Difficulties in sexual functioning are common. Males often experience erectile dysfunction
during intoxication or chronic use. Female s commonly have disturbances of reproductive
function and irregular menses.
In relation to infections such as cellulitis, hepatitis, HIV infection, tuberculosis, and en-
docarditis, opioid use d isorder is associated with a mort ality rate as high as 1.5%–2% per
year. Death most often results from overdose, accidents, injuries, AIDS, or other general
medical complications. Accidents and injuries due to violence that is associated with buy-
ing or selling drugs are common. In some areas,  violence accounts for more opioid-related
deaths than overdose or HIV infection. Phy siological dependence on opioids may occur in
about half of the infants born to females with opioid use disorder; this can produce a se-
vere withdrawal syndrome requiring medical treatment. Although low birth weight is
also seen in children of mothers with opioid  use disorder, it is usually not marked and is
generally not associated with serious adverse consequences.
Differential Diagnosis
Opioid-induced mental disorders. Opioid-induced disorders o ccur frequently in individ-
uals with opioid use disorder. Opioid-induced  disorders may be characterized by symptoms
(e.g., depressed mood) that rese mble primary mental disorders (e.g., persistent depressive dis-
order [dysthymia] vs. opioid-induced depressive disorder, with depressive features, with on-
set during intoxication). Opioids are less likel y to produce symptoms of mental disturbance
than are most other drug s of abuse. Opioid intoxication and opioid withdrawal are distin-
guished from the other opioid-induced disorder s (e.g., opioid-induced  depressive disorder,
with onset during intoxication ) because the symptoms in thes e latter disorders predominate