Talk:Opioid use disorder

message: Hello,
I'm also a fourth-year medical student who will be editing this page as part of an elective rotation. I am planning to focus mainly on the Epidemiology, Prevention, and Treatment sections of the body. I've outlined the aspects of the editing process we've been told to focus on and how I plan to do so below. Please let me know if you have thoughts or suggestions. Looking forward to working with you all!
1. What resources do I intend to look up, and when?
-This week, until 11/25, I will be solidifying resources
-Meta-analyses from reputable journals
-Book chapters from reputable, yet recent sources
2. How will I decide what things (signs, symptoms, side-effects, etc.) to explicitly include/exclude?
-Expand upon information presented in terms of the types of populations in which opioid use disorder is most prevalent and why (e.g., discussing barriers to care in certain populations)
-Update and summarize prevention and treatment sections as appropriate based on secondary research studies
3. Will I also embed additional links to other Wiki pages?
-Yes  — Preceding unsigned comment added by RedStorm1 (talk • contribs) 20:21, 18 November 2019 (UTC)
thread_title:  WikiProject Medicine: MUSC College of Medicine 

message: This was one of the first articles I edited on Wikipedia when
I finally got round to signing up for a user account; it's got a
little bigger, but is still quite unloved.  For something which
affects probably millions of people around the world, you'd
think something more can be written.  Does the article need to
be deleted?  Or merged into Opioid#Dependence_and_withdrawal_issues?
Hence addition of the
 tag.
Richard W.M. Jones 14:46, 1 November 2005 (UTC)
replies: text: I agree the article does need some more work, perhaps as someone going through these issues I will attempt to add some more useful text later when I have some time (although I have never really made major page edits before and worry my personal experience of the issue may cause inadvertent POV issues) MttJocy 21:39, 11 March 2007 (UTC)
thread_title: Article start

message: I think that the name of this page should be opioid dependency rather than opiate, because it then encompasses the full range of opioids rather than simply morphine and codeine
--javsav (cbf logging in)
:Agreed, dependency to opioid drugs and true natural opiates functions in much the same way with similar effects, thus Opioid would be more suitable, I do suggest a redirect is left as well though due to the common erronious perception in the general public that opiate refers to all the opioid drugs, such as heroin, hydrocodone, oxycodone etc are often mistakenly termed opiates. MttJocy 21:39, 11 March 2007 (UTC)
replies: text: I've moved the article, per the request and discussion here. -GTBacchus(talk) 00:43, 20 March 2007 (UTC)
thread_title: Requested name change

message: Prescription pain killers are widely used and for most people who use them, especially those who suffer with chronic pain, they are extremely effective and necessary for them to live a pain free and productive life. It is when these narcotics are abused and used for non-medical purposes that it creates a problem. The effects on the brain from long term use of opioids range from acute sensory effects such as blurred vision or impaired judgement, to extreme effects such as respiratory depression or cardiac arrest. The brain controls the addiction by becoming dependant on the drugs and also by creating a tolerance to the drugs which forces the addict to increase drug usage. Even after the addict has stopped using the opioids, the brain can still create urges and cravings making it hard for the addict to stay away from the drugs.  —Preceding unsigned comment added by Gigi1123 (talk • contribs) 02:14, 25 April 2008 (UTC)
thread_title:  Effects on the brain 

message: The American Psychiatric Association has not released its Diagnostic and Statistical Manual of Mental Disorders into public domain, but claims copyright. The Wikimedia Foundation has received a letter of complaint (Ticket:2010030910040817, for those with access) about the use of their diagnostic criteria in this and a number of other articles. Currently, this content is blanked pending investigation, which will last approximately one week. Please feel free to provide input at the copyright problems board listing during that time. Individuals with access to the books would be particularly welcome in helping to conduct the investigation. Assistance developing a plan to prevent misuse of the APA's material on Wikipedia projects would also be welcome. Thank you.  Moonriddengirl (talk) 14:24, 11 March 2010 (UTC)
replies: text: I am curious about what the outcome is/was of this "ticket"/complaint, as of today. Although I have never used a DSM to gain material for an article on Wikipedia I am one of those who has access to a DSM. I guess I want to be clear about what this is meaning. Does this mean that someone used the information and did not give proper credit to the publisher of the DSM or does this mean that even with proper credit no one is allowed to use any of the information in the DSM? Just curious. Thank you. TattØØdẄaitre§ 23:59, 10 June 2013 (UTC)
replies: text: Hmmm, perfect example of i should research before I ask a question. I followed the link and I do see that all issues have been resolved changed reworded etc however I do still have a question as to exactly what the violation was. Can we use the info from a DSM if we credit right? TattØØdẄaitre§ 00:36, 11 June 2013 (UTC)
replies: text: Put it in your own words, adding some variant of "According to the DSM [insert current version here]...". I dream of horses (T) @  04:13, 11 June 2013 (UTC)
replies: text: Ok Thank You TattØØdẄaitre§ 04:34, 11 June 2013 (UTC)
thread_title: Copyright problems with diagnostic criteria

message: The below refs were listed in reference section but not as inline citations in the article body, so it is not clear which were simply dumped random and which if any were used to write article content. So I have moved them here. If anyone wants to take the time to reference them that would be great.
* Volkow N. What do we know and what don't we know about opiate analgesic abuse? Keynote address, Wednesday, March 30, 2005. Program and abstracts of the 24th Annual Scientific Meeting of the American Pain Society; March 30-April 2, 2005; Boston, Massachusetts.
*
*
*
*
*
* Narcotic & Psychotropic Drugs: Achieving Balance in National Opioids Control Policy © World Health Organization, 2000.
* Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision 2002.
* WHO Expert Committee on Addiction-Producing Drugs, Thirteenth Report, World Health Organization Technical Report Series No. 273. Geneva: World Health Organization, 1964.
* WHO. 5th Review of Psychoactive Substances for International Control. Geneva: World Health Organization, November 16-20, 1981.
* NIDA. Trends in Prescription Drug Abuse 2006.
* 
*
* Use of Essential Narcotic Drugs to Treat Pain is Inadequate, Especially in Developing Countries. International Narcotics Control Board (INCB), Annual Report, 3 March 2004.
*
*
Thanks.--Literaturegeek | T@1k? 23:42, 31 May 2010 (UTC)
thread_title: Refs

