Mental and Behavioural Disorders Due to Opioid Use (F11)
DSM-5-TR: Opioid Use Disorder
ICD-10-AM and DSM-5-TR may classify conditions differently. Refer to APA and WHO for complete diagnostic criteria.
Key Facts
ICD-10 Range
F10-F19
Subcodes
5 subcodes
Australian Prevalence
Approximately 0.4% of Australians have an opioid use disorder. Opioid-related deaths are a significant public health concern, with prescription opioids accounting for the majority of opioid-related fatalities.
Global Prevalence
WHO estimates approximately 16 million people worldwide have an opioid use disorder. Opioid-related harm accounts for approximately two-thirds of the 500,000 deaths attributable to drug use globally.
Duration Requirement
Dependence syndrome (F11.2): three or more features present simultaneously for at least one month, or repeatedly within a 12-month period
Overview
Covers disorders arising from the use of opioids including heroin, morphine, codeine, and prescription opioids such as oxycodone and fentanyl. Presentations range from acute intoxication to dependence and withdrawal syndromes.
Diagnostic Criteria (ICD-10)
Core Features
- Strong desire or compulsion to use opioids
- Difficulty controlling opioid use in terms of onset, termination, or amount
- Physiological withdrawal state when opioid use is reduced or stopped
- Evidence of tolerance — increased doses required for the same effect
- Progressive neglect of alternative pleasures or interests
- Persistent use despite clear evidence of harmful consequences
Duration
Dependence syndrome (F11.2): three or more features present simultaneously for at least one month, or repeatedly within a 12-month period
Exclusion Criteria
- Opioid use for pain management under medical supervision without features of dependence
ICD-10-AM Subcodes
| Code | Name | Description |
|---|---|---|
| F11.0 | Acute intoxication | |
| F11.1 | Harmful use | |
| F11.2 | Dependence syndrome | |
| F11.3 | Withdrawal state | |
| F11.5 | Psychotic disorder |
Classification Boundaries
Includes
- Opioid dependence
- Heroin dependence
- Morphine dependence
Australian Clinical Context
Opioid-related deaths are a significant public health concern in Australia. PBS-subsidised opioid substitution therapy (OST) includes methadone and buprenorphine/naloxone (Suboxone). The National Opioid Pharmacotherapy Program oversees OST access. Take-home naloxone programs are available in all states and territories.
Medicare (MBS) Pathways
Better Access to Mental Health Care
The primary Medicare pathway for mental health treatment in Australia. Requires a GP Mental Health Treatment Plan (MHTP) referral. Available for any clinically diagnosed mental disorder.
| Provider Type | MBS Items | Session Type |
|---|---|---|
| Clinical Psychologist | 80000–80025 | Psychological therapy (higher rebate) |
| Registered Psychologist | 80100–80123 | Focused psychological strategies |
| Occupational Therapist | 80125–80145 | Focused psychological strategies |
| Social Worker | 80150–80175 | Focused psychological strategies |
| Psychiatrist | 291, 296–299, 300–308 | Psychiatric consultation |
Clinical Psychologist
Registered Psychologist
Occupational Therapist
Social Worker
GP referral items: 2700, 2701, 2715, 2717
Eligibility: Any clinically diagnosed mental disorder as defined by WHO ICD-10 Chapter V. Requires a GP or psychiatrist referral.
Exclusions:
- Intellectual disability (use Complex Neurodevelopmental Disorder pathway or specialist referral)
- Dementia and organic mental disorders (use specialist referral pathway)
- Tobacco use disorder
Opioid substitution therapy (OST) is funded through PBS, not MBS Better Access. Psychological treatment for comorbid conditions is covered under Better Access.
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Reference information sourced from MBS Online (mbsonline.gov.au). Item availability, rebates, and eligibility criteria may change. This is not billing advice — always verify current items before claiming. Last verified: April 2026.
Clinical Documentation Notes
The COWS (Clinical Opiate Withdrawal Scale) monitors opioid withdrawal severity. Document substance type (heroin vs prescription opioids), route of administration, dose, frequency, and withdrawal history. RANZCP and RACP guidelines support opioid substitution therapy as first-line treatment for dependence.
Related Diagnostic Codes
ICD-10-AM diagnostic codes commonly associated with the Mental and Behavioural Disorders Due to Opioid Use (F11).
Frequently Asked Questions
References
- World Health Organization. ICD-10-AM.
- American Psychiatric Association. DSM-5-TR. 2022.
- AIHW. National Drug Strategy Household Survey.
Clinical Scoring Calculator — Not a Diagnostic Tool
This tool calculates scores based on published guidelines for professional reference. It does not provide clinical diagnoses. Scores are provided as reference information only and should be interpreted by a qualified practitioner in the context of a comprehensive assessment.
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