Opioid misuse in Canada and critical appraisal of aberrant behavior screening tools

Table 1 Definitions[8,10-13]

Tolerance	A state of adaptation where fixed doses of opioids over time results in the need for increasing doses to maintain the same effect
Physical dependence	A state of adaptation manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist
Dependence (DSM-V criteria)[14]	A substance use disorder as a maladaptive pattern leading to clinically significant impairment or distress for at least 12 mo and meet ≥ 2 of the following:
	Recurring opioid use leading to a failure to fulfill role obligations
	Societal and interpersonal problems
	Using opioids in situations that are physically hazardous
	Tolerance
	Withdrawal
	Taking opioid in larger amounts and for longer periods than intended
	Unsuccessful at cutting down
	Spending time to obtain or use the opioid
	Giving up activities due to opioid use
	Continuing use despite physical or psychological problems
	Craving or strong urge to use the opioid
Aberrant behavior	Behaviours that may cause suspicion about addiction in opioid-treated pain patients or a behavior outside the boundaries of the agreed-on treatment plan which is established as early as possible in the doctor-patient relationship
Misuse	Use of a medication for non-medical use or for reasons other than prescribed. Wilful or unintentional use of a substance in a manner not consistent with legal or medical guidelines such as altering dosage forms, sharing medications with the potential for harmful consequences.
Abuse	Misuse with consequences. The use of a substance to modify/control mood or state of mind (to obtain a “high”) in a manner that is illegal or harmful to oneself or others. Examples of potential consequences include accident, injuries, blackouts, legal issues, and sexual behavior increasing the risk of sexually-transmitted diseases
Addiction	A primary, chronic, neurobiological disease with genetic, psychosocial and environmental factors influencing its development and manifestations. It is characterized by compulsive use, continued use despite harm and craving
Diversion	The unintentional transfer of a controlled substance from legitimate distribution and dispensing channels into illegal channels or obtaining a substance by an illegal method

DSM-V: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.