message: Many sources I have run across in general research indicate that there is a significant effort to get the general public to distinguish between physical dependency, characterised by physical symptoms when use is discontinued, and addiction, characterized by drug-seeking behaviors and continued use despite negative consequences.  Advocacy groups for both recovering addicts and patients who use medications known to cause physical dependency have both done a great deal of work to separate the two in the minds of the general populace, but this entry (and possibly the diagnostic criteria it discusses) conflates the two. This may be why the article is not getting much love.  My vote would be to absorb it into the larger article as a specific reference to a particular diagnosis associated with the larger problem.  Nightsmaiden (talk) 10:19, 30 July 2010 (UTC)
thread_title:  Possible Reason for the Un-Love 

message: I am curious about the section titled 12 step support groups. I am going to attempt to add more sources... but I am wondering if this section should really be here. There are other articles that specifically talk about addiction and what the 12 step programs are used for.
Dependence (on any drug not just Opioid) has two factors and is the progressive need for the drug that results from the use of that drug
:1. The need creates psychological and physical changes
::A. Psychological dependence occurs when a user needs the substance to feel normal or to function adequately in normal daily activities 
::B. Physical dependence occurs when the body adapts to the substance and needs increasing amounts to ward off the effects of withdrawal
The "addiction" part and therefore the need for a 12-step program to stop using the drug is a separate issue. Someone can use the drug and be dependent on it but not be addicted to it. Am I making sense? Just because a person suffers from withdrawals (which is the physical factor) when they stop using the drug, does not make them an addict (Psychological and Physical factors). 
Any thoughts would be appreciated. TattØØdẄaitre§ 23:47, 10 June 2013 (UTC)
replies: text: Yes, I pretty much agree with you on all of that. It's always seemed a little strange to me to have that section on 12 steps here. Perhaps we should shorten it according to WP:Summary style, and if so, I'd be happy to help doing that. Someone can be physically dependent (as someone on methadone would be), and still be able to function constructively in society, so it becomes a matter of opinion whether one would want to call such a person "addicted" in the same way that someone on heroin (for example) might be. --Tryptofish (talk) 20:07, 11 June 2013 (UTC)
replies: text: Hmmm, so I wonder what we do now? Since we both agree maybe there are others that would think so too? I am rather new at all this stuff so not sure what the next step would be for us to request to have that section removed or shortened as you suggest. Or do we just do it? I thank you for your input for sure. TattØØdẄaitre§ 04:31, 12 June 2013 (UTC)
replies: text: I've been at this a long time, and it's pretty much a matter of WP:BEBOLD. I'd like to give it another day or so, just in case someone else drops by and has a different view, and then either you or I can go ahead and do it. (If someone complains later, which is highly improbable, it can always be undone.) --Tryptofish (talk) 19:16, 12 June 2013 (UTC)
replies: text: Thank you sounds good. TattØØdẄaitre§ 20:22, 12 June 2013 (UTC)
replies: text: . --Tryptofish (talk) 20:07, 18 June 2013 (UTC)
thread_title:  opioid dependence 2 factors 

message: As much as we like to think professionals don't look to wikipedia for factual information, they do. For methadone the length of typical withdrawal is about 30days same for bupe. Spreading misinformation (be it cited or not from a professional source) is going to seriously hurt some people. Typical time frames for short acting opiods can be as short as 2 or 3 days (especially if a taper is involved) to 7 to 10 days and even beyond depending on a lot of factors. Actually from your own source "Methadone, for example, has a half-life of anywhere from 15 to as long as 60 hours, with an average half-life of approximately 24 hours. For a daily user of methadone, withdrawal symptoms will begin to be felt within 24-48 hours of last methadone exposure. The physical withdrawal for methadone can last up to 4 weeks or longer, with symptoms of withdrawal reaching their peak around the 7-10 day mark. ". One other thing, change the image on the page, for those going through withdrawal that's a trigger image. This one is just saying "guys be respectful" more then anything else.  — Preceding unsigned comment added by 71.199.64.166 (talk) 10:56, 31 October 2014 (UTC)
replies: text: As far as I can tell, the website cited as a source for that information does not meet the WP:MEDRS criteria. Regarding the image: please see WP:NOTCENSORED. -- The Anome (talk) 23:29, 31 October 2014 (UTC)
replies: text: Please see also a discussion that I started at WT:PHARM#"Trigger image" at Opioid dependence. --Tryptofish (talk) 23:31, 31 October 2014 (UTC)

text: Agree the source clearly does not meet standards for medical information sources. It needs to stay out unless a better source can be found, e.g. a meta analysis, professional medical association treatment guideline, or review.Formerly 98 (talk) 23:34, 31 October 2014 (UTC)
thread_title: Opiod Withdrawal Timeframes and remove trigger image

message: Back at the start of April, I boldly redirected the Opioid replacement therapy (ORT) article after having merged it here in the Management section.  You can see this in the history; it was part of a larger effort to consolidate and synchronize the various bits of content we had on this that were scattered across several WP articles. 
Am opening this now as User:Bpmcneilly has left a very civil message on my talk page suggesting that the ORT article be recreated.  I don't see much use in that, as the content all seems to fit very comfortably here, but am happy to discuss to hear what advantages there are in a re-split of ORT (or undoing the merge, as it were).  And of course get others' take on this.  Jytdog (talk) 03:38, 2 May 2016 (UTC)
replies: text: NB: should have originally noted that the ORT article looked like this before the merger. Jytdog (talk) 04:23, 2 May 2016 (UTC)

text: I honestly don't think the management section is long enough to merit making an independent article for ORT. Seppi333 (Insert 2¢) 03:48, 2 May 2016 (UTC)
replies: text: So, my argument for re-adding the ORT article is that the space in this article deals specifically with medications as an option for those dealing with opioid use. The ORT article would serve as a space to both discuss what is mentioned here (the physical options for drugs used) as well as legal differences across jurisdictions and academic / clinical arguments in favor of or against the use of this method of treatment. I think the latter two are out of scope the way the current article is structured. the former ORT article included data about effectiveness from the WHO, various examples of where ORT is practiced and the differences between them, thigns of that nature. Bpmcneilly (talk) 04:10, 2 May 2016 (UTC)
replies: text: That's interesting.  Some of that content was already in the former article and indeed came over here (like the WHO recommendation and discussion of effectiveness, and where it is done; that stuff is not gone).  The detail on legal/jurisdictional stuff as well as the philosophical debates  could well go into a Society and Culture section here, which is now lacking.  If that gets too big we could discuss at that time what WP:SPLIT would be appropriate... Jytdog (talk) 04:23, 2 May 2016 (UTC)
replies: text: agree could go into Society and Culture section --Ozzie10aaaa (talk) 13:18, 2 May 2016 (UTC)
replies: text: Agree improve and expand here. If it becomes to big than split. Doc James (talk · contribs · email) 20:16, 2 May 2016 (UTC)
replies: text: Agree that split should only occur if/when size permits. Yobol (talk) 14:20, 3 May 2016 (UTC)
thread_title:  Merge/redirect of [[Opioid replacement therapy]] 

