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol). Psychoactive substance abuse .2 Dependence syndrome A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state. The dependence syndrome may be present for a specific psychoactive substance (e.g. tobacco, alcohol, or diazepam), for a class of substances (e.g. opioid drugs), or for a wider range of pharmacologically different psychoactive substances. Chronic alcoholism Dipsomania Drug addiction .3 Withdrawal state A group of symptoms of variable clustering and severity occurring on absolute or relative withdrawal of a psychoactive substance after persistent use of that substance. The onset and course of the withdrawal state are time-limited and are related to the type of psychoactive substance and dose being used immediately before cessation or reduction of use. The withdrawal state may be complicated by convulsions.

Based upon the F11.1 and F11.2 codes, "opioid use disorder" is a catch-all term that describes any form opioid use-related behavior associated with addiction (as we've defined it in that article), dependence (as we've defined it in that article), or otherwise harmful behavior involving the use of opioids. This diagnosis includes, but is not limited to, opioid dependence without opioid addiction, opioid addiction without opioid dependence, and comorbid opioid addiction with physical ± psychological opioid dependence. The DSM-5 characterizes an opioid use disorder in the same manner (addiction and/or dependence), but their criteria focus more on the personal, professional, and social consequences of an addiction (criteria 5–9 from ) than the actual addiction-related behaviors and pathologically altered cognitive processes that cause them (criteria 1–4 from; criterion 2 corresponds to impaired inhibitory control; criterion 4 corresponds to amplified incentive salience attribution to opioid use; criteria 1 and 3 refer to observable behaviors).

So, if a cancer patient is tolerant and experiences marked withdrawal symptoms when they stop using opioids but is not using opioids compulsively, then they have a mild opioid use disorder on the basis of the ICD-10's and DSM-5's diagnostic criteria (note: tolerance and withdrawal are criteria 10 and 11 from the DSM-5's criteria; these are listed on page 13 of and page 1 of, although the 2nd ref seems to suggest that the withdrawal criterion doesn't apply to individuals taking opioids under medical supervision).

Dependence and addiction are two distinct diseases that arise through different biomolecular mechanisms, so it's unfortunate that diagnostic manuals conflate these two diseases in one diagnosis. Physical dependence and addiction arise through entirely disjoint biomolecular signaling processes because they involve completely different sets of neurons, while psychological dependence and addiction arise through partially overlapping biological processes. In the nucleus accumbens, addiction and the motivational component of psychological dependence arise through overlapping signaling cascades that diverge – i.e., stop overlapping – at the CREB transcription factor. Upregulation of CREB expression in the nucleus accumbens is a key mediator of psychological dependence (specifically, CREB mediates the inhibition of reward-related motivational salience, a.k.a. incentive salience); in addiction, drug use induces CREB expression in the nucleus accumbens, which then induces accumbal ΔFosB expression (the ΔFosB protein expression-dependently amplifies incentive salience for rewarding stimuli), where the overexpression of ΔFosB in a specific group of neurons within the nucleus accumbens is the common mechanistic trigger for all drug and behavioral addictions. (Note: this paragraph is just a brief summary of Addiction#Reward sensitization and Opioid use disorder#Dependence in the event anyone is interested in references)

In conclusion, this article's scope should be defined by diagnostic criteria that clinicians currently use to diagnose an opioid addiction or opioid dependence. At the moment, the characterization of a "mild" opioid use disorder (analogous to the ICD's F11.1 code) isn't covered in the lead of this article; this should probably be included. Also, IMO opioid dependence should redirect to this article, not substance dependence, because opioid dependence is covered more thoroughly in this article relative to substance dependence; the substance dependence article covers drug dependence only in generality. Seppi333 (Insert 2¢) 00:37, 23 March 2017 (UTC)

Synonyms

The ICD10 says "opioid dependence" is applicable to OUD[5]

Doc James (talk · contribs · email) 23:44, 16 March 2017 (UTC)

The ref says "approximate synonyms". You have put it in the infobox as "synonyms". So that is incorrect. zzz (talk) 00:20, 17 March 2017 (UTC)

I disagree. "Approximate synonyms" is close enough. And it actually says "opioid dependence applicable to opioid use disorder" Doc James (talk · contribs · email) 00:42, 17 March 2017 (UTC)

But what you are saying then is "Opioid addiction is the compulsive use of opioids despite adverse consequences from continued use." And all addicts, e.g. cancer patients, have opioid use disorder, and get adverse consequences. (And "Opioid use disorder is opioid addiction.", which the lead may as well say instead, since it's more succinct and clears up the confusion?) You actually are saying "Opioid use disorder is opioid addiction." I guess. But the ref only says "approximate". zzz (talk) 00:49, 17 March 2017 (UTC)

I am saying that the terms are used synonymously often.

I think you mean "opioid tolerance" which of course is not the same as opioid addiction. People with cancer may develop tolerance without addiction or OUD. Doc James (talk · contribs · email) 01:07, 17 March 2017 (UTC)

There's 2 types of synonyms, "strictly" and "loosely" [6] so it does kind of make sense. Cheers. zzz (talk) 01:44, 17 March 2017 (UTC)

No, cancer patients are not addicts. "Tolerance" is one aspect of needing more opiates to achieve the same therapeutic benefit. There is also "dependence" where a patient will have symptoms of withdrawal if the drug is removed. For substances like alcohol, which has no medical use, it is fair to say that "dependence" is abuse/addiction/disorder synonyms. For opiates, that is not the case. End stage cancer patients using fentanyl are both tolerant and dependent. They do not have "opioid use disorder." This is where it is important to understand what is a synonym and what is not. Dependence and tolerance are not synonymous with OUD. --DHeyward (talk) 08:23, 17 March 2017 (UTC)

Agree tolerance is not. We have refs that state "opioid dependence" is a loose synonym. Doc James (talk · contribs · email) 17:44, 17 March 2017 (UTC)

I disagree. The refs on dependence require treatment for abuse to be a valid diagnosis. No one is treating cancer patients that have prescriptions for fentanyl with having OUD. Anyone that has a fentanyl prescription is tolerant and dependent. Doctors that treat chronic pain make a distinction between OUD and patients that take opioids in order to function with their disease. The loose synonym with dependence is only valid in response to abuse. We should not blanket declare all fentanyl users as having OUD which is what happens when dependence is assumed to be a disorder. Cancer patients are not drug addicts, abusers or suffering from a disorder beyond their cancer pain. --DHeyward (talk) 07:00, 18 March 2017 (UTC)

Agree that no one is treating cancer patients as having OUD and I do not think I have stated that. Have redirected the term to "Substance dependence" and removed as a synonym. Opioid dependence is part of OUD but not the other way around. Doc James (talk · contribs · email) 00:24, 19 March 2017 (UTC)

References

Definition

Addiction and dependence glossary
addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake) drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose drug withdrawal – symptoms that occur upon cessation of repeated drug use physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens) psychological dependence – dependence socially seen as being extremely mild compared to physical dependence (e.g., with enough willpower it could be overcome) reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach sensitization – an amplified response to a stimulus resulting from repeated exposure to it substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

The CDC gives a definition of "opioid use disorder" of "A problematic pattern of opioid use that causes clinically significant impairment or distress. A diagnosis is based on specific criteria such as unsuccessful efforts to cut down or control use, as well as use resulting in social problems and a failure to fulfill obligations at work, school, or home. "[7]

IMO this can be reasonably paraphrased as "a medical condition characterized by the use of opioids despite adverse consequences."

The second source says "Symptoms of opioid use disorders include strong desire for opioids, inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia."[8]

It does not state that these are required for the definition / diagnosis. Doc James (talk · contribs · email) 08:30, 24 March 2017 (UTC)

We already use a standardized definition of addiction and dependence across a number of WP articles. Why do you want to make it different for this article? Seppi333 (Insert 2¢) 15:14, 24 March 2017 (UTC)

Isn't the actual definition of OUD the first sentence? A problematic pattern of opioid use that causes clinically significant impairment or distress. We currently explain some diagnostic criteria for OUD but I don't think we ever say what it is. Using this definition would nicely match up with our {{Addiction glossary}}'s definition of "Substance use disorder". Also, we're using our definition of "Addiction" to describe OUD which may lead readers to conflate "use disorders" with "addiction". The two terms have overlapping meanings but I don't think they are exactly synonymous. The CDC source seems to be saying it is a super-set of abuse, dependence, and addiction. Sizeofint (talk) 16:07, 24 March 2017 (UTC)

Yes, that is the most straightforward definition for a use disorder, although it is slightly abridged. That was my paraphrasing of box 1 (quoted below) from the 4th ref that cites the addiction glossary. I think it might be a little vague to put that in the lead without clarifying what a SUD entails (i.e., addiction/dependence) as the reference does:

BOX 1. DEFINITIONS.
In this article, the terms apply to the use of alcohol, tobacco and nicotine, prescription drugs, and illegal drugs.
Substance-use disorder: A diagnostic term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) referring to recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity, this disorder is classified as mild, moderate, or severe.
Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder.
— 

Seppi333 (Insert 2¢) 21:49, 24 March 2017 (UTC)

We are using a definition provided by a high quality source which is sort of saying what it is. Doc James (talk · contribs · email) 10:58, 25 March 2017 (UTC)

I suppose I'm okay with the current one, but it still needs a better summary in the lead after the first sentence if that definition is used. Seppi333 (Insert 2¢) 04:20, 27 March 2017 (UTC)

• I'll try to spend some time on this, this week. We need to find high quality sources that discuss what this is, and (importantly) what it is not, and that carefully put it it the context of the traditionally-used terminology and get all that into article in one place, and then make sure that the whole article is consistent. This article needs development and this is a topic with a lot of attention and confusion in the media. Jytdog (talk) 14:44, 27 March 2017 (UTC)

  @Jytdog: is a medical review authored by the director of the National Institute on Drug Abuse which covers the relationship between addiction and a SUD. The references from #Seppi's response above cover the ICD-10's and DSM-5's diagnostic criteria verbatim - the opioid use disorder reference (this one) is literally a republication (with permission from the APA) of the DSM-5's section on OUD. I've also explained in the #Seppi's response comment above how addiction and dependence relate to a SUD. Seppi333 (Insert 2¢) 20:18, 27 March 2017 (UTC)

Yes there are bits and pieces around. I am talking about the actual content of the article, which even with your changes doesn't address what DHeyward wrote above about cancer patients. How do we deal with that? Jytdog (talk) 21:37, 27 March 2017 (UTC)

Based upon the DSM-5 criteria from this ref that I linked in my last reply, a cancer patient wouldn't be diagnosed with an OUD because the withdrawal criterion doesn't apply to opioid use that occurs solely under medical supervision (see the very top of page 2). Based upon the ICD-10 criteria, they probably would be diagnosed with a SUD because it doesn't include such a specific exemption. I didn't articulate that very well in my #Seppi's response comment. The general DSM-5 diagnostic criteria for a SUD doesn't include that exemption, but the specific DSM-5 diagnostic criteria for an OUD do.

