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

yesOther
Persistent desire or failed efforts to control use

yes
Much time spent obtaining, using,or recovering from effects

yes
Craving, strong desire, or urge to use

yes
Failure to fulfill major roles at home, work ,or school

yes
Continued use despite social or interpersonal problems related to use

yes
Giving up or reducing important social, occupational,or recreational activities due to use

yes
Recurrent use in physically hazardous situations (e.g.,operating machinery, driving.

yes
Continued use despite awareness of a physical or psychological problem due to opioids

yes
Tolerance need for a larger amount to achieve desired effect or diminished effect with same amount

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

yes
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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