message: I just ran Earwig's Copyvio Detector() on this article and it scores 51.9% against http://whqlibdoc.who.int/unaids/2004/9241591153_eng.pdf and 47.6% against http://www.who.int/substance_abuse/activities/treatment_opioid_dependence/en/index.html . I see paragraphs in common with only minor differences. Do we have a problem here? --DanielRigal (talk) 17:34, 28 August 2016 (UTC)
replies: text: Thanks for pointing that out. I did some better paraphrasing and  reduced those numbers. Jytdog (talk) 09:10, 29 August 2016 (UTC)
thread_title:  Copyright Problems 

message: ... of primary care based models. doi:10.7326/M16-2149 JFW | T@lk 22:50, 5 December 2016 (UTC)
thread_title:  Scoping review 

message: Hi All,
I am a 4th year medical student at the University of California, San Francisco. As part of an elective I will be editing this article over the next few weeks.
Focussing predominantly on the lead page followed by symptoms of withdrawal, diagnosis, and management:
-	Ensure readability, break down jargon, shorten sentences if need be
-	Add links to other Wikipedia articles
-	Review/add citations
-	If time permits, I would like to add a section about opioid intoxication and a brief note on causes of opioid related deaths
Happy for any feedback.  — Preceding unsigned comment added by Chey.snav (talk • contribs) 19:48, 2 March 2017 (UTC)
replies: text: Please do not focus primarily on the lead.  The lead just summarizes the body.  Please focus first on the body, and once that is well sourced and NPOV and covers the sections described in WP:MEDMOS, then  - and only  then - consider the lead, revising it as necessary per WP:LEAD.  Please note that the Translation task force often just translates the lead, so please make sure the complete citation for each ref used in the lead, is in the lead.  Thanks. Jytdog (talk) 20:31, 2 March 2017 (UTC)
replies: text: Welcome, we'll be happy to see your contributions! If you can better summarize the article please do improve the lead. But Jytdog is right that effort might be better placed on improving the body. If you're adding content it should be first added to the body and then (possibly) summarized in the lead. Sizeofint (talk) 03:51, 3 March 2017 (UTC)

text: There is always WP:BRD but if you think a change is likely going warrant discussion it certainly does not hurt to open a discussion here first. Sizeofint (talk) 19:40, 15 March 2017 (UTC)
replies: text: Incidentally, you can sign your comments using four tildes after your post like ~~~~. Sizeofint (talk) 19:41, 15 March 2017 (UTC)

text: I hope all the action on this page hasn't scared you off :). Sizeofint (talk) 06:12, 30 March 2017 (UTC)
thread_title:  WikiProject Medicine 

message: It seems like you have missed out classification, which is supposed to be the first section. zzz (talk) 03:41, 15 March 2017 (UTC)
replies: text: Sure. Is their a classification of OUD? Also I am "Doc James" not "DocJames" Doc James (talk · contribs · email) 04:08, 15 March 2017 (UTC)
thread_title:  Order 

message: How should we define OUD in the first sentence of the article. The ref from the CDC says:
"A problematic pattern of opioid use that causes clinically significant impairment or distress."
Doc James (talk · contribs · email) 06:45, 28 March 2017 (UTC)
thread_title: RfC regarding the definition

message: Paraphrase it as "a medical condition characterized by a pattern of opioid use which results in negative consequences."
*Support as written in language more suitable for a general audience.Doc James (talk · contribs · email) 06:45, 28 March 2017 (UTC)
thread_title: Option 1

message: Use it verbatim "a medical condition characterized by a problematic pattern of opioid use that causes clinically significant impairment or distress."
*Support - it's not a butchered definition.  Seppi333 (Insert 2¢) 07:03, 28 March 2017 (UTC)
thread_title: Option 2

message: Are we aiming to clarify what the cited source says, or what we think its writer meant? If we suspect they're different, we should avoid interpretation and use a direct quote. (I have an unrelated problem in parsing either definition: is it the "condition", or the "pattern", or the "use" that results/causes ...etc."?) Maproom (talk) 08:07, 30 March 2017 (UTC)
thread_title:  Discussion 

message: Wondering if more information should be added to signs and symptoms, ie. withdrawal symptoms mimic Flu-like symptoms Shenurse512 (talk) 03:09, 24 June 2017 (UTC)
thread_title:  Additional signs and symptoms 

message: This is OR - we really need reviews.  The last one is also not accurate - the one person (!) took the whole herb not an extract. 
;Research
Each of these treatments is experimental, and some remain quite far from having been proven to be effective:
*Clonidine
*Dextromethorphan
*Ibogaine
*Ketamine
*Mitragynine
 
-- Jytdog (talk) 04:06, 24 June 2017 (UTC)
replies: text: Agree we need reviews. So support trimming. Doc James (talk · contribs · email) 03:09, 25 June 2017 (UTC)
thread_title:  reviews needed 

message: I do not feel that this section is adequate.  Something more like this would be better.  
"Brain abnormalities resulting from chronic use of heroin, oxycodone, and other morphine-derived drugs are underlying causes of opioid dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and addiction (intense drug craving and compulsive use). The abnormalities that produce dependence, well understood by science, appear to resolve after detoxification, within days or weeks after opioid use stops. The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. They may involve an interaction of environmental effects—for example, stress, the social context of initial opiate use, and psychological conditioning—and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid dependent." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/  Gandydancer (talk) 03:42, 16 July 2017 (UTC)
thread_title:  "Cause" section 

message: 12-step Program:
The 12 Step Program is an adopted form of the Alcoholics Anonymous program. The program strives to help create behavioral change by fostering peer-support and self-help programs. In recent years, this program has been implemented by the Narcotics Anonymous support group. The model helps assert the gravity of addiction by enforcing the idea that addicts must surrender to the fact that they are addicted and to be able to recognize the problem. It is also helps maintain self control and restraint to help promote one's capabilities. 
::These details belong on the sub page about 12-Step programs IMO and are overly detailed here. Doc James (talk · contribs · email) 19:53, 1 November 2017 (UTC)
thread_title: Edit 1:

