DSM-5 Criteria for Opioid Use Disorder

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”.  

Diagnostic Criteria*

*These criteria not considered to be met for those individuals taking opioids solely under appropriate medical supervision

Check all that apply

  1. Opioids are often taken in larger amounts or over a longer period of time than intended.
  2. There is a persistent desire or 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.
  4. Craving, or a strong desire to use opioids.
  5. Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home.
  6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
  7. Important social, occupational or recreational activities are given up or reduced because of opioid use.
  8. Recurrent opioid use in situations in which it is physically hazardous
  9. 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.
  10. *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
  11. *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.

9 thoughts on “DSM-5 Criteria for Opioid Use Disorder

  1. dan bolger

    And diabetics have insulin use disorder?
    Psychiatric bull-shit pseudo science has no bottom.
    It all started with Cocaine Freud and continues today,
    Btw, PROPaganda “experts” Anna The Insane Lembke and Andrew Kolodny the Dr Mengele of Pain Care are both psychiatrists.

    Liked by 2 people

    Reply
  2. Kathy C

    It is not an accident they formatted it that way. They did not want to call attention to their deliberate and dangerous mistake from the last edition. We won’t see any researchers quantifying the damage they did. It is really clear that this mistake, was deliberate, and for a purpose. I wonder how many suicides and ruined lives, they caused with their arbitrary and deceptive descriptions. They are counting on the fact that no one will notice their addition, and the way ignorance and propaganda perpetuates, this won’t change the stigmatizing and misleading discourse.

    This is what happens when science and facts are secondary to profit and propaganda. They have not done much for the “mentally ill either. There is now no such thing as a misdiagnosis even when a persons life is ruined, or people with serious disorders are made worse. These ghouls are not scientists, they are marketers, this has nothing to do with facts or science. It is no wonder the number of people with ‘mental illness” are rising along with rates of suicides, addiction, and despair.

    Note that they did not use the words, pain, chronic pain, intractable chronic pain or physical disorder. I would be willing to bet that they had help from some industry insiders, the very same ones that fund a lot of their misreported research.

    Liked by 1 person

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    1. Zyp Czyk Post author

      I’m appalled at what passes for science these days and how it’s used to justify absurdities like this.

      Any of us could do a better job of deciding whether someone is suffering from addiction or chronic pain, but the “experts” just make a giant confusing mess of it.

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  4. Kathy c

    I just did a bounce around the Interweb. Last nights headlines about “mental health” stigmatizing. attacking and blaming is sector of the population, should have brought a fact based response from the psychological community, but instead they used it as a marketing opportunity. The APA used the opportunity to do a little marketing, and obfuscation for a big tech corporations, that by the way funds their research. They claim that this corporation relies on and ethicist. There has been a lot of talk lately about the evils these corporations are involved, in but the APA gets out in front of that talk.

    We have not seen any level headed talk at any mass media site. The mental health industry, big pharma, and the healthcare industry are all seeing dollar signs. The Mental health Industry has still not recognized the cognitive dissonance that can lead to despair, when people are targeted and maligned. They turned it all into marketing opportunities, confusing the general public. One would think that the rising rates of suicide might inspire some actual objective research, but we see the opposite happening. We have to remember that this stuff is profitable.

    Here is the schedule at their corporate funded convention. https://convention.apa.org/blog/day-3 They even re-frame “gun Violence” as “good for us.”

    “Always Be Selling” The first rule of marketing. They tailor every word to maximize corporate funding, and to please the corporations.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      I think the problem was unleashed when the Supreme Court decided that corporations are “people”. That was the beginning of the destruction of any care or compassion for those who can’t contribute to the “bottom line”.

      We are considered nothing but a burden and it seems they’d prefer we just stop living. In a way, that makes our staying alive almost a protest – suicide would be letting them “win” by removing an expense for them.

      If we can’t contribute to corporate profits, we’re no longer welcome in America.

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  5. Mr. Richard hane

    I’ve been under a dr. care for 15 years. Taking 1 to 2 Lortab a day for arthritis . until I Crushed 2 lower lumbar disc’s in 2012. then I was taking 3. now 7 years later still in constant pain I take 4 a day. The biggest pain I have now is having to go to the Dr. EVERY MONTH to get my script filled. Instead of every 3 months.
    I checked no boxes Why don’t they just build more prisons an leave People n their DR. ALONE.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      It’s certainly not good practice to force people in pain to make an appointment, drive to their doctor for the prescription, then drive to the pharmacy with the prescription, and then stand around or sit in uncomfortable chairs waiting before driving back home *every* month for a prescription that hasn’t changed in years.

      It seems the regulators assume we can just hop in our cars and zip around town like they themselves do without pain. They have no idea that that such a drive often aggravates the very pain we need opioids for!

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