Testing and Diagnosis for Opioid Use Disorder

When it comes to opioid use disorder (OUD), early testing and diagnosis are critical. OUD is a serious condition that affects millions of people worldwide. OUD is when someone cannot control their use of opioids. Opioids can be prescription painkillers like oxycodone or illegal drugs like heroin. People with OUD use the drugs even though they negatively affect their life.^1,2

Early diagnosis is important for managing OUD and improving quality of life. Understanding the diagnostic criteria and using self-assessment tools can help identify signs of OUD early and save lives.¹

Diagnostic criteria for opioid use disorder

Doctors use specific criteria to make an opioid use disorder diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the following signs of OUD. If someone has at least 2 of these symptoms within a 12-month period, they may have OUD:^1-3

• Taking opioids in larger amounts or for longer than intended
• Trying to cut down or stop using opioids but not being able to
• Spending a lot of time getting, using, or recovering from opioids
• Having strong cravings or urges to use opioids
• Failing to meet work, school, or home responsibilities because of opioid use
• Continuing opioid use even though it causes problems in relationships
• Giving up important activities due to opioid use
• Using opioids in dangerous situations, such as driving
• Continuing use even though it causes physical or mental health problems
• Developing a tolerance to opioids, which means needing more opioids to feel the same effect
• Experiencing withdrawal symptoms when stopping opioids

Doctors use these criteria to understand how severe OUD is. Having 2 or 3 symptoms is considered mild OUD. Having 4 or 5 symptoms points to moderate OUD. Having 6 or more symptoms indicates severe OUD.^1,3

Opioid risk assessment tools

Recognizing the signs of opioid use disorder early can help prevent the condition from getting worse. Various opioid risk assessment tools are available. Anyone can use them to evaluate their behavior and risk level. These tools are not a replacement for a professional diagnosis, but they can guide people to get help.⁴

Current Opioid Misuse Measure (COMM)

COMM is a 17-question self-assessment tool. It includes questions about opioid use. For example:^4,5

• In the past 30 days, how often have you had trouble with thinking clearly or had memory problems?
• In the past 30 days, how often have you taken your medications differently from how they are prescribed?
• In the past 30 days, how much of your time was spent thinking about opioid medications (having enough, taking them, dosing schedule, etc.)?
• In the past 30 days, how often have you borrowed pain medication from someone else?

Each of the 17 questions has a score of 0 to 4 points. After completing the questionnaire, if someone scores 9 or more points, they could have an opioid problem. This tool can help people identify their need for further evaluation.^4,5

Opioid Risk Tool

The Opioid Risk Tool is a list of 5 questions that measure a person’s risk for OUD. It is typically used in medical settings for those who have been prescribed opioid medicine for chronic pain. The scores indicate risk like this:^4,6

• 0 to 3 – low risk for OUD
• 4 to 7 – moderate risk for OUD
• 8 or higher – high risk for OUD

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

SBIRT is an approach used by healthcare providers to identify and address substance use disorders. SBIRT is quick and non-judgmental. It focuses on connecting people with the right resources. SBIRT has 3 steps:⁷

• Screening – A healthcare professional asks questions to determine the level of substance use.
• Brief intervention – The provider offers feedback, advice, and motivation to reduce risky behavior.
• Referral to treatment – If needed, the person is referred to a treatment program for additional help.

When to seek professional help

If you think you or a loved one may have OUD, do not wait to get help. Healthcare providers, such as primary care doctors (PCPs) or addiction specialists, can offer guidance and connect you to resources. These providers will conduct a full evaluation that includes:⁸

• Asking questions about your opioid use history
• Reviewing your medical and mental health history
• Using standardized screening tools

Drug screening in the form of urine tests may also be used to confirm opioid use. But these tests do not diagnose OUD on their own. Diagnosis depends on understanding someone’s behavior and symptoms.^1,2

The Substance Abuse and Mental Health Services Administration (SAMHSA) can also help you locate a treatment program near you and find support. On their website, you can find resources, treatment options, and support for people affected by OUD.

Early diagnosis can save lives

Early diagnosis of OUD can make a life-saving difference. It allows people to start treatment before the condition becomes dangerous or life-threatening. Effective treatments include medicines for OUD, counseling, behavioral therapy, and support programs. The earlier someone gets help, the better their chances of recovery.⁸