message: Cognitive Behavioral Therapy:
While there are many ways to manage opioid use disorder, cognitive behavioral therapy (CBT), a form of psychosocial intervention that is used to improve mental health, may not be as effective as other forms of treatment. CBT primarily focuses on an individual's coping strategies to help change their cognition, behaviors and emotions about the problem. This intervention has demonstrated success in many psychiatric conditions (eg. depression) and substance use disorders (eg. tobacco). However, the use of CBT alone in opioid dependence has declined due to the lack of efficacy and many are relying on medication therapy or medication therapy with CBT since it was found to be more efficacious than CBT alone.
::WHat is the page number for the first source? We do not generally use blogs. Please read WP:MEDRS Doc James (talk · contribs · email) 19:53, 1 November 2017 (UTC)
replies: text:  I changed and updated the correct sourcing for the CBT section.Jurjy (talk) 00:11, 7 November 2017 (UTC)
replies: text:  The fourth reference is a primary literature of a randomized controlled trial. The original research has potential risk of misuse and misinterpretation and thus not recommended in Wikipedia article as a reliable source. Also this article does not seem to be freely accessible. Yeonbi0705 (talk) 04:35, 8 November 2017 (UTC)
thread_title: Edit 2:

message: Naloxone:
Naloxone is a mu-opioid receptor antagonist that is used for emergency reversal of opioid overdosehttp://www.crlonline.com/lco/action/doc/retrieve/docid/patch_f/7338#f_pharmacology-and-pharmacokinetics. It can be administered by many routes (intramuscular, intravenous, subcutaneous, intranasal, and inhalation) and acts very quickly by kicking off and replacing opioids from the opioid receptors. Since this is a life-saving medication, many states have implemented Standing Orders for law enforcement to carry and administer Naloxone as neededhttps://www.fda.gov/downloads/Drugs/NewsEvents/UCM454810.pdf. http://naloxoneinfo.org/case-studies/standing-orders  
In addition, naloxone could be used to challenge a patient's opioid abstinence status prior to starting a medication such as naltrexone, which is used in the management of opioid addictionhttp://www.nejm.org/doi/full/10.1056/NEJMra1604339#t=article.
Vreddy9 (talk) 17:30, 2 November 2017 (UTC)
replies: text:  I'm satisfied with the revised version of the text for this edit; if Vreddy9 finds it acceptable and wants to use it in the article, I'd be okay them adding it. However, I still need to get feedback from this student about the http://www.crlonline.com/lco/action/doc/retrieve/docid/patch_f/7338#f_pharmacology-and-pharmacokinetics reference since I'm not sure if it's MEDRS-quality (it probably is) and the citation is still a bare url. If that reference were replaced with the HMDB citation that I provided above and this ref or these Rx info citations, the revised version of this student's edit could be used right now. Seppi333 (Insert 2¢) 00:11, 4 November 2017 (UTC)
thread_title: Edit 3:

message: Naltrexone is an opioid receptor antagonist. It works by blocking the physiological effects of opioids and thereby preventing euphoria from opioid use. Non-compliance with naltrexone is a concern for oral formulations because of its daily dosing [63]. The alternative intramuscular injection has better patient compliance due to its monthly dosing. Naltrexone monthly IM injections (Vivitrol®) received FDA approval in 2010 for indication of use in patients with opioid dependence but not current opioid users [64].
https://www.ncbi.nlm.nih.gov/books/NBK64042/
http://www.annualreviews.org.ucsf.idm.oclc.org/doi/pdf/10.1146/annurev-pharmtox-010617-052534
https://www.vivitrol.com
https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021897s015lbl.pdf
Umordi (talk) 17:27, 2 November 2017 (UTC)
replies: text: I'll provide some feedback on this proposed edit in a few hours. Need to log off for now. Seppi333 (Insert 2¢) 20:24, 2 November 2017 (UTC)
replies: text:  I read through the references you listed and added them to the appropriate sentences in my suggested changes to your edit.  I also added the Cochrane review on naltrexone that's currently cited in the article to your edit.  If you're satisfied with my changes and want to use my revised version, feel free replace the existing content in Opioid use disorder#Naltrexone with it at any time. Seppi333 (Insert 2¢) 23:13, 3 November 2017 (UTC)

text:  I'm perfectly satisfied with both the revised wording and the references that were provided for this proposed edit.  If Umordi wants to replace the entire Opioid use disorder#Naltrexone section with the revised wikitext in the first collapse tab above, I'd approve of that. Seppi333 (Insert 2¢) 23:13, 3 November 2017 (UTC)
replies: text: If you are satisfied then make the edit. I am not a fucking TA. Jytdog (talk) 23:18, 3 November 2017 (UTC)
replies: text: The only reason I pinged you is because you've been reverting their edits.  My intent was to inform you that I've checked the sourcing and the text is accurate. Its their assignment, so I'm not going to do it for them. Seppi333 (Insert 2¢) 00:14, 4 November 2017 (UTC)
replies: text: sorry i was in a very very bad mood that night and should not have been editing. Jytdog (talk) 19:04, 6 November 2017 (UTC)
replies: text: NO! copied from the Vivitrol source being used as a ref here: page 11 There is also the possibility that a patient who is treated with VIVITROL could overcome the opioid blockade effect of VIVITROL. Although VIVITROL is a potent antagonist with a prolonged pharmacological effect, the blockade produced by VIVITROL is surmountable. This poses a potential risk to individuals who attempt, on their own, to overcome the blockade by administering large amounts of exogenous opioids. Any attempt by a patient to overcome the antagonism by taking opioids is very dangerous and may lead to fatal overdose. Injury may arise because the plasma concentration of exogenous opioids attained immediately following their acute administration may be sufficient to overcome the competitive receptor blockade. As a consequence, the patient may be in immediate danger of suffering life-endangering opioid intoxication (e.g., respiratory arrest, circulatory collapse). Patients should be told of the serious consequences of trying to overcome the opioid blockade same with naloxone/natrexone. We should NOT say that there is a complete "blocker" because that is not correct and could be dangerous misinformation. TeeVeeed (talk) 00:07, 9 November 2017 (UTC)
replies: text: All reversible competitive antagonists are surmountable, so surmountability is implied by the current text; however, I suppose something explicit about the surmountability of naltrexone and naloxone can be added.  addressing this issue would actually require stating that it's a reversible competitive antagonist, although not necessarily in the first sentence. Seppi333 (Insert 2¢) 07:29, 9 November 2017 (UTC)
replies: text: Is it being surmountable of clinical importance? Doc James (talk · contribs · email) 07:34, 9 November 2017 (UTC)
replies: text: Yes.  One can OD on a selective agonist after being given a high dose of a surmountable antagonist, but not an insurmountable antagonist. In this context, it means one can still OD on opioids while under the effects of naltrexone/naloxone. Seppi333 (Insert 2¢) 07:45, 9 November 2017 (UTC)
thread_title:  Edit 4: Naltrexone Section  

