title: Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic noncancer pain: do different measures identify the same patients?
abstract: The International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM) are routinely used in diagnosing illicit substance use disorders, but for people taking prescribed opioids they remain controversial. In pain medicine, the concept of "Addiction" is preferred with reduced emphasis on tolerance and withdrawal. This article examines the prevalence and characteristics of pharmaceutical opioid dependence/disorder according to ICD, DSM, and the pain medicine concept of "Addiction," among chronic noncancer pain (CNCP) patients prescribed opioids. In the current study, we used data from a national sample of 1134 people prescribed opioids for CNCP. Past 12-month "Addiction" (based on Pain Medicine definition), DSM, and ICD dependence definitions were assessed using the Composite International Diagnostic Interview. Twenty-four percent of the cohort met the criteria for "Addiction," 18% for DSM-5 use disorder and 19% for ICD-11 dependence. There was "substantial" concordance between "Addiction" and both DSM-5 use disorder and ICD-11 dependence, although concordance was much greater with ICD-11 dependence (kappa = 0.63 and 0.79, respectively). Participants meeting the criteria for "Addiction" only were older, less likely to engage in nonadherent behaviours, self-reported fewer problems or concerns with their medication, and had lower rates of psychological distress than those who also met the DSM-5 and ICD-11 criteria. The definition of "Addiction" captures a larger group of patients than other classification systems and includes people with fewer "risk" behaviours. Despite removal of tolerance and withdrawal for prescribed opioid use for DSM-5, we found that "Addiction" was more closely related to an ICD-11 diagnosis of pharmaceutical opioid dependence.
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Campbell
authors.affiliation: School of Medicine, University of Tasmania, Hobart, Australia.
authors.forename: Raimondo
authors.initials: R
authors.lastname: Bruno
authors.affiliation: Sydney Medical School, Sydney University, Sydney, Australia.|The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.affiliation: St Vincent's Clinical School, UNSW Medicine, UNSW, Sydney, Australia.
authors.forename: Milton
authors.initials: M
authors.lastname: Cohen
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.|National Addiction Centre, Kings College London, United Kingdom.
authors.forename: Wayne
authors.initials: W
authors.lastname: Hall
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mattick
authors.affiliation: Sydney Medical School, Sydney University, Sydney, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Blyth
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Farrell
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.|School of Population and Global Health, University of Melbourne, Australia.|Murdoch Children's Research Institute, Melbourne, Australia.|Department of Global Health, School of Public Health, University of Washington, WA, USA.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000209:etiology; D063189:Symptom Assessment
chemical_list: D000701:Analgesics, Opioid