Opioid Dependence

Opioid Dependence

Opioid dependency is a medical diagnosis characterized by an individual's inability to stop using opioids (morphine, heroin, codeine, oxycodone, hydrocodone, etc.) even when objectively it is in his or her best interest to do so. In 1964 the WHO Expert Committee on Drug Dependence introduced "dependence" as "A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Determinants and problematic consequences of drug dependence may be biological, psychological or social, and usually interact". The core concept of the WHO definition of "drug dependence" requires the presence of a strong desire or a sense of compulsion to take the drug; and the WHO and DSM-IV-TR clinical guidelines for a definite diagnosis of "dependence" require that three or more of the following six characteristic features be experienced or exhibited:

1. A strong desire or sense of compulsion to take the drug;
2. Difficulties in controlling drug-taking behaviour in terms of its onset, termination, or levels of use;
3. A physiological withdrawal state when drug use is stopped or reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
4. Evidence of tolerance, such that increased doses of the drug are required in order to achieve effects originally produced by lower doses;
5. Progressive neglect of alternative pleasures or interests because of drug use, increased amount of time necessary to obtain or take the drug or to recover from its effects;
6. Persisting with drug use despite clear evidence of overtly harmful consequences, such as harm to the liver, depressive mood states or impairment of cognitive functioning.

The Walid-Robinson Opioid-Dependence (WROD) Questionnaire was designed based on these guidelines. According to position papers on the treatment of opioid dependence published by the United Nations Office on Drugs and Crime and the World Health Organization, care providers should not mistake opioid dependence for a weakness of character or will. Accordingly, detoxification alone does not constitute adequate treatment.