Opioid dependence latent structure: two classes with differing severity?
OBJECTIVE
To examine the structure of illicit opioid abuse and dependence within an opioid dependent sample and its relationship to other clinical variables.


METHODS
A cross-sectional study of 1511 opioid dependent individuals recruited through opioid pharmacotherapy clinics in the Sydney area, Australia.


METHODS
A face-to-face structured interview covering substance use and dependence, psychiatric history, child maltreatment, family background, adult violence and criminal history. Dimensional, latent class and factor mixture models were fit to the opioid abuse and dependence data. Classes were then compared on a range of demographic and clinical covariates.


RESULTS
A two-class, one-factor model provided the best fit of all the models tested. The two classes differed with respect to endorsement probabilities on a range of abuse and dependence criteria, and also with respect to the odds of other drug dependence diagnoses, antisocial personality disorder and non-fatal opioid overdose. Within-class severity was associated with similar variables: other drug dependence, borderline personality disorder and opioid overdose.


CONCLUSIONS
In an in-treatment, opioid-dependent sample, there appears to be two classes of individuals exhibiting distinct patterns of abuse and dependence criteria endorsement and to differ on externalizing but not internalizing disorders. This study provides preliminary evidence that the proposed DSM-V opioid use disorder distinction between moderate and severely dependent people is valid. Class one participants were not only more severely dependent, but had greater odds for opioid overdoses, other drug dependence and antisocial personality disorder.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia. fionas@unsw.edu.au
Fiona L
FL
Shand
Tim
T
Slade
Louisa
L
Degenhardt
Andrew
A
Baillie
Elliot C
EC
Nelson
D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D062787:Drug Overdose / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D015233:Models, Statistical; D009517:New South Wales / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000145:classification* / Q000453:epidemiology / Q000523:psychology*; D010554:Personality Disorders / Q000453:epidemiology / Q000523:psychology; D011336:Probability; D012720:Severity of Illness Index; D016320:Substance Abuse Treatment Centers; D013405:Suicide / Q000706:statistics & numerical data