Opioid Use Disorder (OUD)
What is Opioid Use Disorder (OUD)?
Opioid use disorder is a substance use disorder characterized by significant mental or physical dependence on opioids. Opioids are a class of drugs that are often used to relieve intense or chronic pain.
Similar to other substance use disorders, opioid use disorder (OUD) does not discriminate by gender, age, ethnicity, etc. It can take over a person’s life and have deadly consequences. At the very least, it can greatly impact an individual’s physical and mental health, relationships, social life, career, and many other facets of their life.
By the Numbers
Opioid use disorders affect over 16 million people worldwide. In 2020, an estimated 2.7 million people aged 12 or older in the United States had an opioid use disorder (OUD) in the past 12 months—including 2.3 million people with a prescription opioid use disorder. There is an estimated 50% heritability to opioid use disorder. Patients diagnosed with opioid use disorder exposed to an environment that includes opioid use may be more likely to develop substance abuse disorder. Up to 50% of patients on chronic opioid therapy meet the criteria for opioid use disorder.
Roughly 80% of new heroin users in the United States report pills as their initiation to opioid use and subsequent OUD. More than 60% of people using opioid analgesics for nonmedical reasons get them from family or friends.
Getting an OUD Diagnosis
While there are 2.3 million cases of diagnosed OUD in the U.S., over 9.3 million individuals report misusing prescription opioids annually, indicating that OUD is potentially widely under-addressed.
There is a specific set of definitions that practitioners must use in order to diagnose and treat Opioid Use Disorder (OUD). These definitions are set in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
A patient must meet at least 2 diagnostic criteria to qualify as having an opioid use disorder. Severity is characterized as “mild” if 2 or 3 criteria are met, “moderate” if 4 or 5 criteria are met, and “severe” if 6 or more criteria are met.
Diagnosing OUD requires a thorough evaluation which includes other factors in addition to the DSM Criteria. It is also important to remember that OUD exists on a continuum of severity.
OUD Criteria
The following are diagnostic criteria for opioid use disorder:
- Opioids are often taken in larger amounts or over a longer period of time than intended.
- There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
- A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
- Craving, or a strong desire to use opioids.
- Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home.
- Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
- Important social, occupational or recreational activities are given up or reduced because of opioid use.
- Recurrent opioid use in situations in which it is physically hazardous
- 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.
What is the DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders, more commonly referred to as the DSM, is a guidebook commonly used by psychiatrists and clinicians. It contains descriptions, symptoms, and other criteria necessary for diagnosing mental health disorders.
Published by the American Psychiatric Association (APA) in 1952, the Diagnostic and Statistical Manual has been updated seven times, most recently in 2013 to it’s 5th Edition. Updates to the DSM’s diagnostic categories and criteria require years-long focused research involving groups of experts.