The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) considers opioid use disorder to be present if the pattern of use causes clinically significant impairment or distress as manifested by the presence of ≥ 2 of the following over a 12-month period: Taking opioids in larger amounts or for a longer time than intended Persistently desiring or unsuccessfully attempting to decrease opioid use Spending a great deal of time obtaining, using, or recovering from opioids Craving opioids Failing repeatedly to meet obligations at work, home, or school because of opioids Continuing to use opioids despite having recurrent social or interpersonal problems because of opioids Giving up important social, work, or recreational activities because of opioids Using opioids in physically hazardous situations Continuing to use opioids despite having a physical or mental disorder caused or worsened by opioids Having tolerance to opioids (not a criterion when use is medically appropriate) Having opioid withdrawal symptoms or taking opioids because of withdrawal Treatment and Rehabilitation for Opioid Use Disorder For severe, relapsing dependence, maintenance preferred to opioid withdrawal and detoxification For maintenance, buprenorphine or methadone Ongoing counseling and support Physicians must be fully aware of federal, state, and local regulations concerning use of an opioid drug to treat someone with a substance use disorder.