Opioid Use Disorder in the New DSM-5

Opioid Use Disorder in the New DSM-5 Addiction Drug Use Opioids Print Opioid Use Disorder in the New DSM-5 By Elizabeth Hartney, BSc., MSc., MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. Learn about our editorial policy Elizabeth Hartney, BSc., MSc., MA, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on September 10, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on September 11, 2019 Roel Smart / E / Getty Images More in Addiction Drug Use Opioids Cocaine Heroin Marijuana Meth Ecstasy/MDMA Hallucinogens Prescription Medications Alcohol Use Addictive Behaviors Nicotine Use Coping and Recovery Opioid use disorder (also commonly referred to as opioid addiction) is a diagnosis introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It combines two disorders from the previous edition of the Diagnostic and Statistical Manual (DSM-IV-TR) known as opioid dependence and opioid abuse. The DSM-5 diagnosis includes a wide range of illicit and prescribed drugs of the opioid class. 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. A person who has developed heroin addiction would be diagnosed with heroin use disorder. Types of Opioids Opioids are a class of drug that act on opioid receptors  in the brain. They come in many forms, including: Illicit drugs such as heroinAnalgesics used mainly in hospital settings such as morphine (brand names include Roxanol-T and Avinza)Painkillers available with prescription such as Abstral, Actiq, Onsolis, Fentora, Sublimaze (fentanyl); Oxycontin, Xtampza ER, Oxaydo (oxycodone); Vicodin, Hyslinga, Zohydro (hydrocodone); Dilaudid (hydromorphone); and codeineSubstitution drugs used to treat addiction to other opioids such as methadone As a result, opioid use disorder covers a wide range of drugs accessed through many different sources and by people of many different walks of life. Probably the most well-known and notorious type of opioid use disorder is heroin use disorder, yet in 2017, an estimated 1.7 million Americans lived with substance use disorders related to prescription opioids, compared to 652,000 with a heroin use disorder.???? Symptoms of Opioid Use Disorder The diagnosis of opioid use disorder applies to someone who uses opioid drugs and has at least two of the following symptoms within a 12-month period:???? Taking more opioid drugs than intendedWanting or trying to control opioid drug use without successSpending a lot of time obtaining, taking, or recovering from the effects of opioid drugsCraving opioidsFailing to carry out important roles at home, work, or school because of opioid useContinuing to use opioids, despite the use of the drug causing relationship or social problemsGiving up or reducing other activities because of opioid useUsing opioids even when it is physically unsafeKnowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anywayTolerance for opioidsWithdrawal symptoms when opioids are not taken Does Anyone on Opioids Have Opioid Use Disorder? While often people will develop a physical tolerance to prescribed opioids and experience a physical withdrawal without the drug, DSM-5 explicitly states that it is not an opioid use disorder if the individual is experiencing these symptoms under appropriate medical supervision.???? Because addictive disorders are primarily psychological in nature, even if someone develops a normal physical response to prolonged drug exposure, that in itself does not constitute a use disorder. This is especially true if they have no cravings for the drug, no difficulty using appropriate dosages, and no lifestyle problems as a result of taking the drug (someone in pain may have reduced activity as a result of their pain, but that is not the same as reduced activity because of seeking out opioid drugs). This is a major step forward in the understanding of substance use disorders. Using an illicit opioid drug such as heroin does not automatically mean that the individual has an opioid use disorder either. Since the 1970s, it has been known that a sub-population of heroin users who do not develop heroin use disorder. What makes the difference for these heroin users compared to those who have significant problems? They regulate their drug use, use safer methods of taking the drug, cut back or stop as soon as they feel tolerance developing, and they tend to keep their drug use separate from their social life, socializing mainly with non-drug users, rather than other heroin users. While many heroin users claim their use is non-problematic, typically heroin use causes more significant and long-lasting problems for users than other drugs do. It appears that those who develop heroin use disorder have very significant psychological problems even before they start using the drug. In contrast, those who can control and manage their use tend to be more psychologically healthy and socially advantaged prior to use. The same may be true of those who do or do not become addicted to pain medication, but much more research is needed to understand this.???? Screening for Opioid Use Disorder Substance use disorder experts have developed several screening tools that are publicly available. These tools can be used to determine whether someone may need to be assessed for opioid use disorder. One very common use is the CAGE questionnaire, a simple tool that is used to screen for substance use disorders.???? If a person answers yes to any of these questions, they would benefit from a more complete assessment. A more complex screening tool is the opioid risk tool, which calculates the factors that place individuals at greater risk of having a substance use disorder. These factors include past family and personal history of substance use, a history of childhood sexual abuse, age, and history of past or present psychological disorders, including depression and schizophrenia. A Word From Verywell If you think you or a loved one may be struggling with opioid use disorder, be sure to have Narcan (naloxone) on hand in case of emergency. This medication can stop a potential overdose, and you can get it directly from your pharmacy without a prescription. Encourage your loved one to get help by using techniques like open-ended questioning, which can prompt a respectful conversation. If this doesnt work, you may want to talk to their doctor. If its your own use youre worried about, have an open and honest conversation with your doctor about your concerns.