In any event, I've just finished covering how addiction and dependence relate to a SUD in the lead. I'm open to revising what's written there though. Seppi333 (Insert 2¢) 22:10, 27 March 2017 (UTC)

Yes i saw that, nice work. I won't be able to dig into the palliative care piece myself til later this week. Jytdog (talk) 22:33, 27 March 2017 (UTC)

Refs

References

RfC regarding the definition

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

How should we define OUD in the first sentence of the article. The ref from the CDC says:

"A problematic pattern of opioid use that causes clinically significant impairment or distress." Doc James (talk · contribs · email) 06:45, 28 March 2017 (UTC)

Option 1

Paraphrase it as "a medical condition characterized by a pattern of opioid use which results in negative consequences."

• Support as written in language more suitable for a general audience.Doc James (talk · contribs · email) 06:45, 28 March 2017 (UTC)
• Oppose - Constipation and any other adverse effect is a negative consequence. This definition implies that everyone taking opioid medications has a substance use disorder. Seppi333 (Insert 2¢) 07:03, 28 March 2017 (UTC)
  • "Constipation" is "clinically significant distress" so the CDC definition does not exclude that either. Doc James (talk · contribs · email) 07:54, 28 March 2017 (UTC)

Option 2

Use it verbatim "a medical condition characterized by a problematic pattern of opioid use that causes clinically significant impairment or distress."

• Support - it's not a butchered definition. Seppi333 (Insert 2¢) 07:03, 28 March 2017 (UTC)
• Support - I prefer something more along these lines. The other wording seems to imply that even trivial negative effects are evidence of OUD. We need to state somewhere that the effects have to be significant. Sizeofint (talk) 15:40, 28 March 2017 (UTC)
• Support the verbatim quote from a highly authoritative source is good. Roger (Dodger67) (talk) 12:28, 30 March 2017 (UTC)

Discussion

Are we aiming to clarify what the cited source says, or what we think its writer meant? If we suspect they're different, we should avoid interpretation and use a direct quote. (I have an unrelated problem in parsing either definition: is it the "condition", or the "pattern", or the "use" that results/causes ...etc."?) Maproom (talk) 08:07, 30 March 2017 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Glossary

We have interwiki links. IMO we do not need to put this template on this article[9]. IMO it should only occur on the 13 articles for which it mentions the term. Doc James (talk · contribs · email) 06:37, 27 March 2017 (UTC)

Does anyone besides Doc James object to putting the above glossary in the article? Seppi333 (Insert 2¢) 06:52, 27 March 2017 (UTC)

If people want to read the definitions of the different words they can click on them. The glossary can than go on the pages of those words. I am not supportive of putting this glossary on every article that is somewhat related. There are a number of more articles this glossary should be trimmed from.

My concerns is that different individuals have specific areas of interest and what do we do when someone wants a glossary for their area of interest on this page aswell as they feel words in their area are commonly misunderstood? We are not a dictionary. Doc James (talk · contribs · email) 07:52, 27 March 2017 (UTC)

I support the idea of a glossary but am not ready to support this particular implementation of one. I would support development of the concept, and I support limited roll-out of this glossary for a limited time if that helps to get comments on the idea, but I am not ready to say that this idea should broadly go out. At Quantum mechanics, a technical topic, they use an infobox which includes a "glossary" tab which links to Glossary of elementary quantum mechanics and other introductory concepts. That seems like a good idea, except that the glossary has no citations and no community engagement, so apparently there was no great demand to engage with it. Here is some criticism of this particular glossary - no citations, not certain where it goes, it hangs as its own box separate from other reading aids, there is little manual of style guidance to direct people to engage with a glossary, and on its face this seems like the kind of project which should have partnership with Wikidata, the table function of Wikimedia Commons, Simple English, or Wiktionary. I would like for you to have support to develop the concept and get comments but not to say that complicated pages can optionally have glossaries without a special discussion about it. Blue Rasberry (talk) 14:33, 27 March 2017 (UTC)

Seppi, my sense is that Doc James is objecting to the glossary here and now, due to the instability of this article over the past couple of weeks, caused by people wanting to apply the traditional categories on the one hand, and a desire not to misrepresent the situation of people in palliative care on the other, and all of this in turn operating under the pressure of people concerned about the opioid crisis. In my view, if the article is able to develop to the point where the traditional terms in the glossary are all used and addressed and the concerns about palliative care are addressed in the medical sections, it would be useful to restore the glossary. It might also be useful to include OUD in the glossary itself as it is a strange animal. Jytdog (talk) 14:39, 27 March 2017 (UTC)

Just so that I understand correctly, people here are objecting to a glossary, but not what's in the glossary. Is that right? Seppi333 (Insert 2¢) 19:35, 27 March 2017 (UTC)

I wonder if the article would be more likely to "develop to the point where the traditional terms in the glossary are all used and addressed" if the glossary were in the article right now. It might be easier, e.g., for editors to separate "addiction" from "dependence" when the definitions are staring us in our faces. WhatamIdoing (talk) 19:42, 27 March 2017 (UTC)

I was objecting to concept of a glossary taking up article real estate on the side of the page as an experimental article feature. Blue Rasberry (talk) 15:18, 28 March 2017 (UTC)

That would be ideal, and it's what I've been advocating in the section above. My decision to insert the glossary in the mechanisms section is mainly meant to address the fact that we have an addiction and dependence section but don't say what addiction or dependence are, nor do we explain how they relate to a SUD. Seppi333 (Insert 2¢) 20:19, 27 March 2017 (UTC)

This issue is now moot since I've just copy/pasted (w/ modification) the relevant definitions into the addiction and dependence sections. Placing the glossary in the mechanisms section would now be redundant and is wholly unnecessary. Seppi333 (Insert 2¢) 21:27, 27 March 2017 (UTC)

Additional signs and symptoms

Wondering if more information should be added to signs and symptoms, ie. withdrawal symptoms mimic Flu-like symptoms Shenurse512 (talk) 03:09, 24 June 2017 (UTC)

reviews needed

This is OR - we really need reviews. The last one is also not accurate - the one person (!) took the whole herb not an extract.

Research

Each of these treatments is experimental, and some remain quite far from having been proven to be effective:

• Clonidine
• Dextromethorphan
• Ibogaine
• Ketamine
• Mitragynine

References

-- Jytdog (talk) 04:06, 24 June 2017 (UTC)

Agree we need reviews. So support trimming. Doc James (talk · contribs · email) 03:09, 25 June 2017 (UTC)

"Cause" section

I do not feel that this section is adequate. Something more like this would be better.

"Brain abnormalities resulting from chronic use of heroin, oxycodone, and other morphine-derived drugs are underlying causes of opioid dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and addiction (intense drug craving and compulsive use). The abnormalities that produce dependence, well understood by science, appear to resolve after detoxification, within days or weeks after opioid use stops. The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. They may involve an interaction of environmental effects—for example, stress, the social context of initial opiate use, and psychological conditioning—and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid dependent." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/ Gandydancer (talk) 03:42, 16 July 2017 (UTC)

UCSF CP133 Health Policy course-related edits (2017)

Group 20:

We will be adding info for CBT and editing the naltrexone section Amirsali094 (talk) 06:06, 16 October 2017 (UTC)

I will be editing the section on naltrexone for my CP 133: Health Policy course. Umordi (talk) 14:59, 18 October 2017 (UTC)UM from UCSF SOP

Okay make sure you have read WP:MEDRS Doc James (talk · contribs · email) 20:26, 18 October 2017 (UTC)

Group 20: We will be adding additional information about naloxone and 12 step program Jurjy (talk) 19:34, 24 October 2017 (UTC)

The edits are for UCSF Pharmacy students. We have 4 members working on different parts of this article.

Edit 1:

12-step Program:

The 12 Step Program is an adopted form of the Alcoholics Anonymous program. The program strives to help create behavioral change by fostering peer-support and self-help programs. In recent years, this program has been implemented by the Narcotics Anonymous support group. The model helps assert the gravity of addiction by enforcing the idea that addicts must surrender to the fact that they are addicted and to be able to recognize the problem. It is also helps maintain self control and restraint to help promote one's capabilities.

These details belong on the sub page about 12-Step programs IMO and are overly detailed here. Doc James (talk · contribs · email) 19:53, 1 November 2017 (UTC)

(talk Doc James, I tried to add specifics to the article on how the 12 step program relates specifically to opioid abuse 128.218.42.32 (talk) 18:39, 2 November 2017 (UTC)

Student 1 - This portion of the edits seems to be very neutral and just gives straight facts. Eduvalyan (talk)

Student 3 - The secondary sources are accessible to review.--JV1954 (talk) 16:10, 8 November 2017 (UTC)

Student 4 - No evidence of plagiarism or copyright violations DavidEdit (talk) 06:23, 8 November 2017 (UTC)

References

Edit 2:

Cognitive Behavioral Therapy:

While there are many ways to manage opioid use disorder, cognitive behavioral therapy (CBT), a form of psychosocial intervention that is used to improve mental health, may not be as effective as other forms of treatment. CBT primarily focuses on an individual's coping strategies to help change their cognition, behaviors and emotions about the problem. This intervention has demonstrated success in many psychiatric conditions (eg. depression) and substance use disorders (eg. tobacco). However, the use of CBT alone in opioid dependence has declined due to the lack of efficacy and many are relying on medication therapy or medication therapy with CBT since it was found to be more efficacious than CBT alone.