message: We are students from UCSF School of Pharmacy (Alisha V, Ashley Y, Mindy Y, Victoria S). We plan on contributing, editing, and making improvements on the following sections in the Opioid use disorder Wikipedia page:
- Management: We would like add to this section be creating a subsection called “Pharmacy Involvement” where we discuss how pharmacists can play a large role in dispensing opioid addiction treatment medications and assisting patients in recovery and discuss some advantages of pharmacy involvement
- Epidemiology: We would like to update information on opioid use disorder in US, update data on opioid use and opioid use disorder in San Francisco.
- Prevention: We would like to expand on obtaining naloxone kit, who can administer, naloxone training, pharmacy involvement, insurance coverage, drug abuse hotline.  — Preceding unsigned comment added by Avucsf (talk • contribs) 18:46, 16 October 2018 (UTC)
thread_title:  Pharmacy Students: Proposed Wiki Edits 

message: SP, WY, AN, BP 
* Clarify FDA-approved treatments for OUD vs harm reduction strategies (HAT/diamorphine are the same things)
* Include mechanism of action/pros/cons of each FDA-approved medication. 
* Epidemiology: prevalence of opioid use disorder among incarcerated and statistics regarding opioid overdose and drug related crime.
* Prevention: adding strategies for providers to reduce opioid prescribing patterns in order to reduce development of opioid use disorder   — Preceding unsigned comment added by Pharmacy9876 (talk • contribs) 17:11, 1 November 2018 (UTC)
replies: text: One does not need to state something is FDA approved. That is a USA thing. We are a global encyclopedia. Doc James (talk · contribs · email) 01:06, 2 November 2018 (UTC)
thread_title:  Proposed Edits 

message: Pharmacists can have the ability to play a larger role in managing medications for patients who experience opioid abuse. With flexible hours and increasing involvement in the community, pharmacists can become more involved with handling the paperwork required for opioid addiction treatment that physicians currently process. In addition, they are able to hold patients accountable to take their medications. 
::This is not really appropriately worded for a global encyclopedia. Also please read WP:MEDMOS Doc James (talk · contribs · email) 01:06, 2 November 2018 (UTC)
replies: text: Are you wanting to discuss daily observed taking of opioids? That would be useful as done in many places. Doc James (talk · contribs · email) 17:31, 20 November 2018 (UTC)
thread_title: Pharmacy Involvement

message: Group 8 did a wonderful job with their edits in terms of consistent formatting with Wikipedia's manual of style. They added information about the "Five-Point Opioid Strategy" by first introducing what it was and then describing some of the efforts that are included under this strategy in a list format that was very easy to follow. Wikipedia supports writing that is easy to follow and understandable by all populations of people, and I feel that these edits were appropriate. The grammar, spelling, and punctuation were also correct. There was no ambiguity, jargon, or vague or unnecessarily complex wording. Jennifershieh (talk) 02:46, 7 November 2018 (UTC)
thread_title:  Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify… 

message: Generally, the edits made seem to have verifiable secondary sources. Most sentences I reviewed included reputable journal articles/governmental resources etc cited right after it. The only thing I want to highlight was that I saw an edit addressing the US administration declaring a “Five Point Opioid Strategy”. While the explanation was clear, I think it would be important to cite a reference for that piece. 
Kathyle29 (talk) 02:55, 7 November 2018 (UTC)
thread_title:  Are the points included verifiable with cited secondary sources that are freely available? If not, specify. 

message: For the most part, Group 8's draft submission reflected a neutral point of view. Group 8 added important and objective facts to the page. The addition of "pharmacy involvement" sounded too anecdotal and I got the impression that the writer was advocating for pharmacists and what they could/should do. I would consider rewording it to be more objective or adding more information about the role of healthcare as a whole in opioid use disorder.
Eyang92 (talk) 02:57, 7 November 2018 (UTC)
thread_title:  Does the draft submission reflect a neutral point of view? If not, specify… 

message: I did not detect any evidence of plagiarism or copyright violation. I believe Group 8 did an amazing job of using reputable sources, as well as re-writing concepts in their own words. They clearly put a lot of time into creating edits that greatly added to this Wikipedia article. Within the sections that this group edited, there were no statements that citations were needed.  — Preceding unsigned comment added by Cindynguyeen (talk • contribs) 06:15, 7 November 2018 (UTC)
thread_title:  Is there any evidence of plagiarism or copyright violation?  

message: Group 2
• Does the draft submission reflect a neutral point of view? If not, specify…
  The edits done by Group 18 are fairly neutral for the most part. One statement stuck out to me that had a slight bit of bias which was the one that stated that more research needs to be done in order to determine if dihydrocodeine can be utilized as an effective opioid addiction treatment. Otherwise I would say their statements stuck to the facts and showed very little opinion. Ranaran35 (talk) 01:53, 8 November 2018 (UTC)
replies: text: - I did not find any evidence of plagiarism within the UCSF students' edits. Chellefsh (talk) 02:38, 20 November 2018 (UTC)
thread_title:  UCSF CP133 Pharmacy Student Peer Reviews 

message: This is not true globally "Physicians, nurse practitioners, and physician assistants can only prescribe buprenorphine for OUD if they receive special training on the medication, receive a DATA 2000 waiver, and get a unique DEA number. Currently, these restrictions are only required if buprenorphine is being used to treat OUD. They don't apply if buprenorphine is being used for pain management. " plus it is unreferenced. Belongs on the subpage and needs to state it only applies in the USA. Doc James (talk · contribs · email) 17:28, 20 November 2018 (UTC)
replies: text: Always bad to use the word "currently". Better to state a specific date. What happens 5 years from know when the rules change? Doc James (talk · contribs · email) 17:36, 20 November 2018 (UTC)
thread_title: Global encyclopedia

message: Jamie,
Thank you for contributing to an article that is extremely pertinent to public health in this country today. It is important that facts and statistics on this issue stay up-to-date and accurate, and your contribution of naloxone stats does just that. As far as general improvements, I think that this article could use more information on the outward signs of this disorder, as well as on the diagnostic process. For instance, several of the signs and symptoms are vague and limited (i.e. "legal or social ramifications secondary to drug use"), and the Diagnosis section does not specify who can make a diagnosis or under what clinical circumstances can a diagnosis be made. Just a few thoughts.
Keep up the good work!
Alexyoung339 (talk) 00:58, 18 February 2019 (UTC)
thread_title:  Peer Review 

