Exploring the latent trait of opioid use disorder criteria among frequent nonmedical prescription opioid users.
There is a need to explore the dimensional and categorical phenotypes of criteria of opioid use disorder among frequent nonmedical users of prescription opioids (NMUPO) users.



We used pooled data of 2011-2012 National Survey on Drug Use and Health to examine reliability and phenotypic variability in the diagnosis of OUD secondary to NMUPO in a nationally-representative sample of 18+ years-old frequent past-year NMUPO users (120+ days, n = 806). Through exploratory factor analysis (EFA) and latent class analysis (LCA), we examined 10 past-year OUD criteria. We examined associations between the latent classes and sociodemographic/psychiatric/NMUPO correlates.



OUD criteria were unidimensional, and a three-class model was the overall best fitting solution for characterizing individuals into phenotypes along this unidimensional continuum: a "non-symptomatic class" (40.7%), "Tolerance-Time spent class" (29.0%) with high probability of endorsing Tolerance/Time Spent criteria, and a "High-moderate symptomatic class" (30.1%). The last class was significantly associated with being male, having insurance and obtaining prescription opioids (PO) nonmedically via "doctor shopping" as compared to the non-symptomatic class. "Tolerance-Time spent class" was significantly associated with being younger (18-25 years) and obtaining PO nonmedically from family/friends as compared to the non-symptomatic class.



This study revealed the different characteristics and routes of access to PO of different classes of frequent NMUPO users. It is possible that these groups may respond to different interventions, however such conclusions would require a clinical study.
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, 05403, Brazil; Interdisciplinary Group of Studies on Alcohol and Drugs, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, 05403, Brazil; Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, 09060, Brazil.
João Mauricio
JM
Castaldelli-Maia
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, 05403, Brazil.
Laura H
LH
Andrade
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA.
Katherine M
KM
Keyes
Department of Emergency Medicine and Violence Prevention Program, University of California, Davis, USA.
Magdalena
M
Cerdá
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, USA.
Daniel J
DJ
Pilowsky
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA. Electronic address: ssm2183@cumc.columbia.edu.
Silvia S
SS
Martins
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid; D002648:Child; D005163:Factor Analysis, Statistical; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D055815:Young Adult
D000701:Analgesics, Opioid
Doctor shopping; NMUPO; Prescription opioids; Time spent; Tolerance