There is no question that opioid use disorders are a serious problem in the United States. Increasing recognition of the scope of the problem has led to political and policy attention. While evidence-based treatments for opioid dependence are available, they remain difficult to access. Treatments that involve opiate replacement such as methadone are particularly stigmatized.
Psychosis, agitation, disorientation, or bizarre behavior due to drug ingestion is a common presentation to the emergency department (ED), and frequently psychiatry is consulted to assess for an underlying psychiatric illness. A working knowledge of how different substances are expected to affect patients is an important part of keeping up-to-date as a psychiatric emergency clinician.