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. Author manuscript; available in PMC: 2022 Nov 15.
Published in final edited form as: AIDS. 2021 Nov 15;35(14):2237–2247. doi: 10.1097/QAD.0000000000003051

Table 1.

OUD Diagnostic Criteria and Manifestations in Adolescents

DSM-5 Diagnostic Criteria for OUD  Examples of OUD Signs in Adolescents
 1. Opioids are taken in larger amounts, duration than intended

  • Overdosing

  • Using outside of weekends or social situations
 2. Persistent desire/unsuccessful effort to cut down or control opioid use

  • Multiple unsuccessful quit attempts
 3. A great deal of time is spent obtaining, using or recovering from the effects of opioids

  • Missing school or work due to side effects of opioids

  • Engagement with new peer group to obtain opioids

  • New romantic relationship to obtain opioids
 4. Craving

  • Missing obligations to seek opioids
 5. Recurrent use of opioid results in failure to fulfill major role obligations at work, school, or home.

  • Truancy

  • Missed work

  • Decline in grades or academic failure

  • Missed athletic or extracurricular obligations
 6. Continued use despite social/interpersonal substance - related problems.

  • Continued use despite loss of friend/peer group

  • Continued use despite worsening familial relationships

  • Continued use despite legal ramifications

  • Use associated with suspensions or fighting
 7. Important social, occupational, or recreational activities are given up or reduced because of substance use

  • Withdrawal from extracurricular activities

  • Loss of employment

  • Withdrawal from previous peer groups

  • Self-isolating from family and friends
 8. Recurrent use in hazardous situations

  • Impaired driving, or riding in a vehicle with an impaired driver

  • Continued use despite risk of assault or violence

  • Use while driving with strangers

  • Use prior to sex

  • Carrying a weapon while under the influence of opioids
 9. Continued use despite knowledge of having a persistent or recurrent opioid-related physical or psychological problem that is likely caused or exacerbated by opioid use

  • Use despite depression, constipation, erectile dysfunction, mental illness

  • Continued IDU despite chronic blood borne infection (HIV, HCV) or STI
 10. Tolerance
 11. Withdrawal

  • Diarrhea, Flu-like illness, malaise, chills, sweats, nausea and vomiting