Opiates

1. Do you use opiates in larger amounts or for longer amount of time than you intended?

   Yes No

2. Do you want to cut down or stop taking opiates, but are unable to?

   Yes No

3. Do you spend a lot of time looking for, taking, or recovering from the effects of opiates?

   Yes No

4. Do you experience cravings, or strong desires and urges to use opiates?

   Yes No

5. Are you unable to manage doing what you should at work, home, or school because of your opiate use?

   Yes No

6. Do you continue to use opiates, even when it causes problems in your relationships?

   Yes No

7. Do you give up important social, occupational, or recreational activities because of your opiate use?

   Yes No

8. Do you tend to put yourself in physically hazardous situations when using opiates?

   Yes No

9. Do you continue to use opiates even when you know you have a physical or psychological problem that could have been caused or made worse by the opiates?

   Yes No

10. Do you need to use more opiates to get the same effect?

    Yes No

11. Have you ever had opiate withdrawal symptoms, which may include depressed mood, nausea, vomiting, muscle aches, runny nose or eyes, dilated pupils, sweating, diarrhea, yawning, fever, and insomnia? Or have you ever taken a medication such as Suboxone or Methadone to relieve these symptoms ?

    Yes No