DSM-5 Criteria for Diagnosis of Opioid Use Disorder– from American Psychiatric Association
These are the latest diagnostic criteria for what used to be called addiction. They make it seem like everyone on opioid therapy for chronic pain has “opioid use disorder” (OUD).
The writers of this new version of the manual thought the term “addiction” would be stigmatizing, so they created this new disorder as a continuum of “dependence”, further erasing the line between “use of opioids” and “addiction to opioids”.
It makes me think they themselves can’t see the difference that’s so obvious to us. Or perhaps they relied on addiction specialists, most of whom see any use of opioids beyond 90 days as an “opioid use disorder”.
*These criteria not considered to be met for those individuals taking opioids solely under appropriate medical supervision
Check all that apply
- Opioids are often taken in larger amounts or over a longer period of time than intended.
- There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
- A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
- Craving, or a strong desire to use opioids.
- Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home.
- Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
- Important social, occupational or recreational activities are given up or reduced because of opioid use.
- Recurrent opioid use in situations in which it is physically hazardous
- Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.
- *Tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of opioids to achieve intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of an opioid
- *Withdrawal, as manifested by either of the following:
(a) the characteristic opioid withdrawal syndrome
(b) the same (or a closely related) substance are taken to relieve or avoid withdrawal symptoms
Below is the most important part for pain patients, a mere asterisk, an afterthought in small print at the very bottom. Only if someone looks carefully will they even notice it or consider it worth noticing.
* Patients who are prescribed opioid medications for analgesia may exhibit these two criteria (withdrawal and tolerance), but would not necessarily be considered to have a substance use disord
Total Number Boxes Checked: _________________
Severity: Mild: 2-3 symptoms. Moderate: 4-5 symptoms. Severe: 6 or more symptoms
*Criteria from American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,. Washington, DC,
I’m surprised to see that the DSM-V has a copyright date of 2013, when it wasn’t really used until years later.