Opioid Use Disorder in the DSM-5

Elizabeth Hartney, BSc, MSc, MA, PhD
·5 min read
Roel Smart / E+ / Getty Images
Roel Smart / E+ / Getty Images

Medically reviewed by Steven Gans, MD

Opioid use disorder (also referred to as opioid addiction) is a diagnosis that was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The diagnosis combines two disorders from the previous edition of the DSM (DSM-IV-TR): opioid dependence and opioid abuse.





The DSM-5 diagnosis of opioid use disorder 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. For example, a person who has developed heroin addiction would be diagnosed with heroin use disorder.

Related: An Overview of Substance Use

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 substances. 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).

Related: The Top 10 Most Addictive Pain Medications

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





If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.




Can Anyone Taking Opioids Have Opioid Use Disorder?

Certain risk factors may increase the likelihood that a person develops an opioid use disorder due to taking prescription medications. These risk factors include:

  • Younger age

  • Current or past substance misuse

  • Untreated psychiatric disorders

  • Social or family environments that encourage drug misuse

People can develop a physical tolerance to prescribed opioids and experience physical withdrawal when they reduce the dose or stop the medication. 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.





If a person develops a normal physical response to prolonged drug exposure, this response in itself does not constitute a use disorder.




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.

Related: Symptoms of Addiction

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.





CAGE Questionnaire

The CAGE questionnaire is a common and simple tool that can be used to screen a person for substance use disorders.

CAGE is an acronym pertaining to specific words in each of the tool's four questions:

  1. Have you ever felt you should cut down on your drinking?

  2. Have people annoyed you by criticizing your drinking?

  3. Have you ever felt bad or guilty about your drinking?

  4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

If a person answers "Yes" to any of the questions, they would benefit from a more complete assessment.




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.

Related: When Does Drug Use Become Addiction?

Treatment for Opioid Use Disorder

If you are concerned about your opioid use, talk to 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.

Treatments for opioid use disorder include medications and psychotherapy.

Medications

Some medications that can be used to treat opioid addiction include:

  • Buprenorphine: Blocks opioid receptors in the brain to prevent withdrawal symptoms

  • Methadone: Reduces opioid cravings and withdrawal symptoms; blocks the effects of opioids

  • Naltrexone: Blocks opioid receptors and prevents them from having an effect

Psychotherapy

Behavioral interventions that can help treat opioid addiction include:

  • Cognitive behavior therapy (CBT): Addresses thoughts and behaviors while improving coping skills

  • Motivational enhancement therapy (MET): Increase the motivation and commitment to recovery

  • Contingency management (CM): Offers reward incentives for drug abstinence

  • 12-step programs: Supportive groups that help guide people through the recovery process





Narcan to Reverse an Opioid Overdose

If a loved one is misusing opioids, learn how to administer Narcan (naloxone) and have it on hand in the event of an emergency. The medication can reverse a potentially fatal opioid overdose. You don't need a prescription to get Narcan—you can get it directly from a pharmacy.




Read Next: Treatment for Opioid Addiction