NCLIP

Opioid Use Disorder

3 min read

Opioid Use Disorder

Key Points

  • OUD can begin with prescribed analgesics or illicit opioid use and progresses through tolerance, dependence, and compulsive use.
  • The opioid overdose triad is pinpoint pupils, respiratory depression, and decreased level of consciousness.
  • Naloxone rapidly reverses opioid effects but requires ongoing monitoring because rebound toxicity can occur.
  • Sustained recovery usually requires medication-assisted treatment plus behavioral and social support.

Pathophysiology

Opioids bind central opioid receptors involved in analgesia and reward. Repeated exposure causes tolerance, then physiologic dependence, so abrupt cessation triggers withdrawal symptoms and intense craving.

As use escalates, intoxication and respiratory suppression risk increase, especially with fentanyl-contaminated supply or polysubstance use. Reduced tolerance after abstinence sharply increases overdose risk during relapse.

Classification

  • Prescription opioid misuse: Overuse, non-prescribed use, or diversion of opioid analgesics.
  • Illicit opioid use: Heroin and nonmedical synthetic opioids.
  • Complicated OUD: OUD with injection-related infection, social destabilization, or repeated overdose.

Nursing Assessment

NCLEX Focus

In suspected overdose, assess airway and respiratory status first, then neurologic status and exposure history.

  • Assess opioid type, route, last use, and prior overdose history.
  • Assess intoxication findings: miosis, sedation, dysarthria, impaired attention, respiratory depression.
  • Assess for injection-related harms (track marks, skin infection, HIV/HBV/HCV risk).
  • Assess withdrawal severity with CINA or cows at protocol intervals.
  • Assess readiness for change, treatment preference, and discharge barriers.

Nursing Interventions

  • Activate emergency response and provide rescue breathing/oxygen or compressions as indicated.
  • Administer naloxone and repeat dose in 2 to 3 minutes if response is inadequate.
  • Monitor for recurrent sedation/respiratory depression due to naloxone short duration.
  • Initiate detox symptom management and transition planning for ongoing treatment.
  • Provide harm-reduction education and linkage to community recovery resources.

Recurrent Toxicity Risk

Naloxone can wear off before the opioid clears; continuous reassessment is mandatory.

Pharmacology

FDA-approved medications for OUD include buprenorphine, methadone, and naltrexone. Buprenorphine and methadone reduce craving and withdrawal burden; naltrexone blocks opioid euphoria.

Nurses support medication initiation, monitor adverse effects, and reinforce adherence and overdose-prevention planning. Medication should be paired with behavioral treatment and social support for best outcomes.

Clinical Judgment Application

Clinical Scenario

An unresponsive client is found with shallow respirations, pinpoint pupils, and cyanotic lips.

Recognize Cues: Classic opioid overdose triad with hypoventilation. Analyze Cues: Immediate risk is hypoxic arrest from respiratory failure. Prioritize Hypotheses: Stabilize airway/breathing and reverse opioid effect. Generate Solutions: Call emergency team, ventilatory support, naloxone administration. Take Action: Deliver naloxone and reassess respiratory rate and consciousness. Evaluate Outcomes: Confirm return of adequate ventilation and arrange definitive monitoring/treatment.

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