Opioid use disorder is characterized by which of the following? SELECT ALL THAT APPLY

A. Strong desire or craving for opioid use: Opioid use disorder involves dysregulation of the brain’s reward pathways, leading to persistent cravings and compulsive drug-seeking behavior. Craving reflects neuroadaptations in dopamine and opioid receptor systems. It is a core diagnostic criterion in substance use disorders. B. Continued opioid use despite risk or harm: Individuals with opioid use disorder continue using opioids despite physical, psychological, or social consequences. This behavior reflects impaired control and prioritization of substance use over safety and responsibilities. Ongoing use despite harm is central to the diagnosis. C. Unsuccessful efforts to cut down or control opioid use: Repeated failed attempts to reduce or stop opioid use indicate loss of control over substance intake. Neurobiological dependence and withdrawal symptoms reinforce continued use. This pattern distinguishes substance use disorder from occasional or prescribed use. D. Opioids taken in smaller amounts and several times per day: Opioid use disorder is characterized by taking larger amounts or using for longer periods than intended, not smaller amounts. Frequency alone does not define the disorder without loss of control or negative consequences.