Criteria
Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)[1]
Opioid use disorder is defined as two or more of the following within a 12-month period:
Using larger amounts of opioids or over a longer period than was intended
Persistent desire to cut down or unsuccessful efforts to control use
Great deal of time spent obtaining, using, or recovering from use
Craving, or a strong desire or urge to use substance
Failure to fulfill major role obligations at work, school, or home due to recurrent opioid use
Continued use despite recurrent or persistent social or interpersonal problems caused or exacerbated by opioid use
Giving up or reducing social, occupational, or recreational activities due to opioid use
Recurrent opioid use in physically hazardous situations
Continued opioid use despite physical or psychological problems caused or exacerbated by its use
Tolerance (marked increase in amount to achieve intoxication or desired effect; marked decrease in effect with continued use of same dose)
Withdrawal syndrome as manifested by cessation of opioids or use of opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.
Tolerance and withdrawal criteria are not considered to be met for those taking opioids solely under appropriate medical supervision.
Severity of opioid use disorder is categorized as mild (presence of 2-3 symptoms), moderate (4-5 symptoms), or severe (6 or more symptoms).
Remission of opioid use disorder is categorized as:
In early remission: where none of the criteria for opioid use disorder have been met for at least 3 months but for less than 12 months (with the exception of craving, or a strong desire or urge to use opioids), but full criteria for opioid use disorder were previously met.
In sustained remission: where none of the criteria for opioid use disorder have been met at any time during a period of 12 months or longer (with the exception of craving, or a strong desire or urge to use opioids), but full criteria for opioid use disorder were previously met.
It is also important to specify whether an individual with opioid use disorder is on maintenance therapy, such as taking a prescribed agonist (methadone), partial agonist (buprenorphine), agonist/antagonist (buprenorphine/naloxone), or a full antagonist (naltrexone).
It should be specified if the individual is in an environment where access to opioids is restricted (e.g., closely supervised and substance-free jails, therapeutic communities, and locked hospital units).
International statistical classification of diseases and health related problems, 11th revision (ICD-11)[2]
According to ICD-11 classification of mental, behavioral, or neurodevelopmental disorders, diagnosis of conditions due to use of opioids is categorized into three pathologic syndromes, each defined by a set of essential features:
Opioid dependence
A pattern of recurrent episodic or continuous use of opioids with evidence of impaired regulation of opioid use that is manifested by two or more of the following:
Impaired control over opioid use (i.e., onset, frequency, intensity, duration, termination, context)
Increasing precedence of opioid use over other aspects of life, including maintenance of health, and daily activities and responsibilities, such that opioid use continues or escalates despite the occurrence of harm or negative consequences (e.g., repeated relationship disruption, occupational or scholastic consequences, negative impact on health)
Physiologic features indicative of neuroadaptation to the substance, including:
Tolerance to the effects of opioids or a need to use increasing amounts of opioids to achieve the same effect
Withdrawal symptoms following cessation or reduction in use of opioids, or
Repeated use of opioids or pharmacologically similar substances to prevent or alleviate withdrawal symptoms.
The features of dependence are usually evident over a period of at least 12 months, but the diagnosis may be made if use is continuous (daily or almost daily) for at least 3 months.
Opioid intoxication
Transient and clinically significant disturbances in consciousness, cognition, perception, affect, behavior, or coordination that develop during or shortly after the consumption or administration of opioids.
The symptoms must be compatible with the known pharmacologic effects of opioids, and their intensity is closely related to the amount of opioids consumed.
Presenting features may include somnolence, stupor, mood changes (e.g., euphoria followed by apathy and dysphoria), psychomotor retardation, impaired judgment, respiratory depression, slurred speech, and impairment of memory and attention. In severe intoxication, coma may ensue. A characteristic physical sign is pupillary constriction but this sign may be absent when intoxication is due to synthetic opioids.
The symptoms of intoxication are time-limited and abate as opioids are cleared from the body.
Symptoms are not better accounted for by another medical condition or another mental disorder.
Opioid withdrawal
The presence of a clinically significant cluster of symptoms, behaviors, and/or physiologic features that occurs upon cessation or reduction in the use of opioids in individuals who have developed dependence on opioids or have used opioids for a prolonged period or in large amounts. Opioid withdrawal can occur when prescribed opioids (e.g., oxycodone, morphine) have been used in standard therapeutic doses.
Presenting features of may include depressed or dysphoric mood, craving for an opioid, anxiety, nausea or vomiting, abdominal cramps, muscle aches, yawning, perspiration, hot and cold flashes, hypersomnia (typically in the initial phase) or insomnia, diarrhea, piloerection, and pupillary dilation.
The severity and time course of withdrawal is influenced by many factors that include the type of opioid taken; its half-life and duration of action; the amount, frequency, and duration of opioid use before cessation or reduction of use; prior experience of opioid withdrawal; and expectations of the severity of the syndrome.
Symptoms are not better accounted for by another medical condition or another mental disorder.
Use of opioids tips into a disorder when the pattern of use causes harm to the person's physical or mental health or has resulted in behavior leading to the harm of others.[2] Harm to the health of the individual occurs due to behavior related to intoxication, direct or secondary toxic effects on body organs and systems, or a harmful route of administration.[2] Harm to health of others includes any form of physical harm, including trauma, or a mental disorder attributable to intoxication behavior.[2] Both DSM-5-TR and ICD-11 classify opioid use disorder when a harmful pattern of use is evident over a 12-month period or at least 1 month if use is continuous.[1][2]
Use of this content is subject to our disclaimer