Zoom Issue Tracking

1

Do you spend a lot of time getting opioids, using them, or recovering from your use of them?* This field is required.

YESNO

2

Do you often use opioids for a longer time than you originally intended, and/or in greater doses than intended?* This field is required.

YESNO

3

Because of your opioid use, have you failed to meet obligations and responsibilities at home, work, or school?* This field is required.

YESNO

4

Have you suffered relationship issues or social problems because of your opioid use, but kept using opioids anyway?* This field is required.

YESNO

5

Have you been forced to reduce or abandon your social or recreational activities (like spending time with friends or doing hobbies) due to your continued use of opioids?* This field is required.

YESNO

6

Have you taken opioids when it was physically dangerous to do so (like while driving or in other unsafe situations)?* This field is required.

YESNO

7

Have you often wanted to cut back on your use of opioids, and/or tried unsuccessfully to cut back or quit?* This field is required.

YESNO

8

Do you experience powerful cravings and strong urges to use opioids?* This field is required.

YESNO

9

Have you continued using opioids even when you knew this was worsening your physical or mental health issues?* This field is required.

YESNO

10

When you go for a period of time without using opioids, have you experienced withdrawal symptoms or felt dopesick? Or have you taken opioids especially to avoid or relieve withdrawal symptoms?* This field is required.

YESNO

11

After taking the same dose of opioids for a period of time, have they had less of an effect on you? And/or have you found yourself needing to take larger doses or stronger opioids to get the effect you wanted?* This field is required.

YESNO

12

Total Score