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.

KEYWORDS:

• Opioids
• drug-use disorder
• DSM-5
• DSM-4
• prescription drugs
• pain
• outpatients

Acknowledgments

Preliminary results from this study were presented at the 15th Annual HMO Research Network Conference, Danville, PA, April 2009. Funding for this study was by a grant from the Administrative Committee for Research (ACR), Geisinger Clinic, Grant No. TRA-015 (Dr. Boscarino, PI). The ACR had no role in study design, data collection, analysis, interpretation, writing, or in the decision to submit the manuscript for publication.