What to know
- Identification of opioid use disorder (OUD) is an opportunity for clinicians to initiate potentially life-saving interventions.
- Clinicians should collaborate with the patient regarding their safety to increase the likelihood of successful treatment.
- Treatment with opioids for pain is associated with increased risk for OUD, particularly if opioids are prescribed for more than 90 days.
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Identifying OUD
If clinicians are concerned and suspect their patient may have OUD, they should discuss the concerns with the patient in a nonjudgmental manner. Clinicians can provide an opportunity for patients to disclose related concerns or problems. Concerns about OUD may be informed by
- Patient stated concerns
- Patient behavior
- Findings in prescription drug monitoring program (PDMP) data
- Results of toxicology testing
Clinicians should assess for the presence of OUD using the following checklist based on the DSM-5 criteria.
Diagnostic criteria
OUD is demonstrated by at least 2 out of the 11 criteria below occurring within a year. Severity of OUD is determined based on the number of criteria met.A
- Mild: 2-3 criteria
- Moderate: 4-5 criteria
- Severe: greater than or equal to 6 criteria
Diagnostic CriteriaB
- Taking opioids in larger amounts or over a longer period of time than intended
- Having a persistent desire or unsuccessful attempts to reduce or control opioid use
- Spending excess time obtaining, using, or recovering from opioids
- Craving opioids
- Continued opioid use causing inability to fulfill work, home, or school responsibilities
- Continuing opioid use despite having persistent social or interpersonal problems
- Lack of involvement in social, occupational, or recreational activities
- Using opioids in physically hazardous situations
- Continuing opioid use in spite of awareness of persistent physical or psychological problems
- a. A need for markedly increased amounts of opioids to achieve intoxication or desired effect, or
- b. Markedly diminished effect with continued use of the same amount of an opioid.
- a. A need for markedly increased amounts of opioids to achieve intoxication or desired effect, or
- Exhibiting withdrawal symptoms, as manifested by either of the following:*
- a. The characteristic opioid withdrawal syndrome, or
- b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.
- a. The characteristic opioid withdrawal syndrome, or
*Tolerance and withdrawal are not considered to be met for those taking opioids solely under appropriate medical supervision.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
- This the criteria is adapted and has been edited for plain language from the American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.