2026-2027 | Live Session | Opioid Use Disorder: Board Review | September 2026-Opioid Use Disorder: Board Review Presentation

Opioid Use Disorder: Board Review Presentation

Pdf Summary

This ACAAM board-review session from Montefiore Medical Center and Albert Einstein College of Medicine provides a clinical overview of opioid use disorder (OUD), treatment, and harm reduction.<br /><br />The presenters emphasize that stigma in healthcare can undermine patients’ dignity and discourage them from seeking care. They review opioid types and receptors, the overdose epidemic, and DSM-5 criteria for OUD: diagnosis requires at least two criteria within 12 months, with severity based on the number met. Tolerance and withdrawal do not count when opioids are taken under medical supervision.<br /><br />Withdrawal can be assessed with tools such as COWS and SOWS. Treatment includes methadone, buprenorphine, or—in selected inpatient settings—full agonist opioids, with adjunctive medications as needed. Overdose care should prioritize restoring breathing, minimizing unnecessary withdrawal, and providing compassionate follow-up; naloxone is central to reversal.<br /><br />The session compares medications for OUD. Methadone is a full agonist requiring careful, individualized titration; buprenorphine is a high-affinity partial agonist with a respiratory-depression ceiling but can precipitate withdrawal if started too soon. Standard, low-dose, and high-dose initiation strategies are discussed. Naltrexone blocks opioid effects but requires a period of opioid abstinence before initiation. Methadone and buprenorphine are associated with substantially lower overdose risk than no treatment.<br /><br />Chronic pain is common among people with OUD and calls for individualized, multimodal care. Guidance favors risk-benefit assessment, functional goals, and gradual, voluntary tapering rather than abrupt or involuntary dose reductions. The session also covers overdose prevention—naloxone, drug checking, overdose prevention centers, and avoiding solitary use—and opioid-adjacent substances such as “lean,” kratom products, and tianeptine, which can carry dependence and toxicity risks.

Keywords

opioid use disorder

harm reduction

methadone

buprenorphine

naloxone

DSM-5 criteria

overdose prevention

withdrawal assessment

chronic pain management

stigma in healthcare