Opioid use disorder (OUD) is a substance use disorder relating to the use of an opioid. Any such disorder causes significant impairment or distress. Signs of the disorder include a strong desire to use opioids, increased tolerance to opioids, difficulty fulfilling obligations, trouble reducing use, and withdrawal symptoms with discontinuation. Opioid withdrawal symptoms may include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are components of a substance use disorder. Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems at school, work, or home.An article in The Lancet compared the harm and dependence liability of 20 drugs, using a scale from zero to three for physical dependence, psychological dependence, and pleasure to create a mean score for dependence. The 20 drugs were several opioids (morphine, heroin, methadone, hydromorphone, oxycodone), barbiturates (pentobarbital, secobarbital, amobarbital, phenobarbital), benzodiazepines (diazepam, temazepam, nitrazepam, lorazepam, triazolam), nicotine, cocaine, amphetamine, MDMA (ecstasy), alcohol, and cannabis. Selected results can be seen in the chart below. Diacetylmorphine and morphine both scored a 3.0 and ranked highest. Hydromorphone followed with a mean of 2.76, cocaine scoring 2.4, oxycodone 2.31, and methadone at 1.75. The mean benzodiazepine score was elevated to due to high scores exhibited by triazolam and temazepam for pleasure and psychological dependence. Opioids include substances such as heroin, morphine, fentanyl, codeine, dihydrocodeine, oxycodone, and hydrocodone. In the United States, a majority of heroin users begin by using prescription opioids that may also be bought illegally.
Subacute bacterial endocarditis, abbreviated SBE, is a type of endocarditis (more specifically, infective endocarditis). Subacute bacterial endocarditis can be considered a form of type III hypersensitivity. Signs and symptoms
Among the signs of subacute bacterial endocarditis are:
Malaise
Weakness
Excessive sweat
Fever

Causes
It is usually caused by a form of Viridans group streptococcus bacteria that normally live in the mouth (Streptococcus mutans, mitis, sanguis or milleri).Other strains of streptococci can cause subacute endocarditis as well. These include streptococcus intermedius, which can cause
acute or subacute infection (about 15% of cases pertaining to infective endocarditis).Enterococci from urinary tract infections and coagulase negative staphylococci can also be causative agents. Mechanism
The mechanism of subacute bacterial endocarditis could be due to malformed stenotic valves which in the company of bacteremia, become infected, via adhesion and subsequent colonization of the surface area. This causes an inflammatory response, with recruitment of matrix metalloproteinases, and destruction of collagen.Underlying structural valve disease is usually present in patients before developing subacute endocarditis, and is less likely to lead to septic emboli than is acute endocarditis, but subacute endocarditis has a relatively slow process of infection and, if left untreated, can worsen for up to one year before it is fatal. In cases of subacute bacterial endocarditis, the causative organism (streptococcus viridans) needs a previous heart valve disease to colonize. On the other hand, in cases of acute bacterial endocarditis, the organism can colonize on the healthy heart valve, causing the disease.