WHat is the page number for the first source? We do not generally use blogs. Please read WP:MEDRS Doc James (talk · contribs · email) 19:53, 1 November 2017 (UTC)

@Doc James: I changed and updated the correct sourcing for the CBT section.Jurjy (talk) 00:11, 7 November 2017 (UTC)

The fourth reference is a primary literature of a randomized controlled trial. The original research has potential risk of misuse and misinterpretation and thus not recommended in Wikipedia article as a reliable source. Also this article does not seem to be freely accessible. Yeonbi0705 (talk) 04:35, 8 November 2017 (UTC)

Student 1 - As far as being neutral, this portion of the edits are ok, as long as all the claims of efficacy and use regarding CBT are supported by the cited resources. Eduvalyan (talk)

Student 3 - The edits are consistent with Wikipedia's manual of style. --JV1954 (talk) 16:14, 8 November 2017 (UTC)

Student 4 - No evidence of plagiarism or copyright violations DavidEdit (talk) 06:25, 8 November 2017 (UTC)

References

Edit 3:

Naloxone:
Naloxone is a mu-opioid receptor antagonist that is used for emergency reversal of opioid overdose. It can be administered by many routes (intramuscular, intravenous, subcutaneous, intranasal, and inhalation) and acts very quickly by kicking off and replacing opioids from the opioid receptors. Since this is a life-saving medication, many states have implemented Standing Orders for law enforcement to carry and administer Naloxone as needed. In addition, naloxone could be used to challenge a patient's opioid abstinence status prior to starting a medication such as naltrexone, which is used in the management of opioid addiction.

Vreddy9 (talk) 17:30, 2 November 2017 (UTC)

• @Vreddy9: Keep in mind that punctuation should be placed before references, not after. I'd suggest revising this paragraph slightly (see the revised paragraph immediately below). I've made minor changes to the wording of the text, added a few wikilinks, and reformatted the references in this revised version; all of the references are the same ones as above, but they've been placed inside reference templates.

Suggested changes to this proposed edit (feel free to modify it as you like) – Seppi333 (Insert 2¢) 20:15, 2 November 2017 (UTC)

Naloxone is a competitive antagonist of the μ-opioid receptor that is used for the emergency treatment of an opioid overdose. It can be administered by many routes (e.g., intramuscular, intravenous, subcutaneous, intranasal, and inhalation) and acts very quickly by displacing opioids from opioid receptors and preventing activation of these receptors by opioids. Since this is a life-saving medication, many states have implemented standing orders for law enforcement to carry and administer naloxone as needed. In addition, naloxone could be used to challenge a patient's opioid abstinence status prior to starting a medication such as naltrexone, which is used in the management of opioid addiction. The source code for this edit is below (i.e., this is how the wikitext above appears when editing the page source); you can copy/paste this directly into the article's source code if you want to use this version: [[Naloxone]] is a [[competitive antagonist]] of the [[μ-opioid receptor]] that is used for the [[Opioid overdose#Treatment|emergency treatment of an opioid overdose]].<ref name="paywalled">http://www.crlonline.com/lco/action/doc/retrieve/docid/patch_f/7338#f_pharmacology-and-pharmacokinetics</ref> It can be administered by many routes (e.g., intramuscular, intravenous, subcutaneous, intranasal, and inhalation) and acts very quickly by displacing opioids from opioid receptors and preventing activation of these receptors by opioids.<ref name="paywalled" /> Since this is a life-saving medication, many states have implemented standing orders for law enforcement to carry and administer naloxone as needed.<ref name="FDA – law enforcement and naloxone">{{cite web | vauthors = Childs R | date = July 2015 | title = Law enforcement and naloxone utilization in the United States | url = https://www.fda.gov/downloads/Drugs/NewsEvents/UCM454810.pdf | website = United States Food and Drug Administration | publisher = North Carolina Harm Reduction Coalition | accessdate = 2 November 2017 | pages = 1-24}}</ref><ref name="Naloxone standing orders">{{cite web | title = Case studies: Standing orders | url = http://naloxoneinfo.org/case-studies/standing-orders | website = NaloxoneInfo.org | publisher = Open Society Foundations | accessdate = 2 November 2017}}</ref> In addition, naloxone could be used to challenge a patient's opioid abstinence status prior to starting a medication such as naltrexone, which is used in the management of opioid addiction.<ref name="pmid27464203">{{cite journal | vauthors = Schuckit MA | title = Treatment of Opioid-Use Disorders | journal = The New England Journal of Medicine | volume = 375 | issue = 4 | pages = 357–368 | date = July 2016 | pmid = 27464203 | doi = 10.1056/NEJMra1604339 | url = http://www.nejm.org/doi/full/10.1056/NEJMra1604339#t=article}}</ref>

• I don't have access to http://www.crlonline.com/lco/action/doc/retrieve/docid/patch_f/7338#f_pharmacology-and-pharmacokinetics so I don't know if they explicitly state that naloxone as a competitive antagonist (the mechanism of action described in your original edit is that of a competitive antagonist though, so I assume the source at least implies that it is one); however, the Human Metabolome Database entry on naloxone could be used to cite that it's a competitive antagonist if the cited source doesn't state that. I would have suggested citing DrugBank's naloxone page, but they state that it's an inverse agonist and a neutral competitive antagonist in different sections; that's a contradiction since those are mutually exclusive mechanisms of action.
• Also, due to my inability to access http://www.crlonline.com/lco/action/doc/retrieve/docid/patch_f/7338#f_pharmacology-and-pharmacokinetics, I'd need you to tell me the title of that article/webpage, the names of the authors (if listed on the page), a revision/publication date (if listed on the page; it's usually located at the very bottom of a webpage when it's included), and the name of the website and/or publisher (the publisher is usually the entity that is listed after the copyright symbol ©). Alternatively, you could just save that article/webpage as a pdf document, upload it to google drive or a similar file storage website, and link it here so that I can identify those things. Seppi333 (Insert 2¢) 20:15, 2 November 2017 (UTC)

@Jytdog and Doc James: I'm satisfied with the revised version of the text for this edit; if Vreddy9 finds it acceptable and wants to use it in the article, I'd be okay them adding it. However, I still need to get feedback from this student about the http://www.crlonline.com/lco/action/doc/retrieve/docid/patch_f/7338#f_pharmacology-and-pharmacokinetics reference since I'm not sure if it's MEDRS-quality (it probably is) and the citation is still a bare url. If that reference were replaced with the HMDB citation that I provided above and this ref or these Rx info citations, the revised version of this student's edit could be used right now. Seppi333 (Insert 2¢) 00:11, 4 November 2017 (UTC)

• @Seppi333: Thank you for your feedback, I greatly appreciate it. Since this reference isn't publicly available, I will use the one you've provided. Could I upload your edits to the page? Vreddy9 (talk) 03:07, 6 November 2017 (UTC)
  • Sure. Looks good. Seppi333 (Insert 2¢) 18:58, 6 November 2017 (UTC)
  • Ok great, thank you. Vreddy9 (talk) 20:25, 6 November 2017 (UTC)

Student 1 - Very neutral explanation of the mechanism of Naloxone and it's current uses. All claims are backed up by sources. Looks good! Eduvalyan (talk)

Student 3 - The edits are consistent with Wikipedia's manual of style. The contributions by experienced editors for this section were excellent and exhibit high standards of quality and validity. Awesome job. --JV1954 (talk) 16:18, 8 November 2017 (UTC)

Student 4 - No evidence of plagiarism or copyright violations in either revision. DavidEdit (talk) 06:30, 8 November 2017 (UTC)

References

Edit 4: Naltrexone Section

Naltrexone is an opioid receptor antagonist. It works by blocking the physiological effects of opioids and thereby preventing euphoria from opioid use. Non-compliance with naltrexone is a concern for oral formulations because of its daily dosing [63]. The alternative intramuscular injection has better patient compliance due to its monthly dosing. Naltrexone monthly IM injections (Vivitrol®) received FDA approval in 2010 for indication of use in patients with opioid dependence but not current opioid users [64].

https://www.ncbi.nlm.nih.gov/books/NBK64042/ http://www.annualreviews.org.ucsf.idm.oclc.org/doi/pdf/10.1146/annurev-pharmtox-010617-052534 https://www.vivitrol.com https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021897s015lbl.pdf

Umordi (talk) 17:27, 2 November 2017 (UTC)umordi

I'll provide some feedback on this proposed edit in a few hours. Need to log off for now. Seppi333 (Insert 2¢) 20:24, 2 November 2017 (UTC)

• I've revised your proposed edit in the paragraph below; most of the changes involved just adding wikilinks and ensuring compliance with the WP:Manual of style (e.g., MOS:MED and MOS:®). Feel free to further revise it as you like.

