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

IF 5.1 Q1 SUBSTANCE ABUSE Substance Abuse and Rehabilitation Pub Date : 2015-08-19 eCollection Date: 2015-01-01 DOI:10.2147/SAR.S85667
Joseph A Boscarino, Stuart N Hoffman, John J Han
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引用次数: 76

Abstract

Aims: Previously, we estimated the prevalence and risk factors for prescription opioid-use disorder among outpatients on opioid therapy using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and DSM-4 criteria. However, at the time, the DSM-5 criteria were not finalized. In the current study, we analyzed these data using the final DSM-5 criteria and compared these results.

Methods: Using electronic records from a large US health care system, we identified outpatients receiving five or more prescription orders for opioid therapy in the past 12 months for noncancer pain (mean prescription orders =10.72; standard deviation =4.96). In 2008, we completed diagnostic interviews with 705 of these patients using the DSM-4 criteria. In the current study, we reassessed these results using the final DSM-5 criteria.

Results: The lifetime prevalence of DSM-5 opioid-use disorders using the final DSM-5 criteria was 58.7% for no or few symptoms (<2), 28.1% for mild symptoms (2-3), 9.7% for moderate symptoms (4-5), and 3.5% for severe symptoms (six or more). Thus, the lifetime prevalence of "any" prescription opioid-use disorder in this cohort was 41.3% (95% confidence interval [CI] =37.6-45.0). A comparison to the DSM-4 criteria indicated that the majority of patients with lifetime DSM-4 opioid dependence were now classified as having mild opioid-use disorder, based on the DSM-5 criteria (53.6%; 95% CI =44.1-62.8). In ordinal logistic regression predicting no/few, mild, moderate, and severe opioid-use disorder, the best predictors were age <65 years, current pain impairment, trouble sleeping, suicidal thoughts, anxiety disorders, illicit drug use, and history of substance abuse treatment.

Conclusion: Given the final DSM-5 criteria, including the elimination of tolerance and withdrawal, inclusion of craving and abuse symptoms, and introduction of a new graded severity classification, the prevalence of opioid-use disorders has changed, while many of the DSM-4 risk factors for opioid dependence were similar. To our knowledge, this is one of the first studies to compare the final results for DSM-5 versus DSM-4 prescription opioid-use disorders among a high-risk patient population.

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长期阿片类药物治疗患者的阿片类药物使用障碍:DSM-5最终诊断标准对患病率和相关因素的影响
目的:先前,我们使用精神疾病诊断与统计手册(DSM)-5和DSM-4标准估计阿片类药物治疗门诊患者处方阿片类药物使用障碍的患病率和危险因素。然而,在当时,DSM-5标准还没有最终确定。在目前的研究中,我们使用最终的DSM-5标准分析这些数据并比较这些结果。方法:使用来自美国大型医疗保健系统的电子记录,我们确定了过去12个月内接受5个或更多阿片类药物治疗处方的门诊患者,用于治疗非癌性疼痛(平均处方订单=10.72;标准差=4.96)。2008年,我们使用DSM-4标准完成了对705名患者的诊断访谈。在目前的研究中,我们使用最终的DSM-5标准重新评估了这些结果。结果:使用最终DSM-5标准的DSM-5阿片类药物使用障碍的终生患病率为58.7%,无症状或很少症状(结论:鉴于最终DSM-5标准,包括消除耐受性和戒断,包括渴望和滥用症状,以及引入新的分级严重程度分类,阿片类药物使用障碍的患病率发生了变化,而许多DSM-4阿片类药物依赖的危险因素是相似的。据我们所知,这是在高危患者人群中比较DSM-5和DSM-4处方阿片类药物使用障碍最终结果的首批研究之一。
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发文量
9
审稿时长
16 weeks
期刊最新文献
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