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The contents of the Opioid replacement therapy page were merged into Opioid use disorder. For the contribution history and old versions of the redirected page, please see its history; for the discussion at that location, see its talk page. |
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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.
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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)
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 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)
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)
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)
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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.
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: CS1 maint: multiple names: authors list (link)Thanks.--Literaturegeek | T@1k? 23:42, 31 May 2010 (UTC)
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)
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
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)
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)
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)
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)
... of primary care based models. doi:10.7326/M16-2149 JFW | T@lk 22:50, 5 December 2016 (UTC)
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)
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)
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)
@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)
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)
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)
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 [1] 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 [2] for reference).
I don't have access to the DSM-5 itself, but [1] lists the DSM-5's diagnostic criteria for a substance use disorder on slides 9–13 and [2] 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)
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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),[2] but their criteria focus more on the personal, professional, and social consequences of an addiction (criteria 5–9 from [2]) than the actual addiction-related behaviors and pathologically altered cognitive processes that cause them (criteria 1–4 from;[2] 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 [1] and page 1 of,[2] 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)
The ICD10 says "opioid dependence" is applicable to OUD[5]
Doc James (talk · contribs · email) 23:44, 16 March 2017 (UTC)
Addiction and dependence glossary[1][2][3] | |
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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)
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)
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.
— [3]
References
Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.41. ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.
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.
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)
Paraphrase it as "a medical condition characterized by a pattern of opioid use which results in negative consequences."
Use it verbatim "a medical condition characterized by a problematic pattern of opioid use that causes clinically significant impairment or distress."
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)
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)
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)
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)
This is OR - we really need reviews. The last one is also not accurate - the one person (!) took the whole herb not an extract.
Each of these treatments is experimental, and some remain quite far from having been proven to be effective:
References
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-- Jytdog (talk) 04:06, 24 June 2017 (UTC)
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)
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
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.
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. [1]
(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
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[1], 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)[2]. 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[3][4].
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
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Naloxone:
Naloxone is a mu-opioid receptor antagonist that is used for emergency reversal of opioid overdose[1]. 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[1]. Since this is a life-saving medication, many states have implemented Standing Orders for law enforcement to carry and administer Naloxone as needed[2]. [3]
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[4].
Vreddy9 (talk) 17:30, 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.[1] 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.[1] Since this is a life-saving medication, many states have implemented standing orders for law enforcement to carry and administer naloxone as needed.[5][6] 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.[7]
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:
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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
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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
Naltrexone is a competitive antagonist of the opioid receptors that is used for the treatment of opioid addiction.[1][2] It works by blocking the physiological, euphoric, and reinforcing effects of opioids.[2][3] Non-compliance with naltrexone therapy is a concern with oral formulations because of its daily dosing.[3][4] The alternative intramuscular (IM) injection has better patient compliance due to its monthly dosing.[3] Naltrexone monthly IM injections (Vivitrol) received FDA approval in 2010 for the treatment of opioid dependence in abstinent opioid users.[1][3]
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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)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
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)
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)
@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)
WRT "Addiction and dependence are components of a substance use disorder and addiction represents the most severe form of the disorder.[1][2]" not seeing it in the ref?
WRT "Opioid dependence can manifest as physical dependence, psychological dependence, or both.[1][3]" 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)
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)
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:
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
DSM5
was invoked but never defined (see the help page).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.
pmid26740398
was invoked but never defined (see the help page).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)
SP, WY, AN, BP
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)
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. [1]
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)
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.[2]
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)
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)
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)
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)
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…
• [extra question] Has the group achieved its overall goals for improvement? If not, specify…
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)
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)
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[3]. 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[4]. Some studies have noted that women versus men have greater sensitivity to pain[5] and a higher chance for chronic pain[6]. Thus, this may contribute to high rates of opioid prescriptions in women[7]. Additionally, research has suggested that women are more likely to misuse to self-treat other problems[8]. Hnguyc (talk) 04:53, 28 April 2019 (UTC)
This is where you will complete your peer review exercise. Please use the following template to fill out your review.
Guiding questions:
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)
Guiding questions:
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)
Guiding questions:
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)
Guiding questions:
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)
Guiding questions:
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)
Guiding questions: If your peer added images or media
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)
If the draft you're reviewing is a new article, consider the following in addition to the above.
Guiding questions:
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
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(help)CS1 maint: PMC format (link)
"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.[1] "
"Since March 2020 buprenorphine treatment has been available online through telemedicine technology and is currently offered in most states by QuickMD.[2][3]"
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)
• 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)
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)
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)
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)
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)
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)
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)