Suggested changes to the text of this proposed edit (feel free to modify it as you like) – Seppi333 (Insert 2¢) 05:03, 3 November 2017 (UTC); edited at 23:13, 3 November 2017 (UTC)

Naltrexone is a competitive antagonist of the opioid receptors that is used for the treatment of opioid addiction. It works by blocking the physiological, euphoric, and reinforcing effects of opioids. Non-compliance with naltrexone therapy is a concern with oral formulations because of its daily dosing. The alternative intramuscular (IM) injection has better patient compliance due to its monthly dosing. Naltrexone monthly IM injections (Vivitrol) received FDA approval in 2010 for the treatment of opioid dependence in abstinent opioid users. The source code for this edit is below (i.e., this is how the wikitext above appears when editing the page source). You can copy/paste the following block of code into the source code of the articles naltrexone section at any time if you're satisfied with my changes to your edit: [[Naltrexone]] is a [[competitive antagonist]] of the [[opioid receptor]]s that is used for the treatment of opioid addiction.<ref name="Vivitrol Prescribing Information">{{cite web | title = Vivitrol Prescribing Information | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/021897s029lbl.pdf | publisher = Alkermes, Inc. | work = United States Food and Drug Administration |date=December 2015 | accessdate = 2 November 2017 }}</ref><ref name="SAMHSA - Oral naltrexone">{{cite book | publisher = Substance Abuse and Mental Health Services Administration: Center for Substance Abuse Treatment | location = Rockville, MD | date = 2009 | title = Treatment Improvement Protocol Series 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice | chapter = Chapter 4—Oral Naltrexone | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK64042/}}</ref> It works by blocking the physiological, [[euphoria|euphoric]], and [[reinforcement|reinforcing]] effects of opioids.<ref name="SAMHSA - Oral naltrexone" /><ref name="Opioid epidemic review">{{cite journal | vauthors = Skolnick P | title = The Opioid Epidemic: Crisis and Solutions | journal = Annual Review of Pharmacology and Toxicology | volume = | issue = | pages = | date = October 2017 | pmid = 28968188 | doi = 10.1146/annurev-pharmtox-010617-052534 | url = }}</ref> Non-[[Adherence (medicine)|compliance]] with naltrexone therapy is a concern with oral [[Dosage form|formulations]] because of its daily dosing.<ref name="Opioid epidemic review" /><ref name="Oral naltrexone non-compliance – Cochrane review">{{cite journal |vauthors=Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, Verster A | date = April 2011| title = Oral naltrexone maintenance treatment for opioid dependence | url = | journal = Cochrane Database of Systematic Reviews | volume = | issue = 4 | doi = 10.1002/14651858.CD001333.pub4 | pmid = 21491383 | pages=CD001333}}</ref> The alternative [[Intramuscular injection|intramuscular (IM) injection]] has better patient compliance due to its monthly dosing.<ref name="Opioid epidemic review" /> Naltrexone monthly IM injections (Vivitrol) received FDA approval in 2010 for the treatment of opioid dependence in [[Abstinence#Medicine|abstinent]] opioid users.<ref name="Vivitrol Prescribing Information" /><ref name="Opioid epidemic review" />

Preformatted references

I've reformatted the citations you provided and put them into the templates below. All you'd need to do is copy/paste the following references into the source code of the text at the end of the sentence(s) that they cite: Reference template for Vivitrol's prescribing information: <ref name="Vivitrol Prescribing Information">{{cite web | title = Vivitrol Prescribing Information | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/021897s029lbl.pdf | publisher = Alkermes, Inc. | work = United States Food and Drug Administration |date=December 2015 | accessdate = 2 November 2017 }}</ref> Reference template for the opioid epidemic review: <ref name="Opioid epidemic review">{{cite journal | vauthors = Skolnick P | title = The Opioid Epidemic: Crisis and Solutions | journal = Annual Review of Pharmacology and Toxicology | volume = | issue = | pages = | date = October 2017 | pmid = 28968188 | doi = 10.1146/annurev-pharmtox-010617-052534 | url = }}</ref> Reference template for the NCBI bookshelf chapter on naltrexone: <ref name="SAMHSA - Oral naltrexone">{{cite book | publisher = Substance Abuse and Mental Health Services Administration: Center for Substance Abuse Treatment | location = Rockville, MD | date = 2009 | title = Treatment Improvement Protocol Series 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice | chapter = Chapter 4—Oral Naltrexone | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK64042/}}</ref> I wouldn't suggest citing https://www.vivitrol.com since it's essentially just a really dumbed-down version of Vivitrol's prescribing information.

• Seppi333 (Insert 2¢) 05:03, 3 November 2017 (UTC)

@Umordi: I read through the references you listed and added them to the appropriate sentences in my suggested changes to your edit. I also added the Cochrane review on naltrexone that's currently cited in the article to your edit. If you're satisfied with my changes and want to use my revised version, feel free replace the existing content in Opioid use disorder#Naltrexone with it at any time. Seppi333 (Insert 2¢) 23:13, 3 November 2017 (UTC)

@Jytdog and Doc James: I'm perfectly satisfied with both the revised wording and the references that were provided for this proposed edit. If Umordi wants to replace the entire Opioid use disorder#Naltrexone section with the revised wikitext in the first collapse tab above, I'd approve of that. Seppi333 (Insert 2¢) 23:13, 3 November 2017 (UTC)

If you are satisfied then make the edit. I am not a fucking TA. Jytdog (talk) 23:18, 3 November 2017 (UTC)

The only reason I pinged you is because you've been reverting their edits. My intent was to inform you that I've checked the sourcing and the text is accurate. Its their assignment, so I'm not going to do it for them. Seppi333 (Insert 2¢) 00:14, 4 November 2017 (UTC)

sorry i was in a very very bad mood that night and should not have been editing. Jytdog (talk) 19:04, 6 November 2017 (UTC)

NO! copied from the Vivitrol source being used as a ref here: page 11

There is also the possibility that a patient who is treated with VIVITROL could overcome the opioid blockade effect of VIVITROL. Although VIVITROL is a potent antagonist with a prolonged pharmacological effect, the blockade produced by VIVITROL is surmountable. This poses a potential risk to individuals who attempt, on their own, to overcome the blockade by administering large amounts of exogenous opioids. Any attempt by a patient to overcome the antagonism by taking opioids is very dangerous and may lead to fatal overdose. Injury may arise because the plasma concentration of exogenous opioids attained immediately following their acute administration may be sufficient to overcome the competitive receptor blockade. As a consequence, the patient may be in immediate danger of suffering life-endangering opioid intoxication (e.g., respiratory arrest, circulatory collapse). Patients should be told of the serious consequences of trying to overcome the opioid blockade

same with naloxone/natrexone. We should NOT say that there is a complete "blocker" because that is not correct and could be dangerous misinformation. TeeVeeed (talk) 00:07, 9 November 2017 (UTC) edit trying to fix format a bitTeeVeeed (talk) 01:41, 9 November 2017 (UTC)

All reversible competitive antagonists are surmountable, so surmountability is implied by the current text; however, I suppose something explicit about the surmountability of naltrexone and naloxone can be added. @Doc James: addressing this issue would actually require stating that it's a reversible competitive antagonist, although not necessarily in the first sentence. Seppi333 (Insert 2¢) 07:29, 9 November 2017 (UTC)

Is it being surmountable of clinical importance? Doc James (talk · contribs · email) 07:34, 9 November 2017 (UTC)

Yes. One can OD on a selective agonist after being given a high dose of a surmountable antagonist, but not an insurmountable antagonist. In this context, it means one can still OD on opioids while under the effects of naltrexone/naloxone. Seppi333 (Insert 2¢) 07:45, 9 November 2017 (UTC)

References

Thank you @Seppi333, really appreciate your feedback. I agreed with your edits and I hope the changes made the Naltrexone section stronger. Umordi (talk) 02:38, 8 November 2017 (UTC)

Student 1 - Also looks good, in terms of neutrality. Great work! Eduvalyan (talk)

Student 3 - The edits satisfy the Manual of Style guidelines. --JV1954 (talk) 16:21, 8 November 2017 (UTC)

Student 4 - No evidence of plagiarism or copyright violations DavidEdit (talk) 06:31, 8 November 2017 (UTC)

Not needed

This is not needed "is a competitive antagonist of the μ-opioid receptor". If people want to know the mechanism of action they can look at the article about the medication.

Also why this small primary source from the 1980s?[10] Doc James (talk · contribs · email) 04:03, 8 November 2017 (UTC)

Where's that primary source cited?

Anyway, the reason it's stated in the article is because that isn't stated in the lead of the naltrexone or naloxone articles. It doesn't hurt to state a drug's drug class in the body of this article, so I don't see why it shouldn't be included. Besides, this is useful information to include here. Seppi333 (Insert 2¢) 07:15, 9 November 2017 (UTC)

@Doc James: Let's ask others in an RFC. Seppi333 (Insert 2¢) 07:21, 9 November 2017 (UTC)

Naloxone states "Naloxone is a pure opioid antagonist."

And I have added the same to the naltrexone article. Doc James (talk · contribs · email) 07:22, 9 November 2017 (UTC)

Hmm, alright. That seems acceptable. Seppi333 (Insert 2¢) 07:23, 9 November 2017 (UTC)

I am happy to have a RfC if you wish. IMO if every first mention of a medication began with something like "name" followed by "is a competitive antagonist of the opioid receptors" Wikipedia's disease related articles would become quickly unreadable. Doc James (talk · contribs · email) 07:26, 9 November 2017 (UTC)

@Doc James: Given the issue raised in the section above and the message I left you, how do you think that this should be addressed? The simplest approach would be to just state in plain English that the effects of naltrexone and naloxone can be overcome by taking large doses of opioids; however, I think it would also be useful to explain why this is the case (i.e., state that naloxone/naltrexone are reversible competitive antagonists of the opioid receptors which must "compete" with opioids at opioid receptor binding sites; their effects can be overcome because reversible competitive antagonists can be displaced from opioid receptors by taking a large dose of an opioid).

