TABLE 1.

Applicability of DSM-5 Criteria to Patients Receiving Opioids for Pain

DSM-5 Criteria for Dependence	Medical Use of Opioids for Chronic Pain
Tolerance	Expected with prolonged use
Withdrawal	Expected with prolonged use
Using larger amounts for longer time	Pain may last longer than expected
Wants to quit, not able	Pain can interfere with dose tapering
Lots of time getting, using, recovering from substance use	Criterion can be applied: if opioids are prescribed, should not be spending excessive time procuring
Cravings or urges to use	Distinguish from pain-related urges
Not managing at work, etc.	Distinguish problems related to pain from problems related to opioid use
Continuing to use despite problems in relationships	Criterion can be applied: if pain is adequately treated, relationships should improve
Giving up important activities	Criterion can be applied: if pain is adequately treated, ability to engage in activities should improve
Continuing to use despite danger	Criterion can be applied: if opioids are used as prescribed, should be minimal danger
Using despite physical or psychological problems	Must distinguish from problems related to pain