Opioid-use disorder among patients on long-term opioid therapy: impact of final DSM-5 diagnostic criteria on prevalence and correlates

Figures & data

Table 1 Demographic and health characteristics of patients meeting the DSM-5 criteria for lifetime prescription opioid-use disorder (moderate or severe#)

Study variables	Total sample##			DSM-5 opioid-use disorder Moderate or severe		DSM-5 opioid-use disorder Not moderate or severe
	N	Percent	(95% CI)	N	Percent	N	Percent
DSM-5 opioid-use disorder Moderate/severe
% no	612	86.8	(82.4–90.2)
% yes	93	13.2	(9.8–17.6)
Age
% 18–64 years old	558	79.3	(66.7–88.0)	90	16.1	468	83.9***
% 65+ years old	147	20.7	(12.0–33.3)	3	1.8	144	98.2
Sex
% male	232	39.1	(34.3–44.1)	36	14.9	196	85.1
% female	473	60.9	(55.9–65.7)	57	12.1	416	87.9
Race
% white	694	98.4	(95.4–99.5)	90	12.8	604	87.2*
% nonwhite	11	1.6	(0.5–4.7)	3	34.2	8	65.8
Marital status
% married	458	65.6	(61.8–69.2)	58	12.8	400	87.2
% not married	247	34.4	(30.8–38.2)	35	14.0	212	86.0
Employment status
% employed	179	25.7	(22.1–29.6)	19	11.9	160	89.1
% not employed	526	74.3	(70.4–77.9)	74	14.0	452	86.0
Household income
% less than US$30,000 per year	289	41.0	(33.0–49.5)	43	14.6	246	85.4
% greater than US$30,000 per year	326	46.3	(40.8–52.1)	41	12.8	285	87.2
% refused/not reported	90	12.7	(8.6–18.3)	9	10.2	81	89.9
Education
% high school or less	351	50.2	(46.1–54.3)	41	11.7	310	88.3
% some college or more	352	49.8	(45.7–53.9)	52	14.7	300	85.3
Clinic setting
% primary care	563	83.1	(47.1–96.5)	68	12.2	495	87.8*
% specialty care	142	16.9	(3.5–52.9)	25	18.1	117	81.9
Reported health status
% good	570	80.8	(76.2–84.7)	61	10.7	509	89.3**
% fair/poor	135	19.2	(15.4–23.8)	32	23.6	103	76.4
Medically obese (BMI >30)
% yes	353	50.3	(45.3–55.2)	49	13.6	304	86.4
% no	352	49.7	(44.8–54.7)	44	12.8	308	87.2
Reported average pain in past week
% high	173	23.8	(18.4–30.2)	31	17.8	142	82.2
% not high	532	76.2	(69.8–81.6)	62	11.7	470	88.3
Reported pain interference with life or work – greatly or extremely
% yes	426	60.4	(55.4–65.1)	70	16.5	356	83.5*
% no	279	39.6	(34.9–44.6)	23	8.2	256	91.8
(N)	(705)			(93)		(612)

Notes:

# All percent results were adjusted/weighted for response bias and data clustering; Ns are unweighted.

## To aid in data interpretation, the total column is percentized by column and the disorder severity columns are percentized by row.

* P<0.05;

** P<0.01; and

*** P<0.001.

Abbreviations: DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; N, number; CI, confidence interval; BMI, body mass index.

Table 2 Mental health characteristics of patients meeting the DSM-5 criteria for lifetime prescription opioid-use disorder (moderate or severe#)

