Answer the questions below to find out if you or a loved one is at risk for opioid dependence.  

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We encourage you to discuss these results with your doctor or healthcare provider.

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1. Opioid or narcotic prescription pain medications include (but are not limited to): Oxycodone, Oxycontin, Hydrocodone, Vicodin, Norco, Buprenorphine, Fentanyl, Morphine, and Codeine.  I am currently taking one or more of these pain medications.

2. I have chronic pain or have recently had an accident or injury.

3. I have misused drugs or alcohol in the past.

4. I have been taking prescription pain medication for longer than one week.

5. I have difficulty controlling how much I use or for how long I use prescription pain medication.

6. I have made unsuccessful attempts to cut down my use of prescription pain medication.

7. I spend a significant amount of time using or recovering from my use of prescription pain medication.

8. My use of prescription pain medication has had negative consequences on my home life, school, or work.

9. Prescription pain medication has had negative consequences on my relationships or social life.

10. I have continued to use despite any negative consequences.

11. I have concealed how much I use or people have commented on my use.

12. I have procrastinated or neglected to do things because of my prescription pain medication use.

13. I have experienced strong cravings for prescription pain medication.

14. I need a higher dose of prescription pain medication than before to achieve the same result.

15. I have experienced any of the following symptoms after stopping use of prescription pain medication (even after only one day): diarrhea, nausea, vomiting, crying/tears, runny nose, sweating, yawning, chicken skin, anxiety/worrying, trouble sleeping, or fever.

16. My prescription pain medication use caused me to put myself or someone else in a dangerous situation.

This questionnaire was developed by the Hawai‘i Opioid Initiative and based on the DSM-5.