Text adapted in 2023 from "Opioid Use and Opioid Use Disorders" in The Primary Care Addiction Toolkit. Available online only.

Opioid use disorder features a compulsive pattern of opioid use leading to significant impairment in occupational, social and interpersonal functioning (American Psychiatric Association, 2013). The diagnosis requires that the person meet at least two of the 11 DSM-5 criteria within a 12-month period:*

1. Opioid use in larger amounts or over longer period of time than intended
2. Unable to cut down or control opioid use
3. Great deal of time is spent to obtain, use and recover from opioid use
4. Cravings
5. Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home
6. Continued use despite social or interpersonal problems
7. Important occupational, social or recreational activities are given up
8. Recurrent opioid use in physically hazardous situations
9. Continued use despite physical or psychological problems caused by opioid use
10. Tolerance
11. Withdrawal.

These criteria can be grouped into four categories: impaired control (criteria 1–4), social impairment (criteria 5–7), risky use (criteria 8–9) and physical dependence (criteria 10–11).

* DSM-5 criteria reprinted with permission from Diagnostic and Statistical Manual of Mental Disorders (5th ed.), American Psychiatric Association, 2013, Arlington, VA © 2013 American Psychiatric Association.
  

Physical dependence and addiction

Many patients who take opioids daily are physically dependent. This is a state of physical adaptation manifested by tolerance to opioids and withdrawal if the person suddenly stops taking the opioid.

Physical dependence is not the same as having an opioid use disorder. Most patients who take prescribed opioids do not become addicted to them, even with long-term use. People are addicted to a drug when they find its psychoactive effects so reinforcing that they have trouble controlling their use of the drug, and their compulsive drug use creates social, financial or psychological difficulties (American Society of Addiction Medicine, n.d.).
  

Patients at high risk for opioid use disorder

Many factors contribute to the development of an opioid use disorder. The strongest predictor is current or past addiction to opioids or other substances, such as alcohol, cocaine, benzodiazepines or cannabis (Fishbain et al., 2008; Fleming et al., 2008). Other risk factors include:

• younger age (under 40)
• male sex
• concurrent mental health problems, including personality disorders, somatoform disorders, anxiety disorders – particularly posttraumatic stress disorder – and mood disorders (Becker et al., 2008; Edlund et al., 2007; Klimas et al. 2019; Substance Abuse and Mental Health Services Administration, 2022; Wilsey et al., 2008)
• childhood trauma
• family history of addiction and mental health problems.

In Opioid Use and Opioid Use Disorder:

• Screening
  • Identifying unhealthy opioid use
  • Identifying opioid use disorder
  • Screening tools for unhealthy opioid use
• Assessment
  • Clinical assessment of opioid use disorder
  • Urine drug testing  
• Pain management
  • Prescribing opioids for pain patients at risk of unhealthy use
  • Opioid dosing in pain patients at risk of unhealthy use
  • Tapering opioids in pain patients at risk of unhealthy use
  • Prescribing opioids for pain patients with opioid use disorder
• Opioid use disorder treatment
  • Managing opioid withdrawal
  • Treatment options for opioid use disorder
  • Buprenorphine
  • Methadone
  • Slow-release oral morphine
  • Injectable opioid agonist therapy
• Tools and resources
• References
• About the editors and contributors

Virtual Reality (VR) Opioid Overdose Response Training
This free course teaches participants how to effectively administer naloxone, a life-saving treatment that temporarily reverses the effects of an opioid overdose, in a clinical and community setting.

• Access the desktop version of the course. 
• Read more about how to access and enroll in the course
  • PDF version
  • Accessible text format.

Opioid Agonist Therapy: A Prescriber’s Guide to Treatment
Opioid Agonist Therapy: A Prescriber’s Guide to Treatment is a comprehensive, practical resource that supports the work of physicians and nurse practitioners who prescribe medication to treat opioid use disorder. It provides the latest guidance for using OAT medications to meet the varying needs of people with opioid use disorder. Learn more.
   

Canadian Opioid Use Disorder Guideline
Opioid Agonist Therapy: A Synthesis of Canadian Guidelines for Treating Opioid Use Disorder is a national clinical guideline that harmonizes existing guidelines, evidence-based practices and expert opinions into one document, with the aim of providing consistent and high-quality care to people with opioid use disorder. Learn more.