Study variables	Total sample##			DSM-5 opioid-use disorder Moderate or severe		DSM-5 opioid-use disorder Not moderate or severe
	N	Percent	(95% CI)	N	Percent	N	Percent
Lifetime alcohol dependence
% yes	68	9.8	(7.1–13.3)	23	32.6	45	67.4**
% no	637	90.2	(86.7–92.9)	70	11.1	567	88.9
Lifetime tobacco dependence
% yes	251	36.8	(32.1–41.9)	42	16.8	209	83.2*
% no	454	63.2	(58.2–68.0)	51	11.1	403	88.9
Lifetime major depressive disorder
% yes	249	34.6	(29.8–39.7)	63	25.8	186	74.2***
% no	456	65.4	(60.3–70.2)	30	6.5	426	93.5
Lifetime generalized anxiety disorder
% yes	89	12.6	(10.0–15.8)	26	30.1	63	69.9***
% no	616	87.4	(84.2–90.1)	67	10.8	549	89.2
Lifetime post-traumatic stress disorder
% yes	97	13.3	(10.1–17.3)	29	30.6	68	69.4***
% no	608	86.7	(82.7–90.0)	64	10.5	544	89.5
History of high childhood adversity
% yes	178	24.9	(21.3–28.8)	40	22.7	138	77.3***
% no	527	75.1	(71.2–78.7)	53	10.0	474	90.0
History of high exposure to psychological trauma
% yes	161	23.0	(19.0–27.5)	41	24.6	120	75.4***
% no	544	77.0	(72.5–81.0)	52	9.8	492	90.2
History of illicit drug use
% yes	167	24.1	(21.5–26.8)	39	22.7	128	77.3***
% no	432	75.9	(73.2–78.5)	54	10.2	484	89.8
History of any substance abuse treatment
% yes	153	22.5	(20.3–25.0)	49	31.3	104	68.7***
% no	552	77.5	(75.0–79.1)	44	7.9	508	92.1
Current psychotropic medication use
% yes	434	61.1	(58.2–64.0)	81	18.7	353	81.3***
% no	271	38.9	(36.0–41.8)	12	4.5	259	95.5
Antisocial personality disorder
% yes	167	23.8	(21.6–26.1)	40	23.3	127	76.7**
% no	538	76.2	(73.9–78.4)	53	10.0	485	90.0
Ever sleeping problems
% yes	461	64.4	(58.6–69.9)	83	18.1	378	81.9***
% no	244	35.6	(30.1–41.4)	10	4.3	234	95.7
Ever suicidal thoughts
% yes	182	25.6	(22.2–29.4)	52	29.0	130	71.0***
% no	523	74.4	(70.6–77.8)	41	7.7	482	92.3
(N)	(705)			(93)		(612)

Notes:

# All percent results were adjusted/weighted for response bias and data clustering; Ns are unweighted.

## To aid in data interpretation, the total column is percentized by column and the disorder severity columns are percentized by row.

* P<0.05;

** P<0.01; and

*** P<0.001.

Abbreviations: DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; N, number; CI, confidence interval.

Table 3 Prevalence of lifetime DSM-5 prescription opioid-use disorder by lifetime DSM-4 prescription opioid dependence#

Diagnostic criteria*	DSM-5 opioid-use disorder: none/low (<2 symptoms)			DSM-5 opioid-use disorder: mild (2–3 symptoms)			DSM-5 opioid-use disorder: moderate (4–5 symptoms)			DSM-5 opioid-use disorder: severe (6+ symptoms)
	%	95% CI	(n)	%	95% CI	(n)	%	95% CI	(n)	%	95% CI	(n)
DSM-4 no opioid dependence	86.0	82.2–89.1	(391)	14.0	11.0–17.8	(63)	0.0	–	(0)	0.0	–	(0)
DSM-4 opioid dependence	9.3	5.8–14.6	(23)	53.6	44.1–62.8	(135)	27.3	22.1–33.1	(69)	9.8	6.7–14.3	(24)
Total DSM-5 opioid-use disorder	58.7	54.2–63.1	(414)	28.1	25.4–30.9	(198)	9.7	7.3–12.8	(69)	3.5	2.2–5.5	(24)

Notes:

# All percent results are adjusted/weighted for response bias and data clustering; ns are unweighted.

* P<0.0001.

Abbreviations: DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM-4, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; CI, confidence interval; n, number.

Table 4 Ordinal logistic regression model predicting lifetime DSM-5 opioid-use disorders (N=705)#

Predictor variables	OR	95% CI	P-value
Less than 65 years old	1.86	1.14–3.04	0.013
Pain interferes with work/life	2.01	1.38–2.93	<0.001
Ever trouble sleeping	1.81	1.28–2.55	0.001
Ever suicidal thoughts	1.65	1.29–2.12	<0.001
History of general anxiety	1.63	1.11–2.38	0.013
History of post-traumatic stress disorder	1.40	0.99–2.00	0.058
History of illicit drug use	1.75	1.10–2.78	0.018
Ever substance abuse treatment	2.28	1.59–3.26	<0.001
Cut 1	2.23	1.66–2.81	–
Cut 2	4.05	3.43–4.68	–
Cut 3	5.66	4.89–6.42	–

Notes:

# All of the results are adjusted/weighted for survey response bias and data clustering. Ordinal contrasts include no opioid-use disorder (n=414), mild opioid-use disorder (n=198), moderate opioid-use disorder (n=69), and severe opioid-use disorder (n=24). Cuts 1–3 represent the coefficients used to estimate an ordinal model with 4 categories, representing no disorder, mild, moderate, and severe disorder.

Abbreviations: DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; N, total number; OR, odds ratio; CI, confidence interval; n, sample number.