Objective:

The diagnostic criteria for opioid use disorder, originally developed for heroin, did not anticipate the surge in prescription opioid use and the resulting complexities in diagnosing prescription opioid use disorder (POUD), including differentiation of pain relief (therapeutic intent) from more common drug use motives, such as to get high or to cope with negative affect. The authors examined the validity of the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 opioid version, an instrument designed to make this differentiation.

Methods:

Patients (N=606) from pain clinics and inpatient substance treatment who ever received a ≥30-day opioid prescription for chronic pain were evaluated for DSM-5 POUD (i.e., withdrawal and tolerance were not considered positive if patients used opioids only as prescribed, per DSM-5 guidelines) and pain-adjusted POUD (behavioral/subjective criteria were not considered positive if pain relief [therapeutic intent] was the sole motive). Bivariate correlated-outcome regression models indicated associations of 10 validators with DSM-5 and pain-adjusted POUD measures, using mean ratios for dimensional measures and odds ratios for binary measures.

Results:

The prevalences of DSM-5 and pain-adjusted POUD, respectively, were 44.4% and 30.4% at the ≥2-criteria threshold and 29.5% and 25.3% at the ≥4-criteria threshold. Pain adjustment had little effect on prevalence among substance treatment patients but resulted in substantially lower prevalence among pain treatment patients. All validators had significantly stronger associations with pain-adjusted than with DSM-5 dimensional POUD measures (ratios of mean ratios, 1.22–2.31). For most validators, pain-adjusted binary POUD had larger odds ratios than DSM-5 measures.

Conclusions:

Adapting POUD measures for pain relief (therapeutic intent) improved validity. Studies should investigate the clinical utility of differentiating between therapeutic and nontherapeutic intent in evaluating POUD diagnostic criteria.

中文翻译：

---

在使用处方阿片类药物治疗慢性疼痛的患者中诊断处方阿片类药物使用障碍

客观的：

最初为海洛因制定的阿片类药物使用障碍诊断标准并未预料到处方类阿片类药物使用的激增以及由此导致的处方类阿片类药物使用障碍 (POUD) 诊断的复杂性，包括将疼痛缓解（治疗意图）与更常见的药物使用区分开来动机，例如兴奋或应对负面影响。作者检查了物质和精神障碍的精神病学研究访谈（DSM-5 阿片类药物版本）的有效性，这是一种旨在进行这种区分的工具。

方法：

来自疼痛诊所和住院药物治疗的患者（N=606）曾接受过 ≥30 天的阿片类药物处方治疗慢性疼痛，接受了 DSM-5 POUD 评估（即，如果患者仅按规定使用阿片类药物，则不认为戒断和耐受性为阳性，根据 DSM-5 指南）和疼痛调整 POUD（如果疼痛缓解 [治疗意图] 是唯一动机，则行为/主观标准不被认为是积极的）。双变量相关结果回归模型表明 10 个验证者与 DSM-5 和疼痛调整的 POUD 测量相关，使用维度测量的平均比和二元测量的优势比。

结果：

DSM-5 和疼痛调整 POUD 的患病率在≥2 标准阈值时分别为 44.4% 和 30.4%，在≥4 标准阈值时分别为 29.5% 和 25.3%。疼痛调整对物质治疗患者的患病率影响不大，但导致疼痛治疗患者的患病率显着降低。与 DSM-5 维度 POUD 测量相比，所有验证者与疼痛调整的关联显着更强（平均比率的比率，1.22-2.31）。对于大多数验证者来说，疼痛调整的二元 POUD 比 DSM-5 测量具有更大的优势比。

结论：

调整 POUD 措施以缓解疼痛（治疗意图）提高了有效性。研究应调查在评估 POUD 诊断标准时区分治疗和非治疗意图的临床效用。