Do You Have Opioid-Use Disorder?

M.A., Health Writer
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The overuse of opioids is now an acknowledged opioid crisis. In 2016, a total of 236 million prescriptions were written. More than 115 people die every day from opioid overdoses. Opioid use can lead to what was formerly called opioid addiction, and is now “opioid-use disorder.” This change occurred in the 2013 Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (APA), which defines and classifies mental disorders.


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What opioids do

Opioids relieve pain and they include heroin, morphine, oxycodone, and Buprenorphine. They also produce pleasurable effects, such as tranquility, euphoria, and sedation. A 2016 review in the New England Journal of Medicine notes that use of opioids creates the need to escalate doses to achieve desired effects. Opioid-use disorder can occur in people of all educational and socioeconomic levels, the study says. Prescription analgesics and opioids from the street make it easier to overuse.


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A wide range of problems

Problems can extend beyond the physiological. These include legal issues, particularly when a person has a criminal record and is very impulsive, says the study. Other substance use disorders are also prominent, as is depression, insomnia, antisocial personality disorder, and post-traumatic stress disorder. Research has shown that people with opioid-use disorder may have had conduct disorder earlier in life.


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Abstinence reduces adverse outcomes

Comorbidities associated with opioid-use disorder include viral and bacterial infections, increased by injection. Even with periods of abstinence, risk of early death, primarily from an accidental overdose, trauma, suicide, or an infectious disease increases by a factor of 20. The risk of adverse outcomes such as those described, does drop with abstinence.


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Other risks of opioid-use disorder

The APA says opioid use can cause dry mouth and nose, constipation, and problems with visual acuity. Injection can compromise integrity of veins, and result in skin problems: cellulitis, abscesses, and scars. Tuberculosis is prevalent in intravenous drug users. Users who "snort" may perforate their nasal septum. Sexual dysfunction of both genders is also common. Nearly half of infants born to mothers with opioid-use disorder must be treated for severe withdrawal.


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People are 'vulnerable'

The review explains that an opioid-use disorder is defined as the repeated occurrence within a 12-month period of two or more of 11 problems shown at the top of these APA diagnostic criteria. A cluster of six or more items on this list indicates a severe condition. People with the disorder go through exacerbation and remission but are always "vulnerable." It's important for patients to be honest when reviewing the criteria.


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What defines opioid-use disorder?

Now let's look at some of the criteria for opioid-use disorder.

Criteria part I

  1. Opioids are often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or there are unsuccessful efforts to cut down or control opioid use.
  3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.


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Criteria part II

  1. Craving, or a strong desire or urge to use opioids.
  2. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
  3. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.


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Criteria part III

  1. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
  2. Recurrent opioid use in situations in which it is physically hazardous.
  3. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.


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Criteria: about tolerance

  1. Tolerance, as defined by either of the following:

    a. A need for markedly increased amounts of opioids to achieve intoxication or desired effect.

    b. A markedly diminished effect with continued use of the same amount of an opioid.

Note: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.


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Criteria: about withdrawal

  1. Withdrawal, as manifested by either of the following:

a. The characteristic opioid withdrawal syndrome (refer to criteria A and B of the criteria set for opioid withdrawal).

b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.

Again, please note: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.


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Seeking help

If you find yourself identifying with the criteria that would classify you as having opioid-use disorder, seek help by calling a treatment hotline such as 1-800-662-HELP (4357). Your call is completely confidential, and the hotline is staffed by trained professionals, available 24-hours a day, seven days a week.