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Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic noncancer pain: do different measures identify the same patients?

Campbell, Gabrielle; Bruno, Raimondo; Lintzeris, Nicholas; Cohen, Milton; Nielsen, Suzanne; Hall, Wayne; Larance, Briony; Mattick, Richard P.; Blyth, Fiona; Farrell, Michael; Degenhardt, Louisa

doi: 10.1097/j.pain.0000000000000548
Research Paper
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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 = 0.63 and 0.79, respectively). Participants meeting the criteria for “Addictiononly 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.

Supplemental Digital Content is Available in the Text.The “Addiction” concept used in pain medicine is broad and encompasses patients who may not be at high-risk of problematic opioid use.

aNational Drug and Alcohol Research Centre, UNSW, Sydney, Australia

bSchool of Medicine, University of Tasmania, Hobart, Australia

cSydney Medical School, Sydney University, Sydney, Australia

dThe Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, Australia

eSt Vincent's Clinical School, UNSW Medicine, UNSW, Sydney, Australia

fCentre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia

gNational Addiction Centre, Kings College London, United Kingdom

hSchool of Population and Global Health, University of Melbourne, Australia

iMurdoch Children's Research Institute, Melbourne, Australia

jDepartment of Global Health, School of Public Health, University of Washington, WA, USA

Corresponding author. Address: National Drug and Alcohol Research Centre, UNSW, 22-32 King St, Randwick, NSW 2031, Australia. Tel.: +61293850286; fax: +61293850222. E-mail address: g.campbell@unsw.edu.au (G. Campbell).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received December 18, 2015

Received in revised form February 26, 2016

Accepted February 29, 2016

© 2016 International Association for the Study of Pain
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