Friday, 27 May 2022

ICD-11 Criteria for Disorders Due to Use of Nicotine (6C4A)

ICD-11 Criteria for Disorders Due to Use of Nicotine (6C4A)

Disorders due to use of nicotine are characterised by the pattern and consequences of nicotine use. Nicotine is the active dependence-producing constituent of the tobacco plant, Nicotiana tabacum. Nicotine is used overwhelmingly through smoking cigarettes. Increasingly, it is also used in electronic cigarettes that vaporize nicotine dissolved in a carrier solvent for inhalation (i.e., “vaping”). Pipe smoking, chewing tobacco and inhaling snuff are minor forms of use. Nicotine is a highly potent addictive compound and is the third most common psychoactive substance used worldwide after caffeine and alcohol. Nicotine Dependence and Nicotine Withdrawal are well described and Nicotine-Induced Mental Disorders are recognized.

6C4A.0     Episode of Harmful Use of Nicotine

An episode of nicotine use that has caused damage to a person’s physical or mental health. Harm to health of the individual occurs due to one or more of the following: (1) direct or secondary toxic effects on body organs and systems; or (2) a harmful route of administration. This diagnosis should not be made if the harm is attributed to a known pattern of nicotine use.

Exclusions:

  • Nicotine dependence (6C4A.2)
  • Harmful pattern of use of nicotine (6C4A.1)

Harmful effects of or exposure to noxious substances, chiefly nonmedicinal as to source, not elsewhere classified (NE61)

6C4A.1     Harmful Pattern of Use of Nicotine

A pattern of nicotine use that has caused damage to a person’s physical or mental health. The pattern of nicotine use is evident over a period of at least 12 months if substance use is episodic or at least one month if use is continuous (i.e., daily or almost daily). Harm to health of the individual occurs due to one or more of the following: (1) direct or secondary toxic effects on body organs and systems; or (2) a harmful route of administration.

Exclusions:

  • Nicotine dependence (6C4A.2)
  • Episode of harmful use of nicotine (6C4A.0)

6C4A.10       Harmful Pattern of Use of Nicotine, Episodic

A pattern of episodic or intermittent nicotine use that has caused damage to a person’s physical or mental health. The pattern of episodic nicotine use is evident over a period of at least 12 months. Harm to the health of the individual occurs due to one or more of the following: (1) direct or secondary toxic effects on body organs and systems; or (2) a harmful route of administration.

Exclusions:

  • Episode of harmful use of nicotine (6C4A.0)
  • Nicotine dependence (6C4A.2)

6C4A.11       Harmful Pattern of Use of Nicotine, Continuous

A pattern of continuous (daily or almost daily) nicotine use that has caused damage to a person’s physical or mental health. The pattern of continuous nicotine use is evident over a period of at least one month. Harm to health of the individual occurs due to one or more of the following: (1) direct or secondary toxic effects on body organs and systems; or (2) a harmful route of administration.

Exclusions:

  • Episode of harmful use of nicotine (6C4A.0)
  • Nicotine dependence (6C4A.2)

6C4A.1Z       Harmful pattern of use of nicotine, unspecified

6C4A.2     Nicotine dependence

Nicotine dependence is a disorder of regulation of nicotine use arising from repeated or continuous use of nicotine. The characteristic feature is a strong internal drive to use nicotine, which is manifested by impaired ability to control use, increasing priority given to use over other activities and persistence of use despite harm or negative consequences. These experiences are often accompanied by a subjective sensation of urge or craving to use nicotine. Physiological features of dependence may also be present, including tolerance to the effects of nicotine, withdrawal symptoms following cessation or reduction in use of nicotine, or repeated use of nicotine or pharmacologically similar substances to prevent or alleviate withdrawal symptoms. The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if nicotine use is continuous (daily or almost daily) for at least 3 months.

Exclusions:

  • Episode of harmful use of nicotine (6C4A.0)
  • Harmful pattern of use of nicotine (6C4A.1)

6C4A.20       Nicotine Dependence, Current Use

Current nicotine dependence with nicotine use within the past month.

Exclusions:

  • Episode of harmful use of nicotine (6C4A.0)
  • Harmful pattern of use of nicotine (6C4A.1)

6C4A.21       Nicotine dependence, early full remission

After a diagnosis of nicotine dependence, and often following a treatment episode or other intervention (including self-help intervention), the individual has been abstinent from nicotine during a period lasting from between 1 and 12 months.

Exclusions:

  • Episode of harmful use of nicotine (6C4A.0)
  • Harmful pattern of use of nicotine (6C4A.1)

6C4A.22       Nicotine Dependence, Sustained Partial Remission

After a diagnosis of nicotine dependence, and often following a treatment episode or other intervention (including self-help intervention), there is a significant reduction in nicotine consumption for more than 12 months, such that even though intermittent or continuing nicotine use has occurred during this period, the definitional requirements for dependence have not been met.

Exclusions:

  • Episode of harmful use of nicotine (6C4A.0)
  • Harmful pattern of use of nicotine (6C4A.1)

6C4A.23       Nicotine Dependence, Sustained Full Remission

After a diagnosis of nicotine dependence, and often following a treatment episode or other intervention (including self-intervention), the person has been abstinent from nicotine for 12 months or longer.

Exclusions:

  • Episode of harmful use of nicotine (6C4A.0)
  • Harmful pattern of use of nicotine (6C4A.1)

6C4A.2Z       Nicotine dependence, unspecified

6C4A.3     Nicotine intoxication

Nicotine intoxication is a clinically significant transient condition that develops during or shortly after the consumption of nicotine that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of nicotine and their intensity is closely related to the amount of nicotine consumed. They are time-limited and abate as nicotine is cleared from the body. Presenting features may include restlessness, psychomotor agitation, anxiety, cold sweats, headache, insomnia, palpitations, paresthesias, nausea or vomiting, abdominal cramps, confusion, bizarre dreams, burning sensations in the mouth, and salivation. In rare instances, paranoid ideation, perceptual disturbances, convulsions or coma may occur. Nicotine intoxication occurs more commonly in naïve (non-tolerant) users or among those taking higher than accustomed doses.

Coding Note:     Code aslo the causing condition

Inclusions:

  • Bad trips" due to nicotine

Exclusions:

  • Intoxication meaning poisoning (NE61)
  • Possession trance disorder (6B63)

6C4A.4     Nicotine Withdrawal

Nicotine withdrawal is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in degree of severity and duration, that occurs upon cessation or reduction of use of nicotine (typically used as a constituent of tobacco) in individuals who have developed Nicotine dependence or have used nicotine for a prolonged period or in large amounts. Presenting features of Nicotine withdrawal may include dysphoric or depressed mood, insomnia, irritability, anger, anxiety, difficulty concentrating, restlessness, bradycardia, increased appetite, and craving for tobacco (or other nicotine-containing products. Other physical symptoms may include increased cough and mouth ulceration.

Coding Note:     Code aslo the causing condition

6C4A.Y     Other Specified Disorders Due to Use of Nicotine
6C4A.Z     Disorders Due to Use of Nicotine, Unspecified

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/


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