Disorders due to use of opioids

Disorders Due to Use of Opioids are characterized by the pattern and consequences of opioid use. Opioids is a generic term that encompasses the constituents or derivatives of the opium poppy Papaver somniferum as well as a range of synthetic and semisynthetic compounds, some related to morphine and others chemically distinct but all having their primary actions on the µ opioid receptor. Examples of opioids include morphine, diacetylmorphine (heroin), fentanyl, pethidine, oxycodone, hydromorphone, methadone, buprenorphine, codeine and d-propoxyphene. The opioids all have analgesic properties of different potencies and are primarily central nervous system depressants. They suppress respiration as well as other vital functions and are a common cause of overdose and related deaths. Certain opioids are used or administered parenterally, including heroin, a common and potent opioid that is primarily used non-medically. Therapeutic opioids are prescribed for a range of indications worldwide, and are essential for pain management in cancer pain and palliative care, although they are also used for non-therapeutic reasons. In some countries morbidity and mortality related to therapeutic opioids is greater than that related to heroin. All opioids may result in Opioid Intoxication, Opioid Dependence and Opioid Withdrawal. A range of Opioid-Induced Disorders occur, some of which occur following Opioid Withdrawal. Because certain opioids are commonly injected illicitly, their use is a potent mechanism of transmission of blood borne viral infections such as hepatitis B, hepatitis C and HIV/AIDS, as well as bacterial infections. Not including alcohol and tobacco, opioids are the most common cause of death from psychoactive drug use worldwide.

Diagnostic Categories that Apply to Opioids

Following is a list of specific diagnostic categories of that apply to opioids:

• 6C43.0 Episode of Harmful Use of Opioids
• 6C43.1 Harmful Pattern of Use of Opioids
• 6C43.2 Opioid Dependence
• 6C43.3 Opioid Intoxication
• 6C43.4 Opioid Withdrawal
• 6C43.5 Opioid-Induced Delirium
• 6C43.6 Opioid-Induced Psychotic Disorder
• 6C43.70 Opioid-Induced Mood Disorder
• 6C43.71 Opioid-Induced Anxiety Disorder
• 6C43.Y Other Specified Disorder Due to Use of Opioids
• 6C43.Z Disorder Due to Use of Opioids, Unspecified

An additional category of disorder induced by psychoactive substances is included in another part of the ICD-11 chapter on Mental, Behavioural, and Neurodevelopmental Disorders. This is cross-listed in the section below on Substance-induced Mental Disorders for reference:

• 6A41 Catatonia Induced by Substances or Medications

The first three diagnoses listed above (Episode of Harmful Use of Opioids, Harmful Pattern of Use of Opioids, and Opioid Dependence) describe the pattern of opioid use. One of these three diagnoses, or Disorder Due to Use of Opioids, Unspecified, for cases in which the use pattern in unknown at the time of evaluation, is considered to be the primary diagnosis. That is, one of these four diagnoses should be assigned when making a diagnosis of a Disorder Due to Opioid Use.

The remaining diagnoses reflect the impact of the pattern of opioid use and are thus considered to be associated with one of the primary use pattern diagnoses. These diagnoses should therefore be assigned together with the relevant primary diagnosis. For example, 6C43.1/ 6C43.5 is Harmful Pattern of Use of Opioids associated with Opioid-Induced Psychotic Disorder, 6C43.2/6C43.70 is Opioid Dependence associated with Opioid-Induced Mood Disorder, 6C4Z/6C43.3 is Disorders Due to Substance Use, Unspecified associated with Opioid Intoxication (i.e., the pattern of use in this last case is unknown).

Opioid-induced Mental Disorders are characterized by psychological, cognitive, or behavioural symptoms that develop during or soon after opioid intoxication or withdrawal or use or discontinuation of a psychoactive medication. The duration or severity of the symptoms is substantially in excess of the characteristic syndrome of Opioid Intoxication or Opioid Withdrawal.