Zia Health and Wellness 505-299-7873, Medical Cannabis Program Application

Zia Health and Wellness 505-299-7873, Medical Cannabis Program Application

Table one DSM-5 diagnostic criteria for opioid use disorder (Requires two or more)
Patient application for opioid use disorder
Full Name*

First NameLast Name
Phone Number*
E-mail
example@example.com
Use of opioid in larger amounts of for longer period of time than intended

Type option 1
Persistent desire or failed efforts to control use

Type option 3
Much time spent obtaining, using,or recovering from effects

Type option 1
Craving, strong desire, or urge to use

Type option 3
Failure to fulfill major roles at home, work,or school
Continued use despite social or interpersonal problems related to use

Type option 1
Giving up or reducing important social, occupational,or recreational activities due to use

Type option 3
Recurrent use in physically hazardous situations (e.g.,operating machinery, driving.

Type option 3
Continued use despite awareness of a physical or psychological problem due to opioids

Type option 1
Tolerance need for a larger amount to achieve desired effect or diminished effect with same amount

Type option 3
Withdrawal occurrence of a characteristic opioid withdrawal syndrome or continued use of opioid or closely related substances to avoid withdrawal symptoms

Type option 1
Note Tolerance and withdrawal critera do not apply to patients properly taking prescription opoiods under appropriate medical supervision sourse Derivied from DSM-5
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