Opioid-induced mental disorders. Opioid-induced disorders occur frequently in individ- uals with opioid use disorder. Opioid-induced disorders may be characterized by symptoms (e.g., depressed mood) that resemble primary mental disorders (e.g., persistent depressive dis- order [dysthymia] vs. opioid-induced depressive disorder, with depressive features, with on- set during intoxication). Opioids are less likely to produce symptoms of mental disturbance than are most other drugs of abuse. Opioid intoxication and opioid withdrawal are distin- guished from the other opioid—induced disorders (e.g., opioid-induced depressive disorder, with onset during intoxication) because the symptoms in these latter disorders predominate the clinical presentation and are severe enough to warrant independent Clinical attention.
Other substance intoxication. Alcohol intoxication and sedative, hypnotic, or anxiolytic intoxication can cause a clinical picture that resembles that for opioid intoxication. A diag- nosis of alcohol or sedative, hypnotic, or anxiolytic intoxication can usually be made based on the absence of pupillary constriction or the lack of a response to naloxone challenge. In some cases, intoxication may be due both to opioids and to alcohol or other sedatives. In these cases, the naloxone challenge will not reverse all of the sedative effects.
Other withdrawal disorders. The anxiety and restlessness associated with opioid with- drawal resemble symptoms seen in sedative-hypnotic withdrawal. However, opioid
Withdrawal is also accompanied by rhinorrhea, lacrimation, and pupillary dilation, which are not seen in sedative-type withdrawal. Dilated pupils are also seen in hallucinogen intoxication and stimulant intoxication. However, other signs or symptoms of opioid withdrawal, such as nausea, vomiting, diarrhea, abdominal cramps, rhinorrhea, or lacri— mation, are not present.
The most common medical conditions associated with opioid use disorder are viral (e.g.,
HIV, hepatitis C virus) and bacterial infections, particularly among users of opioids by in- jection. These infections are less common in opioid use disorder with prescription opioids.
Opioid use disorder is often associated with other substance use disorders, especially those involving tobacco, alcohol, cannabis, stimulants, and benzodiazepines, which are often taken to reduce symptoms of opioid withdrawal or craving for opioids, or to enhance the ef- fects of administered opioids. Individuals with opioid use disorder are at risk for the devel- opment of mild to moderate depression that meets symptomatic and duration criteria for persistent depressive disorder (dysthymia) or, in some cases, for major depressive disorder.
of a preexisting primary depressive disorder. Periods of depression are especially common during chronic intoxication or in association with physical or psychosocial stressors that are related to the opioid use disorder. Insomnia is common, especially during withdrawal. An- tisocial personality disorder is much more common in individuals with opioid use disorder than in the general population. Posttraumatic stress disorder is also seen with increased fre- quency. A history of conduct disorder in childhood or adolescence has been identified as a significant risk factor for substance-related disorders, especially opioid use disorder.
A. Recent use of an opioid.
B. Clinically significant problematic behavioral or psychological changes (e.g.. initial eu- phoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgment) that developed during. or shortly after, opioid use.