Withdrawal Symptoms Associated With Opioid Use Disorder Among Patients Prescribed Opioids for Chronic Pain

Individuals who are prescribed opioids are expected to develop tolerance and experience withdrawal symptoms if they stop taking them. For this reason, the DSM-5 states that tolerance and withdrawal should not be counted as criteria when considering whether patients who are prescribed opioids have an opioid use disorder (OUD). This study looked at 207 individuals with chronic pain who were prescribed opioids to determine whether withdrawal symptoms (as measured by the Adjective Rating Scale for Withdrawal) were associated with OUD.

• Of the 207 patients, 55 (27%) had symptoms of moderate OUD and 35 (17%) had severe symptoms in DSM-5 assessments that excluded tolerance and withdrawal criteria.
• Of those who reported mild withdrawal symptoms, 11% had moderate-to-severe OUD, compared with 27% who had moderate withdrawal and 62% who had severe withdrawal. Those who reported more severe withdrawal tended to be receiving higher doses of opioids, but the difference was not significant.
• On multivariable analysis, severe withdrawal symptoms were associated with a diagnosis of OUD (adjusted odds ratio, 7.1); the only other factors that were significant were lower age and receiving anxiolytics. Opioid dose was not included in this model.

Comments: This study suggests that patients who are prescribed opioids for chronic pain and who report moderate-to-severe withdrawal symptoms should be assessed for OUD, and that these symptoms should not be dismissed as an expected consequence of receiving opioid medication.

Darius A. Rastegar, MD

Reference: Coloma-Carmona A, Carballo JL, