Screening for Opioid Use Disorder

Opioid use disorder (OUD) has become a widespread epidemic in the United States and across the globe. Early screening can help identify people who need support and treatment.¹

Screening involves looking at different aspects of a person’s life. This includes biological, social, and psychological factors. Screening assesses their risk of harm from opioid use.^1,2

Why screening for OUD matters

Screening for OUD is the first step toward recovery. It helps identify people who need support and connects them to resources. If you or someone you know is struggling to control their opioid use, reach out for help. Opioid use disorder can lead to overdoses, health problems, and even death.¹

During the screening process, healthcare providers ask several questions. They may ask you how much you use and how often. They may ask if you have used opioids in dangerous ways. For example, injecting opioids increases the risk of infections and overdose.¹

Providers may also ask if you have tried to stop using opioids before. They may ask if you have experienced withdrawal symptoms or cravings. These are signs of dependence.¹

Biological, social, and psychological assessments

Recovery is possible with the right treatment and support. By assessing the following biological, social, and psychological factors, your healthcare provider can create a plan to meet your needs.^1,2

Biological assessment

A biological assessment looks at how opioid use affects the body. Healthcare providers may ask about:^1,2

• Your medical history
• Current or past health problems
• Medicines you are currently taking or have taken in the past
• Family history of substance use. If a close relative has a history of addiction, you might be at higher risk

Drug screening in the form of a urine test 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

Social assessment

This looks at how opioid use affects your daily life. That includes your relationships, work, and living situation. Healthcare providers may ask whether opioids have caused:^1,2

• Problems at home or work
• Tension or arguments with loved ones
• A job loss
• Financial problems
• Unstable housing or homelessness

Psychological assessment

This looks at how opioid use affects your mind and emotions. OUD often occurs with other mental health issues like depression and anxiety.^1,3

Some people use opioids to cope with emotional pain. Over time, this can lead to addiction. Providers may also ask if you have ever had thoughts of self-harm or suicide. These are serious signs that you need immediate help.^1,3

Opioid screening tools

Many screening and assessment tools are available for providers to use when diagnosing OUD. There are also self-assessments that a person can do on their own.^1,4

The goal of opioid screening tools is to help you understand your current and future health risks. This helps providers decide on the best course of action. While helpful, no one tool is perfect. Experts recommend using them in addition to the assessments listed above.^1,4

Current Opioid Misuse Measure (COMM)

This 17-question self-assessment tool asks questions about opioid use. Here are some examples:^1,4

• 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?

The questions each have a score of 0 to 4 points. If you score 9 or more total points on the questionnaire, you may have an opioid problem. In this case, you need further evaluation.^1,4

Opioid Risk Tool

This 5-question tool helps doctors measure a person’s risk for OUD before prescribing opioids. Here is what the scores mean:^1,4

• 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 a quick and non-judgmental method that focuses on connecting people with the right resources. It has 3 steps:^4,5

• 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.

Drug Abuse Screening Test (DAST-10)

The DAST-10 is a list of 10 yes/no questions that screens for abuse of substances, including opioids. It helps to quickly identify problematic drug use for further evaluation.⁴

“4Rs and 4Cs”

The “4 Rs and 4 Cs” is a quick tool that may also be used in some healthcare settings.⁴

The 4Rs are:⁴

• Role failure
• Relationship trouble
• Risk of bodily harm
• Repeated attempts to cut back

The 4Cs are:⁴

• Control (loss of it)
• Craving
• Compulsion to use
• Consequences of use

Don’t wait to get help

If you think you or a loved one may have OUD, do not wait to get help. A primary care doctor (PCP), addiction specialist, or other healthcare professional will conduct a full evaluation. They can then connect you to other helpful resources.

You can also visit the Substance Abuse and Mental Health Services Administration (SAMHSA) to locate a treatment program near you and visit their Find Support page. There, you can find information, treatment options, and support for people affected by OUD.