Opioid use disorder includes signs and symptoms that reﬂect compulsive, prolonged self— administration of opioid substances that are used for no legitimate medical purpose or, if another medical condition is present that requires opioid treatment, that are used in doses greatly in excess of the amount needed for that medical condition. (For example, an indi- more than prescribed and not only because of persistent pain.) Individuals with opioid use disorder tend to develop such regular patterns of compulsive drug use that daily activities are planned around obtaining and administering opioids. Opioids are usually purchased on the illegal market but may also be obtained from physicians by falsifying or exagger- physicians. Health care professionals with opioid use disorder will often obtain opioids by patients or from pharmacy supplies. Most individuals with opioid use disorder have significant levels of tolerance and will experience withdrawal on abrupt discontinuation of opioid substances. Individuals with opioid use disorder often develop conditioned responses to drug-related stimuli (e.g., craving on seeing any heroin powder—like sub- stance)—a phenomenon that occurs with most drugs that cause intense psychological changes. These responses probably contribute to relapse, are difficult to extinguish, and typ- ically persist long after detoxification is completed.
Opioid use disorder can be associated with a history of drug-related crimes (e.g., posses- sion or distribution of drugs, forgery, burglary, robbery, larceny, receiving stolen goods).
Among health care professionals and individuals who have ready access to controlled substances, there is often a different pattern of illegal activities involving problems with state licensing boards, professional staffs of hospitals, or other administrative agencies.
Marital difficulties (including divorce), unemployment, and irregular employment are of- ten associated with opioid use disorder at all socioeconomic levels.
The 12-month prevalence of opioid use disorder is approximately 0.37% among adults age 18 years and older in the community population. This may be an underestimate because of the large number of incarcerated individuals with opioid use disorders. Rates are higher in males than in females (0.49% vs. 0.26%), with the male-to-female ratio typically being 1.521 for opioids other than heroin (i.e., available by prescription) and 3:1 for heroin. Female ad- olescents may have a higher likelihood of developing opioid use disorders. The preva- lence decreases with age, with the prevalence highest (0.82%) among adults age 29 years or younger, and decreasing to 0.09% among adults age 65 years and older. Among adults, the prevalence of opioid use disorder is lower among African Americans at 0.18% and over- represented among Native Americans at 1.25%. It is close to average among whites (0.38%),
Asian or Pacific Islanders (0.35%), and Hispanics (0.39%).
Among individuals in the United States ages 12—17 years, the overall 12-month prev- alence of opioid use disorder in the community population is approximately 1.0%, but the prevalence of heroin use disorder is less than 0.1%. By contrast, analgesic use disorder is prevalent in about 1.0% of those ages 12—17 years, speaking to the importance of opioid an- algesics as a group of substances with significant health consequences.
The 12-month prevalence of problem opioid use in European countries in the commu- nity population ages 15—64 years is between 0.1% and 0.8%. The average prevalence of problem opioid use in the European Union and Norway is between 0.36% and 0.44%.