The statement "[Naloxone] ... acts quickly by displacing opioids from opioid receptors and preventing activation of these receptors by opioids" in Opioid use disorder#Prevention describes the effects that a reversible competitive (opioid receptor) antagonist has on opioid drugs following administration, but the converse statement (i.e., "taking high doses of an opioid can displace naloxone/naltrexone from opioid receptors and increase activation of these receptors") isn't currently included in the article. That converse statement is equivalent to stating that naloxone and naltrexone are "surmountable antagonists" which don't fully prevent the potential for subsequent overdose. Seppi333 (Insert 2¢) 09:14, 9 November 2017 (UTC)

"Larger doses of opioids may require larger doses of naloxone or naltrexone to reverse the effects" I think is all that is important. Doc James (talk · contribs · email) 09:17, 9 November 2017 (UTC)

The issue that TeeVeeed raised in the section above is that we don't indicate that overdose is still possible while under the effects of naloxone or naltrexone. You don't think that should be addressed in the article? Seppi333 (Insert 2¢) 09:19, 9 November 2017 (UTC)

What I was trying to say is that we should not implicitly or explicitly say that opiods can be completely "blocked" because they are not. Also somehow acknowledging that some users may attempt to purposely try to override the blocking effects would make sense. The way the staement was worded implied a full block effect all of the time when that is not the case.TeeVeeed (talk) 15:47, 9 November 2017 (UTC)

Thank you all for your feedback, greatly appreciate it!Vreddy9 (talk) 08:23, 15 November 2017 (UTC)

Content

WRT "Addiction and dependence are components of a substance use disorder and addiction represents the most severe form of the disorder." not seeing it in the ref?

WRT "Opioid dependence can manifest as physical dependence, psychological dependence, or both." We have simplified this as "a strong desire to use opioids, ... and withdrawal syndrome with discontinuation" the first which is psychological dependence and the second which is physical dependence. No need to say it twice. Doc James (talk · contribs · email) 20:17, 20 July 2018 (UTC)

@Doc James: Follow link: #Definition; scroll down until you see a green box of definitions; read the definition in this box for Addiction; then, verify that this material is indeed an excerpt from the reference which cites that box. Seppi333 (Insert 2¢) 00:33, 21 July 2018 (UTC)

You could've just verified that by mousing over the reference in the article, since it actually quotes that definition. Seppi333 (Insert 2¢) 00:36, 21 July 2018 (UTC)

Also, psychological dependence encompasses A LOT more than just cravings associated with discontinuation of use. Based upon what I've read in reviews and seen in documentaries, the physical withdrawal syndrome that occurs from opioid discontinuation following a drug binge can be rather excruciating. So, in a nutshell, "a strong desire to use opioids, ... and withdrawal syndrome with discontinuation" doesn't convey the same meaning as "Opioid dependence can manifest as physical dependence, psychological dependence, or both." Seppi333 (Insert 2¢) 00:44, 21 July 2018 (UTC)

Treated is often... & In the United States in 2016, there more than – you really need to proofread your edits before you commit them. Seppi333 (Insert 2¢) 01:05, 21 July 2018 (UTC)

We have the specific symptoms listed by the DSM5. This ref https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927417/ does not mention the title of this article?

Severity per the DSM is defined by the number of criteria present and is divided into three groups so it is not supported by that ref. The DSM5 is also a better source than the other.

This ref https://www.ncbi.nlm.nih.gov/pubmed/?term=26816013 is not stateing these things specifically in relation to opioid use disorder.

With respect to severity "The severity can be classified as mild, moderate, or severe based on the number of criteria present" is more accurate with respect to specifically opioid use disorder and is in the body of the article based on the DSM5.

Those refs well reviews are not directly about this subject. Doc James (talk · contribs · email) 20:27, 21 July 2018 (UTC)

The second paper is titled "Reflections on: “A General Role for Adaptations in G-Proteins and the Cyclic AMP System in Mediating the Chronic Actions of Morphine and Cocaine on Neuronal Function”"and contains zero mentions of "opioid use disorder"

I have thus moved these to the body as the sources are somewhat off this specific topic.

HERE is a copy of the DSM 5 section. Does not support either bit. Doc James (talk · contribs · email) 22:54, 21 July 2018 (UTC)

I can accept the omission of the dependence statement due to the fact that the symptoms are listed. Cutting the addiction and dependence statement on the basis that OUD isn't mentioned carries literally no weight at all. You renamed the article to OUD and now you're arguing that since OUD isn't mentioned in the sources (even though SUD is) that it shouldn't be listed in the lead? The lead summarizes body content and gives adequate weight to the relative coverage of the body (MOS:LEAD): Opioid use disorder#Addiction & Opioid use disorder#Dependence. To my knowledge, none of those sources use the term "Opioid use disorder". So, either delete the statement in the lead and both sections in the body, or leave them in. Alternatively, hold an RFC, because I'm not ok with cutting that sentence out. Seppi333 (Insert 2¢) 14:29, 22 July 2018 (UTC)

Severity of OUD in the DSM5 is NOT determined by whether or not dependence OR addiction is present, it is based on the how many of 11 criteria are present.

Additionally that statement is NOT supported by the OUD chapter of the DSM5 so attaching that chapter of the DSM5 as a ref is not accurate.

That paper does say "In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder". I wonder which chapter that is from?

The ref defines addiction as "compulsive drug taking despite the desire to stop taking the drug" which we had already summarized as "a strong desire to use opioids" and "trouble decreasing use" thus I disagree that we also need to use the terms "addiction" and "dependence" in the lead as the DSM5 does not use that terminology in their criteria.

Doc James (talk · contribs · email) 10:35, 24 July 2018 (UTC)

I don't know why I didn't notice this until now. The severity of OUD in the DSM5 is determined by the presence of addiction. An addiction entails the fulfillment of 7 (arguably 8, but 1 of them is a poor classifier) of those criteria, which would be all except for the three that clearly describe dependence. I discussed which of those criteria correspond to each disorder a while back and anchored it to this link at the time: #Seppi's response.

Also, just pulling random quotes from the full US Surgeon General's Report on addiction:

• "Addiction: The most severe form of substance use disorder, associated with compulsive or uncontrolled use of one or more substances." - page 35
• "Note: A severe substance use disorder is commonly called an addiction." - page 36
• "Historically, treatment services were designed for people with severe substance use disorders (addictions)" - page 37
• "Severe substance use disorders are characterized by compulsive use of substance(s) and impaired control of substance use." [Compare this to the first sentence of addiction ] - page 45
• "For example, severe substance use disorders, commonly called addictions, were once viewed largely as a moral failing or character flaw, but are now understood to be chronic illnesses characterized by clinically significant impairments in health, social function, and voluntary control over substance use." - page 63
• "For those with mild to moderate substance use disorders, treatment through the general health care system may be sufficient, while those with severe substance use disorders (addiction) may require specialty treatment." - page 155
• "Substance use disorders occur along a continuum from mild to severe; severe substance use disorders are also called addictions." - page 317
• "Note: Severe substance use disorders are commonly called addictions." - repeated on page 338

I'm not sure why you feel that addiction and dependence are unrelated to a substance use disorder. SUD is an umbrella diagnosistic term. It is merely a label. I'm virtually certain that a "substance use disorder" will be an archaic medical term in a decade, maybe two at most, given that the actual diseases which that label refers to already have names: addiction and dependence. The APA receives a lot of criticism for not simply referring to these disorders by their common names. Seppi333 (Insert 2¢) 11:27, 24 January 2019 (UTC)

References

UCSF CP133 Health Policy course-related edits (2018)

Pharmacy Students: Proposed Wiki Edits

We are students from UCSF School of Pharmacy (Alisha V, Ashley Y, Mindy Y, Victoria S). We plan on contributing, editing, and making improvements on the following sections in the Opioid use disorder Wikipedia page:

- Management: We would like add to this section be creating a subsection called “Pharmacy Involvement” where we discuss how pharmacists can play a large role in dispensing opioid addiction treatment medications and assisting patients in recovery and discuss some advantages of pharmacy involvement

- Epidemiology: We would like to update information on opioid use disorder in US, update data on opioid use and opioid use disorder in San Francisco.

- Prevention: We would like to expand on obtaining naloxone kit, who can administer, naloxone training, pharmacy involvement, insurance coverage, drug abuse hotline. — Preceding unsigned comment added by Avucsf (talk • contribs) 18:46, 16 October 2018 (UTC)

Proposed Edits

SP, WY, AN, BP

• Clarify FDA-approved treatments for OUD vs harm reduction strategies (HAT/diamorphine are the same things)
• Include mechanism of action/pros/cons of each FDA-approved medication.
• Epidemiology: prevalence of opioid use disorder among incarcerated and statistics regarding opioid overdose and drug related crime.
• Prevention: adding strategies for providers to reduce opioid prescribing patterns in order to reduce development of opioid use disorder — Preceding unsigned comment added by Pharmacy9876 (talk • contribs) 17:11, 1 November 2018 (UTC)
• Update/additional trials for efficacy and mortality risk for Other opioid use for Dihydrocodeine.

Including mechanisms of action and pros/cons may be redundant since each medication will probably have that on their wiki pages. -Ling — Preceding unsigned comment added by Ucsflwang (talk • contribs) 02:46, 31 October 2018 (UTC)

One does not need to state something is FDA approved. That is a USA thing. We are a global encyclopedia. Doc James (talk · contribs · email) 01:06, 2 November 2018 (UTC)

Text

Pharmacy Involvement

Pharmacists can have the ability to play a larger role in managing medications for patients who experience opioid abuse. With flexible hours and increasing involvement in the community, pharmacists can become more involved with handling the paperwork required for opioid addiction treatment that physicians currently process. In addition, they are able to hold patients accountable to take their medications.

This is not really appropriately worded for a global encyclopedia. Also please read WP:MEDMOS Doc James (talk · contribs · email) 01:06, 2 November 2018 (UTC)

Thank you for the feedback! Would it be appropriate if I included pharmacist involvement with medication treatment management from different countries? I am aware that pharmacists hold different responsibilities in other countries and would love to incorporate that somehow. Thank you in advance Doc James. --2602:306:CFF4:9950:B560:FCF1:3319:F62A (talk) 05:33, 20 November 2018 (UTC)

Are you wanting to discuss daily observed taking of opioids? That would be useful as done in many places. Doc James (talk · contribs · email) 17:31, 20 November 2018 (UTC)

National Hotline for Substance Abuse

Many non-profit helplines exist to assist individuals to connect with local resources in treating opioid use disorder. U.S. Department of Health & Human Services provides a national hotline available in English and Spanish without a cost for substance use disorder. Specialists will refer callers to appropriate local groups, organizations and facilities.

