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Opioid  Dependence 
American  Description 

Diagnostic Criteria
Opioid abuse: A destructive pattern of opioid use, leading to significant social, occupational, or medical impairment. 
Must have three (or more) of the following, occurring when the opioid use was at its worst: 
Opioid tolerance: 
Either need for markedly increased amounts of opioid to achieve intoxication, or markedly diminished effect with continued use of the same amount of opioid. 
Opioid withdrawal symptoms: 
Either (a) or (b). 
(a) Two (or more) of the following, developing within several hours to a few days of reduction in heavy or prolonged opioid use: 
sweating or rapid pulse 
increased hand tremor 
insomnia 
nausea or vomiting 
physical agitation 
anxiety 
transient visual, tactile, or auditory hallucinations or illusions 
grand mal seizures 
(b) Opioid is taken to relieve or avoid withdrawal symptoms. 
Greater use of opioid than intended: 
Opioid was often taken in larger amounts or over a longer period than was intended 
Unsuccessful efforts to cut down or control opioid use: 
Persistent desire or unsuccessful efforts to cut down or control opioid use 
Great deal of time spent in using opioid, or recovering from hangovers 
Opioid caused reduction in social, occupational or recreational activities: 
Important social, occupational, or recreational activities given up or reduced because of opioid use. 
Continued using opioid despite knowing it caused significant problems: 
Opioid use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been worsened by opioid 

Associated Features
Learning Problem 
Dysarthria/Involuntary Movement 
Hypoactivity 
Euphoric Mood 
Depressed Mood 
Somatic/Sexual Dysfunction 
Addiction 
Sexually Deviant Behavior 
Dramatic/Erratic/Antisocial Personality 

Differential Diagnosis
Nonpathologic opioid use for recreational or medical purposes; repeated episodes of Opioid Intoxication. 

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