Revised September 2018
Questions about your use of [name of opioid(s)] in the past 12 months (keep track of yes responses):
- Have you often found that when you started using XX, you ended up taking more than you intended to?
- Have you wanted to stop or cut down using or control your use of XX?
- Have you spent a lot of time getting XX or using XX?
- Have you had a strong desire or urge to use XX?
- Have you missed work or school or often arrived late because you were intoxicated, high or recovering from the night before?
- Has your use of XX caused problems with other people such as with family members, friends or people at work?
- Have you had to give up or spend less time working, enjoying hobbies, or being with others because of your drug use?
- Have you ever gotten high before doing something that requires coordination or concentration like driving, boating, climbing a ladder, or operating heavy machinery?
- Have you continued to use even though you knew that the drug caused you problems like making you depressed, anxious, agitated or irritable?
- Have you found you needed to use much more drug to get the same effect that you did when you first started taking it?
- When you reduced or stopped using, did you have withdrawal symptoms or feel sick (aches, shaking, fever, weakness, diarrhea, nausea, sweating, heart pounding, difficulty sleeping, or feel agitated, anxious, irritable, or depressed)?
Count the number of yes answers to the questions above:
- 4-5 - Moderate Opioid Use Disorder
- 6 or more - Severe Opioid Use Disorder
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