Appendix A: Operationalisation of criteria according to diagnostic definitions

Criterion / Definition / DSM-IV diagnoses / DSM-5 diagnoses / ICD-10 diagnoses / ICD-11 / Addiction diagnosis
Larger / Used in larger amounts or longer than intended / Dependence / Use disorder / Dependence+ / Dependence / Addiction
Cut down / Persistent desire or unsuccessful efforts to reduce use / Dependence / Use disorder
Craving / Craving or a strong desire for pharmaceutical opioids / n/a / Use disorder / Dependence / Addiction
Time spent / Great deal of time spent using and recovering from use / Dependence / Use disorder / Dependence++ / Dependence / Addiction
Give up / Social, occupational, other activities reduced due to use / Abuse / Use disorder
Social / Continued used despite recurrent social/interpersonal problems due to use / Dependence / Use disorder / Harmful use+++ / n/a
Continue / Continued use despite recurrent physical or psychological problems / Dependence / Use disorder / Dependence++++ / Addiction
Major role / Recurrent use resulting in failure to fulfil major role obligations due to use / Abuse / Use disorder / Harmful use / n/a / n/a
Legal / Recurrent use despite legal problems / Abuse / n/a / Harmful use / n/a / n/a
Hazard / Recurrent use in hazardous situations / Abuse / Use disorder / Harmful use / n/a / n/a
Tolerance / Tolerance / Dependence / Use disorder1 / Dependence / Dependence / n/a
Withdrawal / Withdrawal / Dependence / Use disorder1 / Dependence / n/a

ICD-10 combines larger and cut down.†ICD-11 draft criteria proposes combining larger, cut down, and craving. ‡ICD-10 combines time spent and give up. §ICD-11 proposes combining time spent, give up, social, and continue ¶ICD-10 dependence criteria require social and continued use to both be present. ||Tolerance and withdrawal combined

Appendix B: Opioid use and health service utilisation of the POINT cohort according to problematic use definitions (n=1,134)

DSM-IV dependence
n=96 / ICD-10 opioid dependence
n=106
History of opioid use
Years of prescribed opioid use (MDN IQR) / 6.2 (4-12) / 6 (4-11)
Years since first symptom of problems related to prescribed opioids (MDN IQR) / 5 (3-8) / 4.5 (3-8)
Current OME (MDN, IQR)# / 120.0 (51.5-200.0) / 120.0 (48.8-203.4)
Past 3 month non-adherence score (ORBIT) (MDN, IQR) / 1 (0-3) / 1 (0-3)
Problems with prescribed opioids (PODS) score (MDN, IQR) / 14 (7-23) / 15 (8-24)
Concerns with prescribed opioids (PODS) score (MDN, IQR) / 16 (12-24) / 16 (12-20)
% opioid side effects (PADT) / 85.4 (76.7-91.3) / 86.8 (78.8-92.1)
Service utilisation
% more than one opioid prescriber+ / 20.8 (69.7-86.3) / 19.8 (13.2-28.6)
% ever mental health professional+ / 75.0 (65.2-82.7) / 69.8 (60.3-77.9)
Clinical correlates
Median pain severity (SD) / 5.4 (1.8) / 5.6 (1.8)
Median pain interference (SD) / 6.7 (2.0) / 6.7 (2.0)
% low pain self-efficacy (<30 PSEQ) / 65.6 (55.4-74.5) / 65.1 (55.4-73.7)
% poor physical functioning (<30 SF-12)+ / 60.3 (48.4-71.0) / 59.5 (48.1-69.9)
% Current generalised anxiety disorder / 44.8 (35.0-55.0) / 45.3 (35.9-55.0)
% Current moderate to severe depression / 75.0 (65.2-82.7) / 77.4 (68.3-84.4)
% post-traumatic stress disorder+ / 37.5 (28.3-47.7) / 38.7 (29.8-48.4)
% lifetime alcohol use disorder+ / 44.8 (35.0-55.0) / 45.3 (35.9-55.0)
% lifetime illicit drug use disorder**+ / 31.3 (22.7-41.4) / 30.2 (22.1-39.7)
% family history of problematic use+ / 9.4 (4.9-17.2) / 11.3 (6.5-19.0)
% ever treatment for SUD + / 21.3 (22.7-41.4) / 26.4 (18.8-35.8)
% childhood maltreatment+ / 70.8 (60.8-79.2) / 72.6 (63.2-80.4)
Demographic variables
% male+ / 58.3 (48.1-67.9) / 51.9 (42.3-63.4)
Median age (IQR) / 52.5 (44.5-59) / 52 (44-59)
% completed year 10 + / 92.7 (85.3-96.5) / 91.5 (84.3-95.6)
% Income below AUD 400 + / 50.0 (40.0-60.0) / 47.2 (37.7-56.8)
% unemployed/not in labour force / 55.2 (45.0-65.0) / 57.5 (47.8-66.7)
% married/defacto + / 39.6 (30.2-49.8) / 40.6 (31.6-50.3)

# based on sample of 1,035 OME- Oral morphine equivalents, mg/day, SUD- substance use disorder