Although the generic term “opioid” is given in the DSM-5, the diagnostic guidelines indicate that the actual opioid drug being used by the individual should be specified in the diagnosis. For example, a person who has developed heroin addiction would be diagnosed with heroin use disorder.
Types of Opioids
Opioids are a drug class that acts on opioid receptors in the brain. They come in many forms, including:
Analgesics used mainly in hospital settings such as morphine (brand names include Roxanol-T and Avinza) Illicit drugs such as heroin Painkillers that are available with a prescription such as Abstral, Actiq, Onsolis, Fentora, Sublimaze (fentanyl); Oxycontin, Xtampza ER, Oxaydo (oxycodone); Vicodin, Hyslinga, Zohydro (hydrocodone); Dilaudid (hydromorphone); and codeine Substitution drugs used to treat addiction to other opioids such as methadone
Opioid use disorder covers a range of drugs that can be accessed by people from different walks of life and from various sources. One of the most well-known opioid use disorders is heroin use disorder. Yet in 2017, an estimated 1.7 million Americans were living with substance use disorders related to prescription opioids (compared to 652,000 with a heroin use disorder).
Symptoms of Opioid Use Disorder
Opioid use disorder is a specific diagnosis. The diagnosis applies to a person who uses opioid drugs and has at least two of the following symptoms within a 12-month period:
Continuing to use opioids, despite the use of the drug causing relationship or social problems Craving opioids Failing to carry out important roles at home, work, or school because of opioid use Giving up or reducing other activities because of opioid use Knowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anyway Spending a lot of time seeking, obtaining, taking, or recovering from the effects of opioid drugs Taking more opioid drugs than intended Tolerance for opioids Using opioids even when it is physically unsafe Wanting or trying to control opioid drug use without success Withdrawal symptoms when opioids are not taken
Can Anyone Taking Opioids Have Opioid Use Disorder?
People can develop a physical tolerance to prescribed opioids and experience a physical withdrawal without the drug. However, the DSM-5 explicitly states that if an individual is experiencing symptoms while taking opioids under appropriate medical supervision, it is not an opioid use disorder. For more mental health resources, see our National Helpline Database. This is particularly true when a person does not have cravings for the drug, does not have difficulty using appropriate dosages, and does not experience any lifestyle problems caused by taking the drug. The distinction is important because a person who is taking opioids as prescribed after a surgery or injury might have reduced activity because of pain and the need for healing, but this is not the same as reduced activity related to seeking out or using opioid drugs. It’s also not always the case that using an illicit opioid drug such as heroin means a person has an opioid use disorder. Since the 1970s, it has been known that there is a sub-population of heroin users who do not develop heroin use disorder. Even though many people who use heroin claim that their use is non-problematic, heroin causes more significant and long-lasting problems for people who use it compared to other drugs.
Cut back or stop as soon as they feel tolerance developingKeep their drug use separate from their social life (socializing mainly with non-drug users rather than other heroin users)Regulate their drug useUse comparatively “safer” methods of taking the drug
Research seems to indicate that people who develop heroin use disorder tended to have significant mental health concerns even before they start using the drug. The people who do not develop use disorder tended to be more healthy psychologically and socially prior to use. More research is needed to see if these factors could also apply to people who do not become addicted to opioid pain medication.
Screening for Opioid Use Disorder
Experts have developed screening tools to assess a person’s risk for use disorders Some of the tools are publicly available and can be used to determine if someone might need to be assessed for opioid use disorder. The opioid risk tool is a more complex assessment that calculates the factors that place individuals at greater risk of having a substance use disorder. Having a past family and personal history of substance use, a history of childhood sexual abuse, and a history of past or present psychological disorders (including depression and schizophrenia), as well as a person’s age, are all associated with an increased risk for substance use disorders. CAGE is an acronym pertaining to specific words in each of the tool’s four questions: If a person answers “Yes” to any of the questions, they would benefit from a more complete assessment.
A Word From Verywell
If you think a loved one might have an opioid use disorder, you can encourage them to get the help they need by using techniques like open-ended questioning to have a respectful conversation about your concerns. You might need to enlist the help of others, such as a mental health professional or healthcare provider. If you are concerned about your own opioid use, reach out to your support network and have a frank conversation with your healthcare provider. If you are not already working with a counselor or therapist, ask your provider for a referral to a clinician or treatment program.
