Definition and Diagnosis
Opioid use disorder involving heroin is a problematic pattern of opioid use leading to clinically significant impairment or distress, with strong craving, tolerance, and a characteristic, often severe, withdrawal syndrome on cessation.
Epidemiology
Heroin use disorder has contributed substantially to the global burden of substance-related mortality, with prevalence varying widely by region and closely tied to availability, prescription opioid patterns, and socioeconomic factors.
Risk Factors
Risk factors include prior use of prescription opioids, history of other substance use, chronic pain, co-occurring mental illness, trauma exposure, and social or economic disadvantage.
Symptoms and Subtypes
Features include intense craving, escalating use, tolerance, and a withdrawal syndrome with muscle aches, sweating, gastrointestinal symptoms, dilated pupils, anxiety, and insomnia, typically peaking 48-72 hours after last use.
Diagnosis
DSM-5-TR criteria for opioid use disorder require at least two of eleven criteria within twelve months. Urine toxicology and clinical history support diagnosis, and overdose risk assessment is an essential part of evaluation.
Treatment
Medication-assisted treatment with methadone or buprenorphine is first-line and substantially reduces mortality and relapse; naltrexone is an alternative for select patients. Structured withdrawal management, psychosocial support, and naloxone provision for overdose prevention are integral to care.
Prognosis
Opioid use disorder carries a high risk of relapse and overdose, particularly after periods of abstinence when tolerance has diminished. Long-term engagement in medication-assisted treatment substantially improves outcomes and survival.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).