From the Guidelines
The severity of opioid use disorder (OUD) is determined by counting the number of diagnostic criteria met by an individual according to the DSM-5 criteria, with mild OUD diagnosed when 2-3 criteria are present, moderate OUD when 4-5 criteria are present, and severe OUD when 6 or more criteria are present. The DSM-5 criteria include using larger amounts or for longer periods than intended, persistent desire or unsuccessful efforts to cut down, spending significant time obtaining or recovering from opioids, craving, failure to fulfill major obligations, continued use despite social problems, giving up important activities, using in hazardous situations, continued use despite physical/psychological problems, tolerance, and withdrawal 1. Assessment should be conducted by a qualified healthcare provider through a comprehensive evaluation including a detailed history of opioid use patterns, physical examination for signs of use (track marks, withdrawal symptoms), and possibly urine drug screening.
Key Diagnostic Criteria
- Using larger amounts or for longer periods than intended
- Persistent desire or unsuccessful efforts to cut down
- Spending significant time obtaining or recovering from opioids
- Craving
- Failure to fulfill major obligations
- Continued use despite social problems
- Giving up important activities
- Using in hazardous situations
- Continued use despite physical/psychological problems
- Tolerance
- Withdrawal The severity level helps determine the appropriate treatment approach, with more severe cases often requiring more intensive interventions such as medication-assisted treatment with methadone, buprenorphine, or naltrexone, combined with counseling and behavioral therapies 1. Additionally, tools like the Clinical Opiate Withdrawal Scale (COWS) can be used to assess the severity of opioid withdrawal, with scores ranging from mild (5-12) to severe (more than 36) 1. Regular reassessment is important as OUD severity can change over time with treatment or with changes in use patterns.
Assessment Tools
- Comprehensive evaluation including a detailed history of opioid use patterns
- Physical examination for signs of use (track marks, withdrawal symptoms)
- Urine drug screening
- Clinical Opiate Withdrawal Scale (COWS) It is essential to prioritize the most recent and highest quality study, which in this case is the 2020 study from the Annals of Emergency Medicine, to guide the assessment and treatment of OUD 1.
From the Research
Determining Severity of Opioid Use Disorder
To determine the severity of opioid use disorder, several tools and methods can be employed. These include:
- The Opioid Use Disorder Severity Scale (OUDSS) which enables dimensional measurement of opioid use severity on an interval scale 2.
- The Adjective Rating Scale for Withdrawal (ARSW) that has been validated for its ability to assess the severity of prescription opioid misuse 3.
- The Opioid Craving Visual Analog Scale (OC-VAS) which has demonstrated predictive validity for opioid use disorder (OUD) 4.
- Screening tools and medical treatments, as well as behavioral interventions, can also be effective in assessing and managing OUD 5.
Assessment Tools
Various assessment tools are available to determine the severity of opioid use disorder. These tools include:
- The Structured Clinical Interview for DSM-IV (SCID) to record DSM-IV symptoms 2.
- The revised Drug Use Screening Inventory (DUSI-R) to assess health, psychological, and social adjustment domains 2.
- The Subjective Opiate Withdrawal Scale (SOWS) and the Clinical Opiate Withdrawal Scale (COWS) to evaluate withdrawal symptoms 4.
- Urine drug screening in combination with validated risk assessment tools to detect opioid misuse 6.
Effective Interventions
Effective interventions for opioid use disorder include: