spent trying to obtain opioids, use opioids, or recover from taking them The individual has cravings for opioids Difficulty fulfilling professional duties at work or school Continued use of opioids leading to social and interpersonal consequences Decreased social or recreational activities Using opioids despite being in physically dangerous settings Continued use despite opioids worsening physical or psychological health (i.e. depression, constipation) Tolerance Withdrawal The severity can be classified as mild, moderate, or severe based on the number of criteria present.The tolerance and withdrawal criteria are not considered to be met for individuals taking opioids solely under appropriate medical supervision.Addiction and dependence are components of a substance use disorder; addiction is the more severe form. Signs and symptoms Opioid intoxication Signs and symptoms of opioid intoxication include: Decreased perception of pain Euphoria Confusion Desire to sleep Nausea Constipation Miosis (pupil constriction) Bradycardia (slow heart rate) Hypotension (low blood pressure) Hypokinesis (slowed movement) Head nodding Slurred speech Hypothermia (low body temperature) Opioid overdose Signs and symptoms of opioid overdose include, but are not limited to:<ref name=":6">Kosten TR, Haile CN. Opioid-Related Disorders. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&sectionid=79757372 Accessed 9 March 2017.</ref> Pin-point pupils may occur. Patient presenting with dilated pupils may still be experiencing an opioid overdose. Decreased heart rate Decreased body temperature Decreased breathing Altered level of consciousness. People may be unresponsive or unconscious. Pulmonary edema (fluid accumulation in the lungs) Shock Death Withdrawal Opioid withdrawal can occur with a sudden decrease in, or cessation of, opioids after prolonged use. Onset of withdrawal depends on the half-life of the opioid that was used last. With heroin this typically occurs five hours after use; with methadone, it may take two days. The length of time that major symptoms occur also depends on the opioid used. For heroin withdrawal, symptoms are typically greatest at two to four days and can last up to two weeks. Less significant symptoms may remain for an even longer period, in which case the withdrawal is known as post-acute-withdrawal syndrome. Agitation Anxiety Muscle pains Increased tearing Trouble sleeping Runny nose Sweating Yawning Goose bumps Dilated pupils Diarrhea Fast heart rate High blood pressure Abdominal cramps Shakiness Cravings Sneezing Treatment of withdrawal may include methadone and buprenorphine. Medications for nausea or diarrhea may also be used. Cause Opioid use