Opioid Use Disorder: Diagnosis

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.
Clinician and patient talking at a desk and reviewing a paper.

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.
  • 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.

*Tolerance and withdrawal are not considered to be met for those taking opioids solely under appropriate medical supervision.

Resources

There are a variety of resources that can assist with diagnosis and treatment of OUD:

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Content Source:
  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
  2. 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.