message: There should be more information on the gender differences.
Research has noted that women are just as likely as men to develop a substance use disorderAnthony JC, Warner LA, Kessler RC. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol. 1994;2(3):244-268. doi:10.1037/1064-1297.2.3.244. It is noted that men are more likely to die from prescription opioids, however from 1999-2016, the deaths due to prescription opioid overdoses increase rapidly increased in womenCenters for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death, 1999-2016 on CDC WONDER Online Database, released 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. https://wonder.cdc.gov/mcd-icd10.html. Published 2017. . Some studies have noted that women versus men have greater sensitivity to painRiley JL, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain. 1998;74(2-3):181-187. and a higher chance for chronic painGerdle B, Björk J, Cöster L, Henriksson K, Henriksson C, Bengtsson A. Prevalence of widespread pain and associations with work status: a population study. BMC Musculoskelet Disord. 2008;9:102. doi:10.1186/1471-2474-9-102. Thus, this may contribute to high rates of opioid prescriptions in womenAiles EC, Dawson AL, Lind JN, et al. Opioid prescription claims among women of reproductive age--United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2015;64(2):37-41.. Additionally, research has suggested that women are more likely to misuse to self-treat other problemsMcHugh RK, Devito EE, Dodd D, et al. Gender differences in a clinical trial for prescription opioid dependence. J Subst Abuse Treat. 2013;45(1):38-43. doi:10.1016/j.jsat.2012.12.007.
Hnguyc (talk) 04:53, 28 April 2019 (UTC)
thread_title:  Gender Differences 

message: This is where you will complete your peer review exercise. Please use the following template to fill out your review.
=== General info ===
* I am reviewing RedStorm1 article on opioid use disorder
* Link to draft you're reviewing: Opioid use disorder
=== Lead ===
Guiding questions:
* Has the Lead been updated to reflect the new content added by your peer? The most recent data is from 2016 which I believe is up to date. It has good recent statistics to show the importance of opioid use disorder. 
* Does the Lead include an introductory sentence that concisely and clearly describes the article's topic? Yes it does. The article clearly states what it is going to be discussing being opioid use disorder and introduces the idea of the problems that patients face with this issue. 
* Does the Lead include a brief description of the article's major sections? I think this lead section does a great job introducing all of the sections. Granted the lead does not go into detail, but it does include everything that is going to be discussed later such that you know what aspects of the disorder you will learn about. 
* Does the Lead include information that is not present in the article? No, as stated previously the lead section I think does a very good job essentially indexing everything that will be discussed in the article. 
* Is the Lead concise or is it overly detailed? Since everything is included in the lead section, I believe there could be some portions that can be cut down. For instance for the diagnosis you can limit that section to just state that it is a DSMV diagnosis, and then go into further detail in that section of the article. I also believe you do not need to go through each symptom since you discus it later. 
==== Lead evaluation: ====
As stated above the lead section is extremely good. I believe that the information provided does a great job detailing what the article is going to be discussing. However, since you do have a history tab dating back to the origins of opioid use I would mention some of that at the beginning of the lead section. I also believe the information is up to date however there might be more recent data now. Lastly, I would cut down on some of the details currently in the lead section. Since you do go over all of the aspects that you are discussing in the article, I believe you can cut down on some information as stated above. As it is the lead section is very good, but if you cut down on some information and add more recent data with some information about the history this will be a great lead section.JacksLog (talk) 17:33, 7 December 2019 (UTC)
thread_title:  Peer review 

message: Guiding questions:
* Has the Lead been updated to reflect the new content added by your peer? The most recent data is from 2016 which I believe is up to date. It has good recent statistics to show the importance of opioid use disorder. 
* Does the Lead include an introductory sentence that concisely and clearly describes the article's topic? Yes it does. The article clearly states what it is going to be discussing being opioid use disorder and introduces the idea of the problems that patients face with this issue. 
* Does the Lead include a brief description of the article's major sections? I think this lead section does a great job introducing all of the sections. Granted the lead does not go into detail, but it does include everything that is going to be discussed later such that you know what aspects of the disorder you will learn about. 
* Does the Lead include information that is not present in the article? No, as stated previously the lead section I think does a very good job essentially indexing everything that will be discussed in the article. 
* Is the Lead concise or is it overly detailed? Since everything is included in the lead section, I believe there could be some portions that can be cut down. For instance for the diagnosis you can limit that section to just state that it is a DSMV diagnosis, and then go into further detail in that section of the article. I also believe you do not need to go through each symptom since you discus it later. 
==== Lead evaluation: ====
As stated above the lead section is extremely good. I believe that the information provided does a great job detailing what the article is going to be discussing. However, since you do have a history tab dating back to the origins of opioid use I would mention some of that at the beginning of the lead section. I also believe the information is up to date however there might be more recent data now. Lastly, I would cut down on some of the details currently in the lead section. Since you do go over all of the aspects that you are discussing in the article, I believe you can cut down on some information as stated above. As it is the lead section is very good, but if you cut down on some information and add more recent data with some information about the history this will be a great lead section.JacksLog (talk) 17:33, 7 December 2019 (UTC)
thread_title:  Lead 

message: As stated above the lead section is extremely good. I believe that the information provided does a great job detailing what the article is going to be discussing. However, since you do have a history tab dating back to the origins of opioid use I would mention some of that at the beginning of the lead section. I also believe the information is up to date however there might be more recent data now. Lastly, I would cut down on some of the details currently in the lead section. Since you do go over all of the aspects that you are discussing in the article, I believe you can cut down on some information as stated above. As it is the lead section is very good, but if you cut down on some information and add more recent data with some information about the history this will be a great lead section.JacksLog (talk) 17:33, 7 December 2019 (UTC)
thread_title:  Lead evaluation: 

message: Guiding questions:
* Is the content added relevant to the topic? Yes it is you discuss everything that should be included for opioid use disorder. However, I would add some information specifically elaborate on the symptoms of overdose and how that is treated.
* Is the content added up-to-date? Yes it is.
* Is there content that is missing or content that does not belong? As stated earlier I would go over more on the treatment of overdose and rather than listing the symptoms discuss when these symptoms are present how do you treat.
==== Content evaluation ====
I believe that there are portions of the content section that can have elaboration. The data that is present is very good, but there is still a little more that I would like added. As stated before I believe there should be more information on the treatment for opioid overdose, and how to spot it. As well as how successful that treatment is in the section discussing overdose rather than just a slight mention in deaths. There should also be more on overdose in the mechanism section since it does play a prevalent role in opioid use disorder. With those changes I believe that the content section will be much improved. I do like the fact there is information on the receptors as well. JacksLog (talk) 17:52, 7 December 2019 (UTC)
thread_title:  Content 

