Prescription Drug and Alcohol Use Disorders: Opioid Use Disorder.

More than 2 million Americans meet the criteria for opioid use disorder. This epidemic has been driven in part by overprescribing. Physicians have an obligation to respond through better opioid stewardship, universal screening for misuse, referral for management, and provision of opioid use disorder management. Opioid use disorder should be diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria and should not be confused with uncomplicated opioid dependence. The pharmacotherapy of opioid use disorder has three overarching goals: to manage withdrawal, to reduce cravings, and to block the effects of nonmedical opioid use. Three drugs are approved by the Food and Drug Administration for the management of opioid use disorder: methadone, buprenorphine, and naltrexone. Drug choice is only one component of the management plan for opioid use disorder; outcomes are improved with multicomponent and interprofessional strategies. Screening for opioid use disorder is indicated for certain populations, including pregnant women, but universal screening currently is not recommended. Pregnant women may be treated with methadone or buprenorphine.