Opioid Use Disorder Diagnosis: Tests, Screening, and More

Being diagnosed with opioid use disorder (OUD) can feel overwhelming, but it’s also the first step toward the care and support you need. If you’re worried about your own opioid use or that of someone you love, it helps to know what the diagnosis process looks like. Understanding it can make the next steps feel less confusing.

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OUD is more than just physical opioid dependence. It involves changes in your behavior, mood, and overall functioning. Like other mental health conditions, OUD can range from mild to severe. Without a diagnosis and treatment, OUD can be life-threatening.

In this article, we’ll explore how healthcare providers diagnose OUD, including the symptoms they look for, the screening tools they might use, and other tests that can help with the diagnosis.

How Is Opioid Use Disorder Identified?

A healthcare provider may suggest evaluating you for OUD or another substance use disorder if they recognize signs and symptoms of OUD. For example, a healthcare provider may have concerns about OUD based on:

• Your own concerns about your opioid use
• Your behavior
• Findings in the prescription drug monitoring program, an electronic database that tracks controlled-substance prescriptions dispensed to you
• Your screening test results

If there are concerns about your opioid use, a healthcare provider will take a closer look at your symptoms and medical history to see if they match the criteria for an OUD diagnosis.

How Is Opioid Use Disorder Diagnosed?

Diagnosing OUD isn’t based on one single test. It requires a thorough evaluation of your symptoms by a healthcare provider. One of the main tools they use is the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). The DSM-5-TR is a manual published by the American Psychiatric Association that outlines criteria to help healthcare providers diagnose mental health and substance use disorders.

DSM-5-TR Diagnostic Criteria for Opioid Use Disorder

The DSM-5-TR identifies 11 symptoms that might indicate an OUD. These symptoms reflect a pattern of opioid drug use that might lead to problems.

People who take prescribed opioids for a medical condition under proper medical care may still develop tolerance and withdrawal. In this case, the criteria alone may not point to OUD and should be considered within the broader clinical picture.

Opioid Use Disorder Severity

Your healthcare provider may use the DSM-5-TR criteria to see how severe an OUD is. The severity is based on the number of criteria you have:

• Mild OUD — Two or three criteria
• Moderate OUD — Four or five criteria
• Severe OUD — Six or more criteria

Knowing how severe OUD is can help guide the best treatment options, such as an intensive outpatient program, residential treatment, or medications for OUD.

Screening Tests for Opioid Use Disorder

Healthcare professionals can use screening tests to check if you have a high risk for OUD. A screening test is a quick questionnaire with questions related to your substance use. These tests can’t diagnose OUD, but they can help healthcare providers decide if you might need a more thorough assessment for OUD.

There are several different screening tests for substance use disorders, including OUD. Most are designed for you to self-report your answers. This means that the results are based on your answers instead of your provider’s observations.

Health experts recommend that healthcare providers regularly screen all adults for drug and alcohol misuse, even if they don’t have any obvious symptoms. You might also need a screening test if you, your healthcare provider, or a loved one notices signs of problematic substance use.

CAGE-AID

The CAGE-AID screening tool has four questions designed to identify substance misuse. It was originally designed to check for alcohol use disorder but was adapted to also look for other drugs. CAGE is an acronym to help remember each question, and AID stands for “adapted to include drugs.” The four questions in this screening tool are:

• Cut down — Have you felt that you should cut down on your drinking or drug use?
• Annoyed — Do you ever feel annoyed when people comment on or criticize your drinking or drug use?
• Guilty — Have you ever felt guilty or embarrassed about your drinking or drug use?
• Eye-opener — Have you ever used drugs or alcohol first thing in the morning?

Answering yes to two or more of these questions could be a sign of a substance use disorder and show the need for more evaluation.

DAST-10

The Drug Abuse Screening Test (DAST-10) is a 10-item screening tool related to drug use patterns and consequences. The score ranges from 0 to 10, with higher scores indicating a greater likelihood of substance use disorder. A score of 3 or higher suggests a moderate to high risk and warrants further assessment.

Opioid Risk Tool

The Opioid Risk Tool (ORT) helps healthcare providers identify people at risk for developing OUD while taking prescription opioids for long-term pain. This tool evaluates your personal and family history of substance use, as well as psychological factors, to determine your risk level. Your healthcare provider may use this tool before you begin treatment with a prescription opioid and during ongoing treatment monitoring.

Other Tests for Opioid Use Disorder

A diagnosis of OUD involves a careful clinical assessment of how you use opioids, how that use affects your daily life, and any medical or social factors that may shape your treatment plan. Other evaluations may also be used to confirm the diagnosis and give your healthcare provider a fuller picture of your condition.

Medical History and Physical Exam

Your healthcare provider will ask you questions about your medical history, such as your personal and family history of mental health conditions (such as depression and anxiety) and substance use disorders. They’ll also ask you about your medical conditions, especially those related to pain. This information can help them understand the medical issues that may be contributing to your symptoms and opioid use.

A physical exam allows your provider to check for signs of opioid use, intoxication, or withdrawal, such as changes in your pupils, skin, respiratory rate, or other vital signs. It also helps to identify potential sources of pain and assess for complications of drug use.

Urine Drug Test

Urine drug tests can show whether opioids or other substances are in the body. They aren’t required to diagnose OUD, but they can give useful information to support a clinical assessment and track treatment progress.

Laboratory Tests

Laboratory tests aren’t needed for an OUD diagnosis. Still, your healthcare provider may order them to check for health problems often linked to substance use disorders, such as infectious diseases (like HIV, hepatitis B, and hepatitis C) or other medical conditions.

The Next Step

If you think you may have OUD, talk with a healthcare provider. They can explain your options, answer your questions, and connect you with treatment. Effective help is available, and many people improve with the right care. Taking the first step may feel hard, but it can make a big difference in your health and well-being.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

What was the diagnostic process like for you? What questions did your doctor ask? Let others know in the comments below.