sults for hepatitis A, B, and C virus are positive in as many as 80%–90% of injection opioid
users, either for hepatitis antigen (signifying ac tive infection) or for hepatitis antibody (sig-
nifying past infection). HIV is prevalent in injection opioid users as well. Mildly elevated
liver function test results are common, either as a result of re solving hepatitis or from toxic
injury to the liver due to contaminants that have been mixed with the injected opioid. Sub-
tle changes in cortisol secretion patterns and body temperature regulation have been ob-
served for up to 6 months following opioid detoxification.
Suicide Risk
Similar to the risk generally observed for a ll substance use disorders, opioid use disorder
is associated with a heightened  risk for suicide attempts and completed suicides. Particu-
larly notable are both accidental  and deliberate opioid overdose s. Some suicide risk factors
overlap with risk factors for an opioid use di sorder. In addition, repeated opioid intoxica-
tion or withdrawal may be associated with severe depressions that, although temporary,
can be intense enough to lead to suicide attempts and completed su icides. Available data
suggest that nonfatal accidental opioid ov erdose (which is common) and attempted sui-
cide are distinct clinically significant proble ms that should not be mistaken for each other.
Functional Consequences of Opioid Use Disorder
Opioid use is associated with a lack of mu cous membrane secretions, causing dry mouth
and nose. Slowing of gastrointestinal activity  and a decrease in gut motility can produce
severe constipation. Visual acuity may be im paired as a result of pupillary constriction
with acute administration. In individuals who inject opioids, sclerosed veins (“tracks”)
and puncture marks on the lower portions of the upper extremities are common. Veins