message: I believe that there are portions of the content section that can have elaboration. The data that is present is very good, but there is still a little more that I would like added. As stated before I believe there should be more information on the treatment for opioid overdose, and how to spot it. As well as how successful that treatment is in the section discussing overdose rather than just a slight mention in deaths. There should also be more on overdose in the mechanism section since it does play a prevalent role in opioid use disorder. With those changes I believe that the content section will be much improved. I do like the fact there is information on the receptors as well. JacksLog (talk) 17:52, 7 December 2019 (UTC)
thread_title:  Content evaluation 

message: Guiding questions:
* Is the content added neutral? In the content section it is. However, there is some negative connotation in the lead section. Even though there are statements that have citations, I feel that some of the wording makes it feel like the writer had negative feelings toward people that have opioid use disorder. However that is only in the lead section.
* Are there any claims that appear heavily biased toward a particular position? No.
* Are there viewpoints that are overrepresented, or underrepresented? No. 
* Does the content added attempt to persuade the reader in favor of one position or away from another? As mentioned above there is a sentence or two that appears to have a negative connotation to it rather than just presenting the facts of opioid use disorder. JacksLog (talk) 17:43, 7 December 2019 (UTC)
thread_title:  Tone and Balance 

message: As mentioned prior I believe the balance is very neutral to the whole article. The article distributes the facts as they are without leading the reader to pick a certain side. However, the lead section does have some negative sentences. To me as a reader it made me believe that there is something personally wrong with the individuals that have opioid use disorder rather than it being a medical problem. If these sentences are changed specifically the opening statement to just present the facts rather than discussing how bad they are it will be more neutral.JacksLog (talk) 17:49, 7 December 2019 (UTC)
thread_title:  Tone and balance evaluation 

message: Guiding questions:
* Is all new content backed up by a reliable secondary source of information? Yes however I believe the newspaper articles can be removed since they are secondary to other more reliable sources.
* Are the sources thorough - i.e. Do they reflect the available literature on the topic? Yes there are good sources, but there is a mixture of unreliable sources that can be removed. I feel they do not add much to the article.
* Are the sources current? Yes there are up to date sources to mix with older sources, but I believe there is enough current sources to make me believe the information is up to date.
* Check a few links. Do they work? Yes
==== Sources and references evaluation ====
Overall I like the amount of sources utilized in this article. Granted the sources like the New York Times does not add anything to the article and could be removed. There is also many sources utilized and therefore not all are the best, but there is enough meta analysis and books to show the information is reliable. I also feel that there is enough up to date sources to show the information has been updated to counteract the sources that are from the early 2000s. JacksLog (talk) 17:57, 7 December 2019 (UTC)
thread_title:  Sources and References 

message: Overall I like the amount of sources utilized in this article. Granted the sources like the New York Times does not add anything to the article and could be removed. There is also many sources utilized and therefore not all are the best, but there is enough meta analysis and books to show the information is reliable. I also feel that there is enough up to date sources to show the information has been updated to counteract the sources that are from the early 2000s. JacksLog (talk) 17:57, 7 December 2019 (UTC)
thread_title:  Sources and references evaluation 

message: Guiding questions:
* Is the content added well-written - i.e. Is it concise, clear, and easy to read? Yes
* Does the content added have any grammatical or spelling errors? No
* Is the content added well-organized - i.e. broken down into sections that reflect the major points of the topic? Yes
==== Organization evaluation ====
The main organization change that I would make is adding the opioid overdose information to the mechanism portion. I believe it is a center point to opioid use disorder, and should be added with dependence. I do believe the grammar and spelling is good, and most of the article is very easy to read. The portions on the receptors gets more challenging due to the medical jargon, so if there is any way to simplify that section I would. I also am not sure what sections you added specifically or what you took away, but overall I believe the article is easy to follow and is well organized. I would just make the simple changes stated above. JacksLog (talk) 18:02, 7 December 2019 (UTC)
thread_title:  Organization 

message: The main organization change that I would make is adding the opioid overdose information to the mechanism portion. I believe it is a center point to opioid use disorder, and should be added with dependence. I do believe the grammar and spelling is good, and most of the article is very easy to read. The portions on the receptors gets more challenging due to the medical jargon, so if there is any way to simplify that section I would. I also am not sure what sections you added specifically or what you took away, but overall I believe the article is easy to follow and is well organized. I would just make the simple changes stated above. JacksLog (talk) 18:02, 7 December 2019 (UTC)
thread_title:  Organization evaluation 

message: Guiding questions: If your peer added images or media
* Does the article include images that enhance understanding of the topic? Yes the graphs and the medications
* Are images well-captioned? Yes
* Do all images adhere to Wikipedia's copyright regulations? I believe so
* Are the images laid out in a visually appealing way? Yes 
==== Images and media evaluation ====
The few images that are present do help with the article. I believe the medication images are placed appropriately and help the reader understand what these medications are aka pills and not liquid or a shot. I also believe the graphs do a good job visually showing the epidemiology in the US. JacksLog (talk) 18:04, 7 December 2019 (UTC)
thread_title:  Images and Media 

message: The few images that are present do help with the article. I believe the medication images are placed appropriately and help the reader understand what these medications are aka pills and not liquid or a shot. I also believe the graphs do a good job visually showing the epidemiology in the US. JacksLog (talk) 18:04, 7 December 2019 (UTC)
thread_title:  Images and media evaluation 

message: Guiding questions:
* Has the content added improved the overall quality of the article - i.e. Is the article more complete? Yes
* What are the strengths of the content added? 
* How can the content added be improved? I would remove the negative sounding sentences in the lead section. I would add more to opioid overdose in the mechanism section. I would discuss the epidemiology of the success of using naltrexone for overdose. I would take away some of the sources that are not good sources like the New York Times. I would also add a sentence about the history in the lead section since this is discussed further down. 
==== Overall evaluation ==== 
I am not sure what specifically you added or took away, but I can say that the article is very well done. This article does a good job staying neutral to the topic of opioid use disorder except for the lead section as mentioned above. I also believe the content is very well organized and extremely complete except for the overdose portion that was also mentioned above. I also appreciate the images that were added to the article. Overall I believe this article is very well done. There are a few small changes that I would make as I stated in the above sections of the peer review, but it is a very good article. It is very well cited and can actually have some citations removed since they don't add much. I believe this is a very good article and whatever you did add or take away does flow well within this article.
@JacksLog Thank you for the suggestions! Incorporated as many as possible as we saw fit.--JacksLog (talk) 04:13, 9 December 2019 (UTC)
thread_title:  Overall impressions 