This is also NOT appropriate for a global encyclopedia. Other countries EXIST other than the United States.Doc James (talk · contribs · email) 01:06, 2 November 2018 (UTC)

I appreciate the feedback! After reading your comment, I would like to improve my first draft and make it more global.

1) I would like to add helpline resources from other countries such as France, UK, and Canada

2) Is it appropriate to have these info under a new sub-header "Telephone assistance for substance use disorder" in the Management section? Pharmacystudent1 (talk) 20:06, 19 November 2018 (UTC)

What references do you have? In countries with universal healthcare, the non-profits are less needed. Doc James (talk · contribs · email) 17:31, 20 November 2018 (UTC)

UK-Addiction Helper offers free 24/7 email, calls, and online chat that help assess status of addiction and direct individuals to appropriate care. Canada - Government of Canada provides a list of resources that helps individuals in finding appropriate helplines based on their location and services that are provided.

Finding resources in other countries that do not use English is a bit challenging since I have limited knowledge in those languages so I completely understand if addition of these won’t be useful. — Preceding unsigned comment added by Pharmacystudent1 (talk • contribs) 21:18, 20 November 2018 (UTC) \

We are looking for high quality secondary sources that discuss the issue. What is the evidence for these help lines? One could simple state "help lines are avaliable in many regions" I guess. Doc James (talk · contribs · email) 01:39, 21 November 2018 (UTC)

Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify…

Group 8 did a wonderful job with their edits in terms of consistent formatting with Wikipedia's manual of style. They added information about the "Five-Point Opioid Strategy" by first introducing what it was and then describing some of the efforts that are included under this strategy in a list format that was very easy to follow. Wikipedia supports writing that is easy to follow and understandable by all populations of people, and I feel that these edits were appropriate. The grammar, spelling, and punctuation were also correct. There was no ambiguity, jargon, or vague or unnecessarily complex wording. Jennifershieh (talk) 02:46, 7 November 2018 (UTC)

I think that this group’s edits do seem to be consistent with Wikipedia’s manual of style. They explained all the content they added to the article and useed appropriate citations, punctuation, and grammar. The content they added was under the correct subheading and it is easy to follow/read. It was helpful that they included more in-depth articles pertaining to their topics, especially in the "Prevention" section and they explained certain terms (or linked the word to another Wiki article) when deemed necessary.Fbchenn (talk) 22:46, 8 November 2018 (UTC)

Group 8 made well cited edits to the page, but what made it not consistent with Wikipedia's manual of style was that a lot of the edits were very US-centered, which is not appropriate for Wikipedia to remain a global encyclopedia. By having US-centered material, it may alienate readers. Specifically, emphasis on pharmacist intervention and naloxone furnishing relatable in the US in only specific states. However, it's good that Group 8 worked under the header for the US so that it's clear to readers that the statistics and information are US-focused. Hopefully as this article expands, wiki-editors from other countries dealing with opioid use disorder can add their specifics. Overall it was easy to read and their edits were easy to understand. Taryn.go (talk) 06:12, 9 November 2018 (UTC)

Are the points included verifiable with cited secondary sources that are freely available? If not, specify.

Generally, the edits made seem to have verifiable secondary sources. Most sentences I reviewed included reputable journal articles/governmental resources etc cited right after it. The only thing I want to highlight was that I saw an edit addressing the US administration declaring a “Five Point Opioid Strategy”. While the explanation was clear, I think it would be important to cite a reference for that piece. Kathyle29 (talk) 02:55, 7 November 2018 (UTC)

All citation completed by group 8 look to be verifiable secondary sources. However possibly citation 98 is not a secondary source but is a good reference to the point trying to be made. Signed - Amenda La — Preceding unsigned comment added by Amendala (talk • contribs) 07:24, 9 November 2018 (UTC)

Citations for the edits were cited appropriately. I was able to verify that the authors mostly used secondary sources to support their claims. However, I would cite where you obtained this information from "Good Samaritan laws typically protect bystanders that administer naloxone".Anthony Lui (talk) 23:11, 9 November 2018 (UTC)

Does the draft submission reflect a neutral point of view? If not, specify…

For the most part, Group 8's draft submission reflected a neutral point of view. Group 8 added important and objective facts to the page. The addition of "pharmacy involvement" sounded too anecdotal and I got the impression that the writer was advocating for pharmacists and what they could/should do. I would consider rewording it to be more objective or adding more information about the role of healthcare as a whole in opioid use disorder. Eyang92 (talk) 02:57, 7 November 2018 (UTC)

Group 18's submission reflect a very neutral point of view and provided unbiased information to the page. I liked that they specified which countries used certain drugs for opioid replacement therapies. I think what would be also helpful to include is for the Prevention section, also including what other countries are doing in terms of reducing opioid use disorders (if there is information on that!). Xcindy huynh (talk) 22:22, 7 November 2018 (UTC)

Group 8's edit do reflect a neutral point of view. By adding the updated 2017 HHS Public Health Emergency To Address National Opioid Crisis, the group provided more updated and relevant information that help increase the credibility of the page. More specifically the updated guide provided a new 5 point strategy to combat opioid crisis, which is extremely useful the readers.--Mia.lim (talk) 21:40, 9 November 2018 (UTC)

Is there any evidence of plagiarism or copyright violation?

I did not detect any evidence of plagiarism or copyright violation. I believe Group 8 did an amazing job of using reputable sources, as well as re-writing concepts in their own words. They clearly put a lot of time into creating edits that greatly added to this Wikipedia article. Within the sections that this group edited, there were no statements that citations were needed. — Preceding unsigned comment added by Cindynguyeen (talk • contribs) 06:15, 7 November 2018 (UTC)

There is no evidence of plagiarism or copyright violation. All newly added information was either reworded or correctly cited to the source. Greenducky1 (talk) 07:16, 9 November 2018 (UTC)

I could not find any evidence of plagiarism or copyright violation. Statements were cited adequately. Albert63093 (talk) 07:53, 9 November 2018 (UTC)

UCSF CP133 Pharmacy Student Peer Reviews

Group 2

• Does the draft submission reflect a neutral point of view? If not, specify…

 The edits done by Group 18 are fairly neutral for the most part. One statement stuck out to me that had a slight bit of bias which was the one that stated that more research needs to be done in order to determine if dihydrocodeine can be utilized as an effective opioid addiction treatment. Otherwise I would say their statements stuck to the facts and showed very little opinion. Ranaran35 (talk) 01:53, 8 November 2018 (UTC)

• Are the points included verifiable with cited secondary sources that are freely available? If not, specify…

All citations under management, epidemiology, and prevention look to be accessible secondary sources (no primary). The dihydrocodeine article (citation 70) is a primary source. — Preceding unsigned comment added by Pzrx (talk • contribs) 04:33, 8 November 2018 (UTC)

• Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify…

In my opinion, this group did a good job of keeping the style consistent with the Wikipedia style in terms of language, grammar, and use of citations. Some of the edited content in the "Prevention" section may be a little specific to the United States. I would suggest moving this content (i.e. good samaritan laws, retail pharmacy chains in the US, and standing orders for law enforcement) to the "United States" section. NavkiranSandhu (talk) 18:30, 8 November 2018 (UTC)

• Is there any evidence of plagiarism or copyright violation? If yes, specify…

- I did not find any evidence of plagiarism within the UCSF students' edits. Chellefsh (talk) 02:38, 20 November 2018 (UTC)

• [extra question] Has the group achieved its overall goals for improvement? If not, specify…

Global encyclopedia

This is not true globally "Physicians, nurse practitioners, and physician assistants can only prescribe buprenorphine for OUD if they receive special training on the medication, receive a DATA 2000 waiver, and get a unique DEA number. Currently, these restrictions are only required if buprenorphine is being used to treat OUD. They don't apply if buprenorphine is being used for pain management. " plus it is unreferenced. Belongs on the subpage and needs to state it only applies in the USA. Doc James (talk · contribs · email) 17:28, 20 November 2018 (UTC)

Always bad to use the word "currently". Better to state a specific date. What happens 5 years from know when the rules change? Doc James (talk · contribs · email) 17:36, 20 November 2018 (UTC)

Peer Review

Jamie,

Thank you for contributing to an article that is extremely pertinent to public health in this country today. It is important that facts and statistics on this issue stay up-to-date and accurate, and your contribution of naloxone stats does just that. As far as general improvements, I think that this article could use more information on the outward signs of this disorder, as well as on the diagnostic process. For instance, several of the signs and symptoms are vague and limited (i.e. "legal or social ramifications secondary to drug use"), and the Diagnosis section does not specify who can make a diagnosis or under what clinical circumstances can a diagnosis be made. Just a few thoughts.

Keep up the good work!

Alexyoung339 (talk) 00:58, 18 February 2019 (UTC)

Gender Differences

There should be more information on the gender differences. Research has noted that women are just as likely as men to develop a substance use disorder. It is noted that men are more likely to die from prescription opioids, however from 1999-2016, the deaths due to prescription opioid overdoses increase rapidly increased in women. Some studies have noted that women versus men have greater sensitivity to pain and a higher chance for chronic pain. Thus, this may contribute to high rates of opioid prescriptions in women. Additionally, research has suggested that women are more likely to misuse to self-treat other problems. Hnguyc (talk) 04:53, 28 April 2019 (UTC)

Peer review

This is where you will complete your peer review exercise. Please use the following template to fill out your review.

