GPAtlas🧭 When to suspect
Opioid dependence is a chronic, relapsing condition in which control over opioid use is lost. Suspect it in anyone using opioids – whether illicit (heroin) or prescribed/over-the-counter (codeine, dihydrocodeine, co-codamol, tramadol, morphine, oxycodone) – who shows tolerance (needing more for the same effect), withdrawal on stopping, strong craving, or continued use despite harm.
Be alert to behavioural clues: frequent early-refill or replacement-prescription requests, “lost” prescriptions, obtaining opioids from several prescribers or non-medical sources, and signs of injecting. Prescription and over-the-counter opioid dependence is a growing primary-care problem and is easily missed.
The two priorities in primary care are to recognise dependence early and engage the patient in treatment, and to never miss an overdose or other emergency.
| Features that suggest opioid dependence (ICD-11) |
|---|
• Impaired control over opioid use – amount, frequency, or duration. |
• Opioid use takes increasing priority over other activities and responsibilities. |
• Physiological features – tolerance, a withdrawal state on stopping, or repeated use to relieve or avoid withdrawal. |
• Strong craving or compulsion to use. |
• Continued use despite harm – physical, psychological, social, or legal. |
Source: Drug Misuse and Dependence: UK Clinical Guidelines · NICE CG52 · ICD-11
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