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Abstract
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DSM-5 criteria for opioid use disorder contain the two elements of the proposed new diagnosis plus nine other criteria describing opioid-related harms. DSM-5 criteria provide a better way to understand risks of opioid pain medication than a new diagnosis exclusively for patients prescribed long-term opioid therapy for pain.
The inability to reduce or discontinue opioids when benefits do not outweigh harms is concerning and needs to be assessed in patients on long-term opioid therapy for pain (LTOT). Overwhelming evidence finds that increased opioid prescribing fueled by assurances that addiction is rare during LTOT has led to opioid-related harms including falls, overdoses, suicides and opioid use disorder (OUD) [1]. Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for OUD better describe opioid-related risks than a new diagnosis exclusively for patients prescribed LTOT.
Decades of research on current and previous DSM criteria support the validity of the OUD diagnosis. Previous editions of the DSM contained two forms of substance use disorders (SUD)--'substance abuse' (diagnosed by meeting one of four criteria) and 'substance dependence' (diagnosed by meeting three of seven additional criteria including 'tolerance' and 'withdrawal'). The DSM-5 workgroup found no clustering of specific criteria such as 'loss of control' with the more severe end of the SUD spectrum [2]. Rather, increasing numbers of criteria met indicated increasing severity of SUD. In DSM-5, an exception was made to exclude 'tolerance' and 'withdrawal' when diagnosing OUD if opioids are taken 'under appropriate medical supervision' [3]. This exclusion was created to avoid an OUD diagnosis in patients prescribed LTOT because these signs are routinely expected. The exclusion was not because these signs did not predict harm or correlate with other OUD criteria.
Language: en |