Understanding Opioid-Related Disorders

Opioid-related disorders is the collective name of a group of substance-related disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, a reference guide commonly used by mental health professionals across America. All of the conditions with this name involve negative consequences associated with the use of a wide variety of opioid narcotic medications or drugs. DSM 5, the 2013 edition of the Diagnostic and Statistical Manual, makes several changes to the definitions of the opioid-related disorders. Some of these changes involve a mere change in wording, while others involve a significant change in meaning.

Opioid-Related Disorder Basics

The five opioid-related disorders listed in DSM 5 are opioid use disorder, opioid intoxication, opioid withdrawal, “other” opioid-induced disorders and “unspecified” opioid-related disorder. Opioid use disorder is a new condition created by blending the definitions for two other conditions, called opioid abuse and opioid dependence, which appeared in the “Diagnostic and Statistical Manual’s” obsolete fourth edition (DSM IV). Opioid intoxication and opioid withdrawal keep the same definitions they had in DSM IV. The “other” opioid-induced disorders heading is a substitute for five separate DSM IV conditions. “Unspecified” opioid-related disorder acts as a substitute for a loosely defined DSM IV disorder called opioid-related disorder not otherwise specified (NOS).

Opioid Use Disorder

Opioid drugs and medications are well known for their ability to trigger substance abuse in users, as well as substance dependence (a medical term for addiction). People affected by substance abuse don’t meet the criteria for diagnosing a physical/mental addiction, but still participate in ongoing substance-based behaviors that strongly impact their lives in negative ways. People affected by substance dependence do meet the criteria for diagnosing an addiction; like substance abusers, they also participate in clearly harmful substance-based behaviors on a regular basis.

Issues of substance abuse and substance dependence overlap to a considerable degree. In fact, from a scientific standpoint, it’s perfectly reasonable to view dependence as a particularly damaging form of abuse. DSM IV kept the diagnosis of substance abuse and substance dependence strictly separated. However, DSM 5 discards the separate listings contained in DSM IV and establishes a replacement condition—called substance use disorder—which joins the symptoms of substance abuse with the symptoms of substance dependence. In accordance with this change, opioid users with significant abuse- or dependence-related problems will now receive a single diagnosis for opioid use disorder.

Opioid Intoxication

People in the midst of opioid intoxication develop at least two symptoms that alter their normal mental function, change their behavior for the worse, or otherwise impede their ability to carry out their typical routines. In all cases, one of the symptoms present must be unusual narrowing or widening of the pupils. Other qualifying symptoms include an inability to pronounce words properly, unusual sleepiness, a decline in normal memory function, a decline in the ability to voluntarily focus attention, and the onset of the dire state of unresponsiveness known as a coma. Additional requirements for a diagnosis include verifiable use of an opioid drug or medication in the very recent past and lack of other psychological or physical issues that could produce the problems attributed to opioid use.

Opioid Withdrawal

Opioid withdrawal occurs when an opioid user who has grown accustomed to the effects of a drug or medication suddenly stops using that drug or medication, or steeply decreases use over a short span of time. The Diagnostic and Statistical Manual provides doctors with guidelines to gauge the seriousness of withdrawal in any given patient. People going through grade 0 opioid withdrawal typically develop symptoms such as anxiety, a strong desire to continue drug/medication use, and the presence of behaviors designed to fulfill that desire. People going through grade 1 withdrawal develop symptoms such as unusual sweat output, uncontrollable yawning and unusual tear or mucus production. Symptoms associated with grade 2 opioid withdrawal include twitching muscles, restricted eating patterns similar to those found in people with anorexia, and pupil dilation. Grade 3 opioid withdrawal symptoms include sleeplessness, cramping abdominal muscles, muscle weakness, diarrhea, vomiting, and abnormal increases in blood pressure, heart rate and breathing rate.

“Other” And “Unspecified” Disorders

The “other” opioid-induced disorders diagnosis is designed to describe the presence of any mental disorder-related symptoms that appear as a consequence of opioid use. It replaces five separate diagnoses contained in DSM IV, including opioid-induced mood disorder, opioid-induced sleep disorder, opioid-induced sexual dysfunction, opioid-induced psychotic disorder with delusions, and opioid-induced psychotic disorder with hallucinations. The “unspecified” opioid-related disorder diagnosis lets mental health professionals identify cases of opioid-related mental health problems that don’t meet the minimum requirements for diagnosing any other opioid-related disorder.