message: I am not sure what specifically you added or took away, but I can say that the article is very well done. This article does a good job staying neutral to the topic of opioid use disorder except for the lead section as mentioned above. I also believe the content is very well organized and extremely complete except for the overdose portion that was also mentioned above. I also appreciate the images that were added to the article. Overall I believe this article is very well done. There are a few small changes that I would make as I stated in the above sections of the peer review, but it is a very good article. It is very well cited and can actually have some citations removed since they don't add much. I believe this is a very good article and whatever you did add or take away does flow well within this article.
@JacksLog Thank you for the suggestions! Incorporated as many as possible as we saw fit.--JacksLog (talk) 04:13, 9 December 2019 (UTC)
thread_title:  Overall evaluation 

message: "Given the more favorable safety profile of buprenorphine and decreased risk of abuse and diversion, there is no need for daily clinic visits and once patients are on maintenance therapy they are spaced out to monthly visits. "
:Were does the reference say this? Doc James (talk · contribs · email) 10:17, 15 May 2020 (UTC)
replies: text: The second bit is an advert. Doc James (talk · contribs · email) 10:17, 15 May 2020 (UTC)
thread_title: New text

message: I propose merging the relatively new article Opioid Withdrawal Syndrome to here, Opioid use disorder, as that connection was suggested by someone on the new article's talk page. After reading over that new article and the discussions on its own talk page, and assessing the many edit tags at the top of that article, I propose that it over-interprets some terminology in the literature in an attempt to form a new scientific term. (See also the rules on original research.) I am not convinced that Opioid Withdrawal Syndrome is a "thing" (as said by someone on that article's talk page) in the scientific literature. That article does have some useful research findings, but not enough to justify an entire new article. I propose merging the verifiable bits to here. ---DOOMSDAYER520 (Talk|Contribs) 15:40, 22 July 2020 (UTC)
replies: text: That's eminently sensible. I wasn't sure if neonatal opioid withdrawal should be separate but the whole babies aren't little people mantra is normally true. PainProf (talk) 19:00, 22 July 2020 (UTC)
replies: text: @PainProf, where do they classify the babies who have opioid problems due to post-birth medical treatment with opioids?  Hopefully that's just a tiny fraction of babies, but it's not like they're going to do major surgery without pain medication on a baby (in this century, anyway *shudder*), and some babies end up in the hospital on these drugs for months. WhatamIdoing (talk) 05:39, 28 July 2020 (UTC)

text: Comment Thanks, I think in looking at this new page, we noticed that the new page as originally written was questionable, but the broader concept is important. This article should discuss Opioid use disorder, which withdrawal can be a component of but withdrawal is not an essential element of Opioid use disorder. The name Opioid withdrawal syndrome is often used as is acute opioid withdrawal, I've personally always called it acute opioid withdrawal but I don't know which is the more common name. In either case they refer specifically to the physiological changes that occur after you suddenly withdraw from Opioids due to physiological adaptation, it is not the same as addiction. In contrast an Opioid use disorder is a problematic pattern of opioid use that leads to physical or emotional distress. It requires multiple elements that aren't always found in opioid withdrawal. Neonatal Abstinence Syndrome or Neonatal withdrawal syndrome is the effects of withdrawal in early neonates. It presents unique challenges due to differences in neonatal physiology. Opioids are different to other drugs in mechanisms of dependence, an article on opioids specifically in neonates may be useful.  PainProf (talk) 22:57, 22 July 2020 (UTC)

text: I can recognise that withdrawal from opioids prescribed for pain does not constitute addiction and so may be out of place on the opioid use disorder page - but perhaps it could still have a home on that page simply in terms of the relevant management and treatment information. I find the details in DSM to be contradictory: one page says it follows heavy and prolonged usage  and another says that it can follow short pain relief treatments. If the page is to stay I would suggest a different page name of just Opioid withdrawal which could cover all aspects without being specific to the disorder/addiction and which would be easily referenced.--Iztwoz (talk) 17:52, 23 July 2020 (UTC)
replies: text:  This is a particularly relevant line: "The last two diagnostic criteria, related to tolerance and withdrawal, are not considered to be met for individuals taking opioids solely under appropriate medical supervision", additionally, there is a detailed explainer from the IASP of why this is the case, https://s3.amazonaws.com/rdcms-iasp/files/production/public/FileDownloads/PCU_21-5_web.pdf, PainProf (talk) 20:09, 23 July 2020 (UTC)
replies: text: Thank you for the link - it's an interesting read. I am inclined to agree with you as previous posting; do you think the change of page name to Opioid withdrawal would be a better fit?--Iztwoz (talk) 20:43, 23 July 2020 (UTC)

text: Agree that seems like right place for a move as it's a more common name. Possibly also a redirect from acute opioid withdrawal another common name.  PainProf (talk) 15:50, 24 July 2020 (UTC)
thread_title:  Merger Proposal (July 2020) 

message: Not asking for a friend, but I read too many strange books. I had no idea what "Naked Lunch" was about, though I'd heard the title many times... It led to Apomorphine which led here which seems to have led nowhere. I'm really curious why there is no mention of "treatment" or "cure" or "recovery" in this article. I'm basically averse to drugs, but it's supposed to be a major social problem these days. A problem without a solution is just the way things are, which is rather bleak, notwithstanding the infamous serenity prayer. I can't imagine that the topic has never been considered as part of the Article, so I guess the real question is why it is excluded? Shanen (talk) 09:53, 17 August 2020 (UTC)
thread_title:  Why no solution approaches? 

message: The section on opioid replacement therapy is terribly written and makes claims and assertions without citation. Methadone should have it's own separate section as well. What's currently there reads like it was copy-pasted from a poorly written treatment service website. — Preceding unsigned comment added by 117.20.69.21 (talk) 00:57, 23 May 2022 (UTC)
thread_title:  Management section poorly written 

message: — Assignment last updated by Ftaylor4 (talk) 15:24, 21 September 2022 (UTC)
thread_title: Wiki Education assignment: Technical and Scientific Communication

message: — Assignment last updated by Kalij94 (talk) 16:18, 31 October 2022 (UTC)
thread_title: Wiki Education assignment: WikiMed Fall 2022

message: — Assignment last updated by DLEMERGEBM (talk) 21:17, 11 January 2024 (UTC)
thread_title: Wiki Education assignment: WikiProject Medicine Winter 2024 UCF COM

message: — Assignment last updated by Caitlincaterinichia (talk) 22:06, 23 May 2024 (UTC)
thread_title: Wiki Education assignment: Psychology Capstone