• Ainhoa Coloma-Carmona, José L Carballo, Jesús Rodríguez-Marín, and Ana Pérez-Carbonell.
• Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202, Elche, Spain. Electronic address: ainhoa.coloma@umh.es.
• Drug Alcohol Depend. 2019 Feb 1; 195: 27-32.

BackgroundThe last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes substantial changes for prescription opioid-use disorder (POUD). After its removal as a criterion, the goal of this study was to estimate the prevalence of withdrawal symptoms in long-term users of prescription opioids and its association with the new DSM-5 POUD classification.MethodsData were collected from 215 long-term consumers of opioid medication who were chronic non-cancer pain patients. Participants completed sociodemographic, Adjective Rating Scale for Withdrawal (ARSW), opioid treatment characteristics, POUD criteria (DSM-5), and pain intensity measurements.Results26.6% of the participants were classified with moderate to severe POUD. Higher intensity of withdrawal symptoms was found in patients with moderate/severe POUD, younger age, and higher pain intensity (p < .01). Anxiolytics (p < .01) and antidepressants use (p < .05) and percentage of smokers (p < .05) were significantly higher in patients with severe withdrawal. Logistic regression analyses suggested moderate [odds ratio (OR) = 3.25] and severe (OR = 10.52) withdrawal as the strongest predictor of POUD. Age, anxiolytics use, and smoking were also associated with POUD, but multilevel analysis showed that these variables do not moderate the association between withdrawal intensity and POUD.ConclusionEscalation of withdrawal intensity during opioid treatment can be used to identify patients with POUD. Further studies are needed to assess the clinical implications of these findings during long-term opioid therapy for chronic pain.Copyright © 2018 Elsevier B.V. All rights reserved.

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