General info

• I am reviewing RedStorm1 article on opioid use disorder
• Link to draft you're reviewing: Opioid use disorder

Lead

Guiding questions:

• Has the Lead been updated to reflect the new content added by your peer? The most recent data is from 2016 which I believe is up to date. It has good recent statistics to show the importance of opioid use disorder.
• Does the Lead include an introductory sentence that concisely and clearly describes the article's topic? Yes it does. The article clearly states what it is going to be discussing being opioid use disorder and introduces the idea of the problems that patients face with this issue.
• Does the Lead include a brief description of the article's major sections? I think this lead section does a great job introducing all of the sections. Granted the lead does not go into detail, but it does include everything that is going to be discussed later such that you know what aspects of the disorder you will learn about.
• Does the Lead include information that is not present in the article? No, as stated previously the lead section I think does a very good job essentially indexing everything that will be discussed in the article.
• Is the Lead concise or is it overly detailed? Since everything is included in the lead section, I believe there could be some portions that can be cut down. For instance for the diagnosis you can limit that section to just state that it is a DSMV diagnosis, and then go into further detail in that section of the article. I also believe you do not need to go through each symptom since you discus it later.

Lead evaluation:

As stated above the lead section is extremely good. I believe that the information provided does a great job detailing what the article is going to be discussing. However, since you do have a history tab dating back to the origins of opioid use I would mention some of that at the beginning of the lead section. I also believe the information is up to date however there might be more recent data now. Lastly, I would cut down on some of the details currently in the lead section. Since you do go over all of the aspects that you are discussing in the article, I believe you can cut down on some information as stated above. As it is the lead section is very good, but if you cut down on some information and add more recent data with some information about the history this will be a great lead section.JacksLog (talk) 17:33, 7 December 2019 (UTC)

Content

Guiding questions:

• Is the content added relevant to the topic? Yes it is you discuss everything that should be included for opioid use disorder. However, I would add some information specifically elaborate on the symptoms of overdose and how that is treated.
• Is the content added up-to-date? Yes it is.
• Is there content that is missing or content that does not belong? As stated earlier I would go over more on the treatment of overdose and rather than listing the symptoms discuss when these symptoms are present how do you treat.

Content evaluation

I believe that there are portions of the content section that can have elaboration. The data that is present is very good, but there is still a little more that I would like added. As stated before I believe there should be more information on the treatment for opioid overdose, and how to spot it. As well as how successful that treatment is in the section discussing overdose rather than just a slight mention in deaths. There should also be more on overdose in the mechanism section since it does play a prevalent role in opioid use disorder. With those changes I believe that the content section will be much improved. I do like the fact there is information on the receptors as well. JacksLog (talk) 17:52, 7 December 2019 (UTC)

Tone and Balance

Guiding questions:

• Is the content added neutral? In the content section it is. However, there is some negative connotation in the lead section. Even though there are statements that have citations, I feel that some of the wording makes it feel like the writer had negative feelings toward people that have opioid use disorder. However that is only in the lead section.
• Are there any claims that appear heavily biased toward a particular position? No.
• Are there viewpoints that are overrepresented, or underrepresented? No.
• Does the content added attempt to persuade the reader in favor of one position or away from another? As mentioned above there is a sentence or two that appears to have a negative connotation to it rather than just presenting the facts of opioid use disorder. JacksLog (talk) 17:43, 7 December 2019 (UTC)

Tone and balance evaluation

As mentioned prior I believe the balance is very neutral to the whole article. The article distributes the facts as they are without leading the reader to pick a certain side. However, the lead section does have some negative sentences. To me as a reader it made me believe that there is something personally wrong with the individuals that have opioid use disorder rather than it being a medical problem. If these sentences are changed specifically the opening statement to just present the facts rather than discussing how bad they are it will be more neutral.JacksLog (talk) 17:49, 7 December 2019 (UTC)

Sources and References

Guiding questions:

• Is all new content backed up by a reliable secondary source of information? Yes however I believe the newspaper articles can be removed since they are secondary to other more reliable sources.
• Are the sources thorough - i.e. Do they reflect the available literature on the topic? Yes there are good sources, but there is a mixture of unreliable sources that can be removed. I feel they do not add much to the article.
• Are the sources current? Yes there are up to date sources to mix with older sources, but I believe there is enough current sources to make me believe the information is up to date.
• Check a few links. Do they work? Yes

Sources and references evaluation

Overall I like the amount of sources utilized in this article. Granted the sources like the New York Times does not add anything to the article and could be removed. There is also many sources utilized and therefore not all are the best, but there is enough meta analysis and books to show the information is reliable. I also feel that there is enough up to date sources to show the information has been updated to counteract the sources that are from the early 2000s. JacksLog (talk) 17:57, 7 December 2019 (UTC)

Organization

Guiding questions:

• Is the content added well-written - i.e. Is it concise, clear, and easy to read? Yes
• Does the content added have any grammatical or spelling errors? No
• Is the content added well-organized - i.e. broken down into sections that reflect the major points of the topic? Yes

Organization evaluation

The main organization change that I would make is adding the opioid overdose information to the mechanism portion. I believe it is a center point to opioid use disorder, and should be added with dependence. I do believe the grammar and spelling is good, and most of the article is very easy to read. The portions on the receptors gets more challenging due to the medical jargon, so if there is any way to simplify that section I would. I also am not sure what sections you added specifically or what you took away, but overall I believe the article is easy to follow and is well organized. I would just make the simple changes stated above. JacksLog (talk) 18:02, 7 December 2019 (UTC)

Images and Media

Guiding questions: If your peer added images or media

• Does the article include images that enhance understanding of the topic? Yes the graphs and the medications
• Are images well-captioned? Yes
• Do all images adhere to Wikipedia's copyright regulations? I believe so
• Are the images laid out in a visually appealing way? Yes

Images and media evaluation

The few images that are present do help with the article. I believe the medication images are placed appropriately and help the reader understand what these medications are aka pills and not liquid or a shot. I also believe the graphs do a good job visually showing the epidemiology in the US. JacksLog (talk) 18:04, 7 December 2019 (UTC)

For New Articles Only

If the draft you're reviewing is a new article, consider the following in addition to the above.

• Does the article meet Wikipedia's Notability requirements - i.e. Is the article supported by 2-3 reliable secondary sources independent of the subject?
• How exhaustive is the list of sources? Does it accurately represent all available literature on the subject?
• Does the article follow the patterns of other similar articles - i.e. contain any necessary infoboxes, section headings, and any other features contained within similar articles?
• Does the article link to other articles so it is more discoverable?

Overall impressions

Guiding questions:

• Has the content added improved the overall quality of the article - i.e. Is the article more complete? Yes
• What are the strengths of the content added?
• How can the content added be improved? I would remove the negative sounding sentences in the lead section. I would add more to opioid overdose in the mechanism section. I would discuss the epidemiology of the success of using naltrexone for overdose. I would take away some of the sources that are not good sources like the New York Times. I would also add a sentence about the history in the lead section since this is discussed further down.

Overall evaluation

I am not sure what specifically you added or took away, but I can say that the article is very well done. This article does a good job staying neutral to the topic of opioid use disorder except for the lead section as mentioned above. I also believe the content is very well organized and extremely complete except for the overdose portion that was also mentioned above. I also appreciate the images that were added to the article. Overall I believe this article is very well done. There are a few small changes that I would make as I stated in the above sections of the peer review, but it is a very good article. It is very well cited and can actually have some citations removed since they don't add much. I believe this is a very good article and whatever you did add or take away does flow well within this article.

@JacksLog Thank you for the suggestions! Incorporated as many as possible as we saw fit.--JacksLog (talk) 04:13, 9 December 2019 (UTC)

References

New text

"Given the more favorable safety profile of buprenorphine and decreased risk of abuse and diversion, there is no need for daily clinic visits and once patients are on maintenance therapy they are spaced out to monthly visits. "

Were does the reference say this? Doc James (talk · contribs · email) 10:17, 15 May 2020 (UTC)

"Since March 2020 buprenorphine treatment has been available online through telemedicine technology and is currently offered in most states by QuickMD."

The second bit is an advert. Doc James (talk · contribs · email) 10:17, 15 May 2020 (UTC)

Merger Proposal (July 2020)

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section. A summary of the conclusions reached follows.

The general consensus is do not merge. Thanks everyone for the in-depth discussion. Note that the the merge proposal banners at the top of each article should not have been removed until this here discussion was closed by the nominator (me) or an Admin, but that's a minor procedural matter. Otherwise, the relatively new article in the proposal, Opioid Withdrawal Syndrome, was renamed as Opioid withdrawal and extensively edited to address the problems it had at the time of the proposal. This discussion also revealed the possible need for complete new articles on "Acute opioid withdrawal" and "Neonatal opioid withdrawal syndrome". ---DOOMSDAYER520 (Talk|Contribs) 01:42, 6 August 2020 (UTC)

---

I propose merging the relatively new article Opioid Withdrawal Syndrome to here, Opioid use disorder, as that connection was suggested by someone on the new article's talk page. After reading over that new article and the discussions on its own talk page, and assessing the many edit tags at the top of that article, I propose that it over-interprets some terminology in the literature in an attempt to form a new scientific term. (See also the rules on original research.) I am not convinced that Opioid Withdrawal Syndrome is a "thing" (as said by someone on that article's talk page) in the scientific literature. That article does have some useful research findings, but not enough to justify an entire new article. I propose merging the verifiable bits to here. ---DOOMSDAYER520 (Talk|Contribs) 15:40, 22 July 2020 (UTC)

• Oppose Opioid use disorder is a unified medical disorder. Opioid withdrawal syndrome or acute opioid withdrawal does not require that an individual has an opioid use disorder. The person who created the page originally was confused by that but the terminology does not over-interpret the scientific literature. A review on this could by found in JCI, by Nora Volkow, head of NIDA and a respected researcher in the field. and I quote "In diagnosing OUD, many confuse opioid physical dependence with OUD, yet this distinction is crucial for selecting treatment. Physical dependence develops rapidly and occurs in most people who are given repeated doses of opioid medications and manifests as the emergence of acute withdrawal symptoms following discontinuation of opioid drugs" - PainProf (talk) 16:26, 22 July 2020 (UTC)

  Additionally if you look at pubmed: https://pubmed.ncbi.nlm.nih.gov/?term=opioid+withdrawal+syndrome there are many reviews specifically on this topic. I was only pointing out the most reliable reviews, i.e. those by well known researchers published in several eminent journals, the NEJM, JAMA and JCI. PainProf (talk) 16:38, 22 July 2020 (UTC)

