Opioid dependence: a maladaptive pattern of opioid use leading to clinical impairment or distress manifested within a 12-month period by ≥3 of the following: |
1. Tolerance: increased amounts of opioids to achieve intoxication or the desired effect or diminished effects with continued use of the same amount of opioid |
2. Withdrawal: manifested by the characteristic withdrawal syndrome or use of opioids to relieve or avoid withdrawal symptoms |
3. Use of opioids in larger amounts or over a longer period of time than intended |
4. Persistent desire or unsuccessful attempts to cut down or control opioid use |
5. Great deal of time spent obtaining opioids, using opioids or recovering from their effects |
6. Loss of interest in social, occupational or recreational activities |
7. Opioid use despite knowledge of physical or psychological problems |