TABLE 5.

Criteria Suggestive of Misuse or Addiction in Patients With Pain

ASAM-APS-AAPM BEHAVIORAL CRITERIA	EXAMPLES OF SPECIFIC BEHAVIORS IN OPIOID THERAPY OF PAIN
Impaired control over use, compulsive use	Frequent loss/theft reported, calls for early renewals, withdrawal noted at appointments
Continued use despite harm due to use	Declining function, intoxication, persistent oversedation
Preoccupation with use, craving	Nonopioid interventions ignored, recurrent requests for opioid increase/complaints of increasing pain in absence of disease progression despite titration

The American Society of Addiction Medicine (ASAM), American Pain Society (APS), and American Academy of Pain Medicine (AAPM) define addiction as a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations characterized by one or more of the behaviors listed above (ASAM, 2001).