Louisa Degenhardt1, Raimondo Bruno2, Nicholas Lintzeris3, Wayne Hall4, Suzanne Nielsen5, Briony Larance5, Milton Cohen6, Gabrielle Campbell5. 1. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia. Electronic address: l.degenhardt@unsw.edu.au. 2. School of Medicine, University of Tasmania, Hobart, TAS, Australia. 3. Sydney Medical School, Sydney University, Sydney, NSW, Australia; The Langton Centre, South East Sydney Local Health District Drug and Alcohol Services, Sydney, NSW, Australia. 4. Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia; National Addiction Centre, Kings College, London, UK. 5. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia. 6. St Vincent's Clinical School, University of New South Wales Medicine, Sydney, NSW, Australia.
Abstract
BACKGROUND: Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used. We compared how WHO's ICD-10 and proposed ICD-11 and the American Psychiatric Association's DSM-IV and DSM-5 classified individuals in a community-based sample of Australians with chronic non-cancer pain for which opioids have been prescribed. METHODS: We studied participants in the Pain and Opioid IN Treatment (POINT) cohort, a 2 year prospective cohort study of 1514 people prescribed pharmaceutical opioids for their chronic pain who were recruited in 2012-13 from community-based pharmacies across Australia. After giving patients the Composite International Diagnostic Interview about their opioid use, we assessed which patients would be categorised as having disorders of pharmaceutical opioid use by ICD-10, the draft ICD-11, DSM-IV, and DSM-5. We examined agreement between classification systems, and tested the unidimensionality of the syndrome with confirmatory factor analysis. FINDINGS: We included 1422 participants (median time of pain disorder 10 years [IQR 5-20]; median length of strong opioid prescription 4 years [IQR 1·5-10·0]; mean age 58 years). Similar proportions of individuals met lifetime criteria for dependence with DSM-IV (127; 8·9%), ICD-10 (121; 8·5%), and ICD-11 (141; 9·9%). Criteria in DSM-5 classified 127 (8·9%) participants with moderate or severe use disorder. There was excellent agreement between ICD-10, ICD-11 and DSM-IV dependence (κ>0·90). However, there was only fair to moderate agreement between ICD-10 and DSM-IV dependence diagnoses, and DSM-5 use disorder (mild, moderate, or severe). There was only good agreement between moderate to severe use disorder in DSM-5 and the other definitions. Criteria for all definitions loaded well on a single factor; the best model fit was for the definition for dependence in the draft ICD-11, the worst was in DSM-5. INTERPRETATION: Classification of problematic pharmaceutical opioid use varies across editions of ICD and DSM. The much lower levels of agreement between DSM-5 and other definitions than between other definitions might be attributed to DSM-5 containing an increased number of criteria and treating dependence and problematic use as a continuum. The more parsimonious ICD-11 dependence definition showed excellent model fit and excellent agreement with previous classificatory systems. FUNDING: Australian National Health and Medical Research Council.
BACKGROUND: Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used. We compared how WHO's ICD-10 and proposed ICD-11 and the American Psychiatric Association's DSM-IV and DSM-5 classified individuals in a community-based sample of Australians with chronic non-cancer pain for which opioids have been prescribed. METHODS: We studied participants in the Pain and Opioid IN Treatment (POINT) cohort, a 2 year prospective cohort study of 1514 people prescribed pharmaceutical opioids for their chronic pain who were recruited in 2012-13 from community-based pharmacies across Australia. After giving patients the Composite International Diagnostic Interview about their opioid use, we assessed which patients would be categorised as having disorders of pharmaceutical opioid use by ICD-10, the draft ICD-11, DSM-IV, and DSM-5. We examined agreement between classification systems, and tested the unidimensionality of the syndrome with confirmatory factor analysis. FINDINGS: We included 1422 participants (median time of pain disorder 10 years [IQR 5-20]; median length of strong opioid prescription 4 years [IQR 1·5-10·0]; mean age 58 years). Similar proportions of individuals met lifetime criteria for dependence with DSM-IV (127; 8·9%), ICD-10 (121; 8·5%), and ICD-11 (141; 9·9%). Criteria in DSM-5 classified 127 (8·9%) participants with moderate or severe use disorder. There was excellent agreement between ICD-10, ICD-11 and DSM-IV dependence (κ>0·90). However, there was only fair to moderate agreement between ICD-10 and DSM-IV dependence diagnoses, and DSM-5 use disorder (mild, moderate, or severe). There was only good agreement between moderate to severe use disorder in DSM-5 and the other definitions. Criteria for all definitions loaded well on a single factor; the best model fit was for the definition for dependence in the draft ICD-11, the worst was in DSM-5. INTERPRETATION: Classification of problematic pharmaceutical opioid use varies across editions of ICD and DSM. The much lower levels of agreement between DSM-5 and other definitions than between other definitions might be attributed to DSM-5 containing an increased number of criteria and treating dependence and problematic use as a continuum. The more parsimonious ICD-11 dependence definition showed excellent model fit and excellent agreement with previous classificatory systems. FUNDING: Australian National Health and Medical Research Council.
Authors: Christina Korownyk; Danielle Perry; Joey Ton; Michael R Kolber; Scott Garrison; Betsy Thomas; G Michael Allan; Cheryl Bateman; Raquel de Queiroz; Dorcas Kennedy; Wiplove Lamba; Jazmin Marlinga; Tally Mogus; Tony Nickonchuk; Eli Orrantia; Kim Reich; Nick Wong; Nicolas Dugré; Adrienne J Lindblad Journal: Can Fam Physician Date: 2019-05 Impact factor: 3.275
Authors: Christina Korownyk; Danielle Perry; Joey Ton; Michael R Kolber; Scott Garrison; Betsy Thomas; G Michael Allan; Cheryl Bateman; Raquel de Queiroz; Dorcas Kennedy; Wiplove Lamba; Jazmin Marlinga; Tally Mogus; Tony Nickonchuk; Eli Orrantia; Kim Reich; Nick Wong; Nicolas Dugré; Adrienne J Lindblad Journal: Can Fam Physician Date: 2019-05 Impact factor: 3.275
Authors: Louisa Degenhardt; Chrianna Bharat; Raimondo Bruno; Meyer D Glantz; Nancy A Sampson; Luise Lago; Sergio Aguilar-Gaxiola; Jordi Alonso; Laura Helena Andrade; Brendan Bunting; Jose Miguel Caldas-de-Almeida; Alfredo H Cia; Oye Gureje; Elie G Karam; Mohammad Khalaf; John J McGrath; Jacek Moskalewicz; Sing Lee; Zeina Mneimneh; Fernando Navarro-Mateu; Carmen C Sasu; Kate Scott; Yolanda Torres; Vladimir Poznyak; Somnath Chatterji; Ronald C Kessler Journal: Addiction Date: 2018-12-09 Impact factor: 6.526
Authors: Eung Don Kim; Jin Young Lee; Ji Seon Son; Gyeong Jo Byeon; Jin Seok Yeo; Do Wan Kim; Sie Hyeon Yoo; Ji Hee Hong; Hue Jung Park Journal: Korean J Pain Date: 2016-12-30
Authors: Johannes M Just; Norbert Scherbaum; Michael Specka; Marie-Therese Puth; Klaus Weckbecker Journal: PLoS One Date: 2020-07-23 Impact factor: 3.240
Authors: Johannes Maximilian Just; Fabian Schwerbrock; Markus Bleckwenn; Rieke Schnakenberg; Klaus Weckbecker Journal: BMJ Open Date: 2019-04-03 Impact factor: 2.692