Opioid use disorder can begin at any age, but problems associated with opioid use are most commonly first observed in the late teens or early 205. Once opioid use disorder develops, it usually continues over a period of many years, even though brief periods of abstinence are frequent. In treated populations, relapse following abstinence is common.
Even though relapses do occur, and while some long—term mortality rates may be as high as 2% per year, about 20%—30% of individuals with opioid use disorder achieve long-term abstinence. An exception concerns that of military service personnel who became depen- dent on opioids in Vietnam; over 90% of this population who had been dependent on opi- oids during deployment in Vietnam achieved abstinence after they returned, but they experienced increased rates of alcohol or amphetamine use disorder as well as increased suicidality.
Increasing age is associated with a decrease in prevalence as a result of early mortality and the remission of symptoms after age 40 years (i.e., ”maturing out”). However, many individuals continue have presentations that meet opioid use disorder criteria for decades.
Genetic and physiological. The risk for opiate use disorder can be related to individual, family, peer, and social environmental factors, but within these domains, genetic factors play a particularly important role both directly and indirectly. For instance, impulsivity and novelty seeking are individual temperaments that relate to the propensity to develop a substance use disorder but may themselves be genetically determined. Peer factors may relate to genetic predisposition in terms of how an individual selects his or her environ- ment.
Despite small variations regarding individual criterion items, opioid use disorder diag- nostic criteria perform equally well across most race/ethnicity groups. Individuals from resented among individuals with opioid use disorder. However, over time, opioid use disorder is seen more often among white middle-class individuals, especially females, suggesting that differences in use reﬂect the availability of opioid drugs and that other so- cial factors may impact prevalence. Medical personnel who have ready access to opioids may be at increased risk for opioid use disorder.
Routine urine toxicology test results are often positive for opioid drugs in individuals with- opioid use disorder. Urine test results remain positive for most opioids (e.g., heroin, mor- phine, codeine, oxycodone, propoxyphene) for 12—36 hours after administration. Fentanyl dures for several days. Methadone, buprenorphine (or buprenorphine/naloxone combi- nation), and LAAM (L-alpha-acetylmethadol) have to be specifically tested for and will not cause a positive result on routine tests for opiates. They can be detected for several days up to more than 1 week. Laboratory evidence of the presence of other substances (e.g., co- caine, marijuana, alcohol, amphetamines, benzodiazepines) is common. Screening test re- sults for hepatitis A, B, and C virus are positive in as many as 80%—90% of injection opioid users, either for hepatitis antigen (signifying active infection) or for hepatitis antibody (sig- nifying past infection). HIV is prevalent in injection opioid users as well. Mildly elevated liver function test results are common, either as a result of resolving hepatitis or from toxic injury to the liver due to contaminants that have been mixed with the injected opioid. Sub- served for up to 6 months following opioid detoxification.