title: Prevalence of prescription opioid-use disorder among chronic pain patients: comparison of the DSM-5 vs. DSM-4 diagnostic criteria.
abstract: The authors estimated the prevalence of lifetime prescription opioid-use disorder among outpatients on opioid therapy using criteria from both versions 4 and 5 of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Using electronic records from a large health care system, a random sample of outpatients undergoing long-term opioid therapy for non-cancer pain was identified and 705 participants completed diagnostic interviews. The prevalence of lifetime DSM-5 opioid-use disorder among these patients was 34.9% (95% confidence interval [CI] = 30.5?39.5), similar to the prevalence of DSM-4 opioid dependence (35.5%, 95% CI = 31.1?40.2). The Kappa value between DSM-5 and DSM-4 criteria was high (Kappa = 0.873, p < 0.0001). Logistic regressions suggested DSM-5 opioid-use disorder was associated with age younger than 65 (odds ratio [OR] = 2.25, p = 0.009), history of opioid abuse (OR = 4.94, p < 0.001), higher opioid withdrawal symptoms (OR = 3.01, p = 0.008), and history of substance abuse treatment (OR = 1.62, p = 0.015), similar to DSM-4. Based on DSM-5, 21.7% of patients met criteria for moderate and 13.2% for severe opioid-use disorder, respectively. Given the changes proposed, the finding that the prevalence of and risk factors for DSM-5 opioid-use disorders were similar to DSM-4 were unexpected. Further research is advised.
authors: Center for Health Research, Geisinger Clinic, Danville, PA 17822-4400, USA. jaboscarino@geisinger.edu
authors: Joseph A
authors: JA
authors: Boscarino
authors: Margaret R
authors: MR
authors: Rukstalis
authors: Stuart N
authors: SN
authors: Hoffman
authors: John J
authors: JJ
authors: Han
authors: Porat M
authors: PM
authors: Erlich
authors: Stephen
authors: S
authors: Ross
authors: Glenn S
authors: GS
authors: Gerhard
authors: Walter F
authors: WF
authors: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D010146:Pain / Q000150:complications / Q000523:psychology*; D010414:Pennsylvania / Q000453:epidemiology; D055553:Prescription Drugs / Q000009:adverse effects*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
chemical_list: D055553:Prescription Drugs