• I think that we should take a look at the broader picture. We probably could have separate articles about:
  • Opioid use disorder
  • Acute opioid withdrawal (e.g., the symptoms that can appear in susceptible non-addicted people who take opioids for a month and then suddenly stop, and what your local hospital ought to do about it, aside from encouraging the surgeons to prescribe fewer opioids in the first place)
  • Neonatal opioid withdrawal syndrome
• Whether that existing content gets merged/split/kept/re-written is less important to me than what we have in the end. WhatamIdoing (talk) 18:37, 22 July 2020 (UTC)

That's eminently sensible. I wasn't sure if neonatal opioid withdrawal should be separate but the whole babies aren't little people mantra is normally true. PainProf (talk) 19:00, 22 July 2020 (UTC)

@PainProf, where do they classify the babies who have opioid problems due to post-birth medical treatment with opioids? Hopefully that's just a tiny fraction of babies, but it's not like they're going to do major surgery without pain medication on a baby (in this century, anyway *shudder*), and some babies end up in the hospital on these drugs for months. WhatamIdoing (talk) 05:39, 28 July 2020 (UTC)

• Comment from Proposer - The proposal is for a fairly straightforward merge of content from a new article to this established article. If folks think that is not a sensible idea, I can close the nomination and we can move on. But the discussion in the past few hours here, and the discussion at the talk page for that new article, indicate that a lot of straightening up needs to be done to multiple articles. I encourage concerned editors to put their best foot forward and take command of the present confusion. ---DOOMSDAYER520 (Talk|Contribs) 22:35, 22 July 2020 (UTC)

Comment Thanks, I think in looking at this new page, we noticed that the new page as originally written was questionable, but the broader concept is important. This article should discuss Opioid use disorder, which withdrawal can be a component of but withdrawal is not an essential element of Opioid use disorder. The name Opioid withdrawal syndrome is often used as is acute opioid withdrawal, I've personally always called it acute opioid withdrawal but I don't know which is the more common name. In either case they refer specifically to the physiological changes that occur after you suddenly withdraw from Opioids due to physiological adaptation, it is not the same as addiction. In contrast an Opioid use disorder is a problematic pattern of opioid use that leads to physical or emotional distress. It requires multiple elements that aren't always found in opioid withdrawal. Neonatal Abstinence Syndrome or Neonatal withdrawal syndrome is the effects of withdrawal in early neonates. It presents unique challenges due to differences in neonatal physiology. Opioids are different to other drugs in mechanisms of dependence, an article on opioids specifically in neonates may be useful. PainProf (talk) 22:57, 22 July 2020 (UTC)

• Support Comment As edited on page there is no difference made in using the word acute - withdrawal symptoms are the symptoms of withdrawal and each substance has its own set of symptoms or syndrome. The incorporation of the referenced prescription opioid use disorder into the opioid use disorder page need present no problem. The collection of symptoms as experienced is identical (in varied combinations) regardless of how they arise. All that a separate page as the new one is, would achieve is a repetition of all that is on the opioid use disorder page with one highlighted claim that it arises from prescription opioids. And this development is often, if not mostly due to the purchase of illegal prescription drugs so it still stands as a substance use disorder.  As for the neonatal withdrawal - the page exists it just needs adding a section on opioid withdrawal - there is very little at the moment that would warrant its own page.--Iztwoz (talk) 14:14, 23 July 2020 (UTC)

Actually that is not correct. If you don't have addiction frequently you won't be diagnosed with an opioid use disorder. It is incorrect that it is most commonly illegal as much of the burden of opioid withdrawal syndromes falls on those who become physically dependent following surgery. The reliable sources make a distinction here and we should too. Opioid use disorder has a very specific medical meaning which requires more than physical withdrawal. The management is different too. In an opioid use disorder it may focus on tapering. This is unlikely to be of benefit for a patient who is physically dependent following short term use as these are opioids that can lead to addiction. In those cases management of symptoms i.e. with the listed pharmacological agents is more helpful and responsible. PainProf (talk) 14:38, 23 July 2020 (UTC)

I can recognise that withdrawal from opioids prescribed for pain does not constitute addiction and so may be out of place on the opioid use disorder page - but perhaps it could still have a home on that page simply in terms of the relevant management and treatment information. I find the details in DSM to be contradictory: one page says it follows heavy and prolonged usage and another says that it can follow short pain relief treatments. If the page is to stay I would suggest a different page name of just Opioid withdrawal which could cover all aspects without being specific to the disorder/addiction and which would be easily referenced.--Iztwoz (talk) 17:52, 23 July 2020 (UTC)

This is a particularly relevant line: "The last two diagnostic criteria, related to tolerance and withdrawal, are not considered to be met for individuals taking opioids solely under appropriate medical supervision", additionally, there is a detailed explainer from the IASP of why this is the case, https://s3.amazonaws.com/rdcms-iasp/files/production/public/FileDownloads/PCU_21-5_web.pdf, PainProf (talk) 20:09, 23 July 2020 (UTC)

Thank you for the link - it's an interesting read. I am inclined to agree with you as previous posting; do you think the change of page name to Opioid withdrawal would be a better fit?--Iztwoz (talk) 20:43, 23 July 2020 (UTC)

Agree that seems like right place for a move as it's a more common name. Possibly also a redirect from acute opioid withdrawal another common name. PainProf (talk) 15:50, 24 July 2020 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Why no solution approaches?

Not asking for a friend, but I read too many strange books. I had no idea what "Naked Lunch" was about, though I'd heard the title many times... It led to Apomorphine which led here which seems to have led nowhere. I'm really curious why there is no mention of "treatment" or "cure" or "recovery" in this article. I'm basically averse to drugs, but it's supposed to be a major social problem these days. A problem without a solution is just the way things are, which is rather bleak, notwithstanding the infamous serenity prayer. I can't imagine that the topic has never been considered as part of the Article, so I guess the real question is why it is excluded? Shanen (talk) 09:53, 17 August 2020 (UTC)

Management section poorly written

The section on opioid replacement therapy is terribly written and makes claims and assertions without citation. Methadone should have it's own separate section as well. What's currently there reads like it was copy-pasted from a poorly written treatment service website. — Preceding unsigned comment added by 117.20.69.21 (talk) 00:57, 23 May 2022 (UTC)

Wiki Education assignment: Technical and Scientific Communication

This article was the subject of a Wiki Education Foundation-supported course assignment, between 22 August 2022 and 9 December 2022. Further details are available on the course page. Student editor(s): Khinsonycp (article contribs).

— Assignment last updated by Ftaylor4 (talk) 15:24, 21 September 2022 (UTC)

Wiki Education assignment: WikiMed Fall 2022

This article was the subject of a Wiki Education Foundation-supported course assignment, between 25 October 2022 and 18 November 2022. Further details are available on the course page. Student editor(s): Kalij94 (article contribs).

— Assignment last updated by Kalij94 (talk) 16:18, 31 October 2022 (UTC)

Wiki Education assignment: WikiProject Medicine Winter 2024 UCF COM

Hello all,

I will be editing and adding to this article for the next few weeks. After reading the article, comments in this Talk page, and literature reviews I have outlined a proposed workplan:

1. As mentioned in a previous comment, the lead is very well done. It is concise and covers almost every section in the article except cause/mechanism. I will attempt to briefly incorporate this as well as other minor edits.

2. Edit Cause/Mechanism section. Overall this article is very well done and free of jargon. The Cause and Mechanism sections are definitely the most cumbersome to read. I will edit and check sources in this section. Additionally, propose addition or hyperlink to different CYP metabolizers which plays a role in susceptibility.

3. Edit mitigation section. CBT and MI are two separate schools of psychotherapy. Both can be implored to help those struggling with Use Disorder. Will clarify roles and possibly separate into sections.

4. Edit epidemiology section. Add or edit parts to map out the "waves" of opioid crisis. May need to hyperlink to another page as this could be it's own article.

5. Edit history section. The mention of Levacetylmethadol at the end seems inappropriately placed.

Thank you all. This will be my first attempt at editing and all comments and suggestions are welcome.

Sean Yumul (talk) 17:27, 10 January 2024 (UTC)

Hey Sean,

Great work editing this page, this is an extremely important subject that we're always learning more about so it's great to keep it up to date.

1. I agree, the lead was very well done so no additions is appropriate
2. Nice additions to the mechanism section. You used recent sources for citations from the last few years and added alot of good info on receptors and receptor genes and their implications in clinical practice.
3. The medication section was already very well put together, but I like that you took the time to add the tidbit about the recent omnibus bill. Any other new info about opioid treatment within the last couple years that can be added for the other medications?
4. The behavioral therapy section is really nicely laid out, very easy to follow with a brief intro section and then a more thorough breakdown of each subset of therapy. The twelve step program section is short, I wouldn't mind seeing a quick sentence on maybe how effective twelve step is compared to the other kinds of therapy.
5. Epidemiology section is much more informative now with the breakdown of the "waves" of the opioid crisis. I wasn't aware of that categorization of opioid crises before but it's really clear now how each wave differs from the other. Around when did the current fourth wave start? Might be helpful info as this edit ages over time
6. Effects of covid on opioid epidemic is a really awesome addition, great idea. Very well written review of the subject.
7. I agree that the section on levacetylmethadol is oddly placed, but I'm not sure there would be a better place for it and it does add relevant info, so I think leaving it there is appropriate.

Overall great job on these edits, I think if you left everything as is it would be perfectly fine. Justin.taylor27 (talk) 21:44, 29 January 2024 (UTC)

Wiki Education assignment: WikiProject Medicine Winter 2024 UCF COM

This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 January 2024 and 2 February 2024. Further details are available on the course page. Student editor(s): Sean Yumul (article contribs).

— Assignment last updated by DLEMERGEBM (talk) 21:17, 11 January 2024 (UTC)