dividual is both in remission and receiving maintenance therapy. “In a controlled environ-
ment” applies as a further specifier of remission if the individual is both in remission and in
a controlled environment (i.e., in  early remission in a controlled environment or in sustained
remission in a controlled envi ronment). Examples of these en vironments are closely super-
vised and substance-free jail s, therapeutic communities, an d locked hospital units. 
Changing severity across time in an individual  is also reflected by reductions in the fre-
quency (e.g., days of use per month) and/or dose (e.g., injections or number of pills) of an
opioid, as assessed by the individual’s self-r eport, report of knowledgeable others, clini-
cian’s observations, and biological testing.
Diagnostic Features
Opioid use disorder includes signs and sympto ms that reflect compulsive, prolonged self-
administration of opioid substances that are used for no legitimate medical purpose or, if
another medical condition is pres ent that requires opioid treatment, that are used in doses
greatly in excess of the amount needed for th at medical condition. (F or example, an indi-
vidual prescribed analgesic opioids for pain re lief at adequate dosing will use significantly
more than prescribed and not only because of persistent pain.) Individuals with opioid use
disorder tend to develop such regular patterns of compulsive drug use that daily activities
are planned around obtaining and administer ing opioids. Opioids are usually purchased
on the illegal market but may also be obtained  from physicians by falsifying or exagger-
ating general medical problems or by receiv ing simultaneous prescr iptions from several
physicians. Health care professionals with op ioid use disorder will often obtain opioids by
writing prescriptions for themselves or by dive rting opioids that have been prescribed for