Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic noncancer pain: do different measures identify the same patients?
Campbell, G and Bruno, R and Lintzeris, N and Cohen, M and Nielsen, S and Hall, W and Larance, B and Mattick, RP and Blyth, F and Farrell, M and Degenhardt, L, Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic noncancer pain: do different measures identify the same patients?, Pain, 157, (7) pp. 1489-1498. ISSN 0304-3959 (2016) [Refereed Article]
Copyright 2016 International Association for the Study of Pain
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 5 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.