Prevalence of Prescription Opioid-Use Disorder Among Chronic Pain Patients: Comparison of the DSM-5 vs. DSM-4 Diagnostic Criteria

TLDR

The study estimates the lifetime prevalence of prescription opioid‑use disorder among chronic pain patients using DSM‑4 and DSM‑5 criteria and calls for further research. The authors used electronic health records from a large health care system to identify a random sample of 705 outpatients on long‑term opioid therapy for non‑cancer pain and conducted diagnostic interviews. Lifetime DSM‑5 opioid‑use disorder prevalence was 34.9%, nearly identical to DSM‑4’s 35.5%, with a high agreement (Kappa = 0.873); risk factors included younger age, prior opioid abuse, withdrawal symptoms, and substance‑abuse treatment, and 21.7% and 13.2% of patients had moderate and severe disorder, respectively, mirroring DSM‑4 findings.

Abstract

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.