What are the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for opioid abuse?

Updated: Jun 21, 2018
  • Author: David W Dixon, DO; Chief Editor: Glen L Xiong, MD  more...
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Answer

The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) defines opioid use disorder as a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: [5]

  • Taking larger amounts of opioids or taking opioids over a longer period than was intended

  • Experiencing a persistent desire for the opioid or engaging in unsuccessful efforts to cut down or control opioid use.

  • Spending a great deal of time in activities necessary to obtain, use, or recover from the effects of the opioid.

  • Craving, or a strong desire or urge to use opioids.

  • Using opioids in a fashion that results in a failure to fulfill major role obligations at work, school, or home.

  • Continuing to use opioids despite experiencing persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.

  • Giving up or reducing important social, occupational, or recreational activities because of opioid use.

  • Continuing to use opioids in situations in which it is physically hazardous.

  • Continuing to use opioids despite knowledge of having persistent or recurrent physical or psychological problems that are likely to have been caused or exacerbated by the substance.

  • Tolerance, as defined by either a need for markedly increased amounts of opioids to achieve intoxications or desired effect, or a markedly diminished effect with continued use of the same amount of an opioid.

  • Withdrawal, as manifested by either the characteristic opioid withdrawal syndrome, or taking opioids to relieve or avoid withdrawal symptoms.

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

Opioid use disorder can be classified by severity as mild, moderate, or severe.

See Workup for more detail.


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