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Opioid Use Disorder and Pain


The Indian Health Service (IHS) works to promote safe and effective therapies to help patients and providers optimally manage pain and stop the inappropriate use of pain medications. Prolonged opioid prescribing at high doses or in combination with certain psychotropic medications and/or alcohol inevitably leads to dependence and overdose risk. Over the last decade, prescription drugs, especially opioid pain medications, have been increasingly implicated in drug overdose deaths. The CDC has identified addiction to prescription pain medication as the strongest risk factor for heroin addiction. Reducing and preventing opioid misuse is a national clinical and public health priority. IHS supports a a holistic, comprehensive, and interdisciplinary approach to address all facets of pain management while reducing medication misuse and diversion in our communities.

Improving Support for Clinicians Managing Alcohol and Substance Use

The Substance Use Warmline (1-855-300-3595) offers on-demand Clinician-To-Clinician support for IHS providers managing alcohol and substance use disorders. Calls are answered by trained clinical support specialists with diverse experience and substantial training in substance use disorder interventions.

The prevalence of alcohol and substance use disorders makes it likely that every clinician will come across substance use related issues in their practice. The Substance Use Warmline brings together clinicians who face these challenging cases in order to share knowledge and information about evidence-based clinical interventions.

The Substance Use Warmline aims to be a highly accessible, free, and confidential resource that clinicians may use to seek support and build on one another’s knowledge. The overall purpose of the Warmline is to maximize clinical services offered to patients, families, and communities facing substance use disorder.

Calls are welcome from all health care providers in IHS federal, tribal, and urban facilities.

What Is Chronic Pain?

Chronic pain is defined as persistent pain, which can be either continuous or recurrent and of sufficient duration and intensity to adversely affect a patient's well-being, level of function, and quality of life. Chronic pain is persistent, typically 3 months or more, and exists beyond an expected time for healing. The cause of pain may not be removable or otherwise treated. It may occur despite generally accepted medical treatment. The IHS Indian Health Manual, Chapter 30 Update: Chronic Non-Cancer Pain Management is available for additional guidance.

What Are Opioids?

Opioids are illicit drugs, such as heroin, as well as some prescription medications used to treat pain. Examples of prescription opioids include: morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorphone, and buprenorphine. Opioids work by binding to specific receptors in the brain, spinal cord, and gastrointestinal tract. In doing so, they minimize the body’s "reward centers" in the brain which can also trigger other systems of the body, such as those responsible for regulating mood, breathing, and blood pressure.

A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea, vomiting, severe allergic reactions (anaphylaxis), and overdose, in which breathing and heartbeat slow or even stop.

Throughout the site, we refer to opioids, which are natural or synthetic derivatives of opium that act on the central nervous system to relieve pain. The term "opioid" is used to distinguish pain medications from illegal narcotics used to induce euphoria.

What is Dependence?

Dependence refers to the normal adaptive state that results in withdrawal symptoms if a medication is abruptly stopped or decreased.

What is Opioid Use Disorder?

The DSM-5 defines opioid use disorder as a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two out of 11 criteria within a 12-month period.

Opioid Use Disorder DSM V Diagnostic CriteriaExit Disclaimer: You Are Leaving [PDF - 101 KB]