Assessment Questionnaire


Could it be opioid dependence?

Think you or someone you know may have opioid dependence? This simple questionnaire, based on DSM-5* criteria for opioid use disorder, can help you determine if it may be time to talk to a doctor. Answer the questions below as accurately and honestly as you can.

  Do you/they use opioids in larger amounts or for a longer period of time than your/their doctor prescribed?
 
  Do you/they have a persistent desire or have you/they had unsuccessful efforts to cut down or control opioid use?
 
  Do you/they spend a great deal of time trying to obtain or use opioids?
 
  Do you/they have a strong desire or urge to take opioids?
 
  Has your/their opioid use resulted in a failure to fulfill major role obligations at work, school, or home?
 
  Do you/they continue to use opioids despite continuing or repeated social or personal problems caused or worsened by the effects of opioids?
 
  Have you/they lost interest in former recreational activities or hobbies because of opioid use?
 
  Have you/they given up or reduced social activities because of opioid use?
 
  Do you/they continue to misuse opioids even though you/they know it has harmful consequences?
 
  Do you/they have difficulty controlling opioid use?
 
  Without the direction of a doctor, do you/they take a higher dose of opioids in order to achieve the effects originally produced by lower doses?
 
  When you/they stop or reduce the amount of opioids, do you/they experience withdrawal symptoms (eg, cramps, diarrhea, runny nose, tearing, sweating, chills, yawning, muscle pain, nausea, or vomiting)?

*Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.
Taking opioids more often or in higher quantities than prescribed or using opioids for nonmedical recreational purposes.

If you have answered "yes" to any of the questions listed above, you should speak with a doctor immediately. Find a doctor in your area.

If you are planning to talk to your doctor about opioid dependence, these helpful tips may help to get the conversation going.


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