Opioids — prescription pain relievers and heroin — are an epidemic in the United States, with millions of people having significantly problematic relationships with this addictive class of drugs. Although originally intended to treat pain or provide relief from other addictions, opioids themselves can readily be abused, leading a person down a seemingly never-ending cycle of abuse. Opioid prescription pain relievers include oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Opioid use disorder — also known as just plain opioid addiction in popular culture — is characterized primarily by a problematic pattern of opioid use that leads to significant distress or impairment in the person’s life. The person is taking or continues to take the opioid for no legitimate medical reasons, even if they initially were prescribed the drug for a legitimate medical reason. Over time, a person with opioid use disorder develops habits revolving around their opioid use, eventually leading to the person’s entire life being consumed with either gaining access to their next dose, using it, or trying to recover from their last hit.
Most people with this disorder will build up a tolerance to the drug and will experience significant withdrawal symptoms if they attempt to discontinue its use abrutly.
Specific Symptoms of Opioid Use Disorder
For the disorder to be diagnosed, a person must have at least two (2) of the following 11 symptoms, occurring together within the past year.
- The drug is taken in larger amounts or over a longer period of time than intended.
- There is a desire by the user, and usually unsuccessful efforts, to control use of the drug or to cut down on its use.
- More and more time is spent trying to gain access to the drug, use it, or recover from its use.
- Activities the person normally enjoys — socially, at work, or for their education — are given up due to use of the drug.
- Cravings for the drug, or an urge to use it again.
- Using the drug in situations where it is dangerous or hazardous to do so (e.g., while driving a car).
- Forgoing major obligations — at work, school, or home — due to use of the drug (e.g., unemployment).
- Continued use of the drug despite persistent problems with social, romantic, or interpersonal relationships.
- Continued use of the drug despite persistent problems with a person’s physical or psychological health, due to overuse of the drug.
- Withdrawal symptoms of opioid use, or additional use of the drug to try and stop the withdrawal symptoms.
- Tolerance of the drug — that is, the person needs more and more of the drug in order to achieve the same effects, and those effects continue to decline over time with continued use of the drug.
A person is classified as having different severity levels of the disorder depending upon how many symptoms the person meets for the diagnosis:
- Mild – 2-3 of the above symptoms
- Moderate – 4-5 of the above symptoms
- Severe – 6 or more of the above symptoms
A person who is diagnosed with opioid use disorder can either be in no remission, early remission (3-12 months of no opioid use), or sustained remission (12 or more months with no use).
Prevalence of Opioid Use Disorder
According to the National Institute on Drug Abuse, prevalence rates have risen sharply in recent years where is now estimated that over 2 million Americans struggle with an opioid addiction. Nearly half of all drug abuse deaths in the United States are now attributed to opioids.
According to the American Society of Addiction Medicine, over 23 percent of people who use heroin will eventually develop an opioid addiction.
Opioid addiction can begin at any age, but is most commonly seen in young adults or older teens. The disorder will generally continue for many years in a person, even though they may have brief periods where they abstain from use of the drug.
Urine tests are the most common way to screen for opioid use, as opioids can be detected in the body for up to 36 hours after they were taken. Some opioids need to be specifically tested for — methadone, fentanyl, buprenorphine, and LAAM — as they will not show up in a standard urine screen.
People who regularly take opioids may have a dry mouth and nose, as well as severe constipation. If opioids are injected, injection marks at the site of injection will be common.
DSM 5 codes for Opioid Use Disorder
Coding of this disorder in the DSM-5 depends on the severity of the syndrome:
- 305.50 (F11.10) Mild: Presence of 2–3 symptoms.
- 304.00 (F11.20) Moderate: Presence of 4–5 symptoms.
- 304.00 (F11.20) Severe: Presence of 6 or more symptoms.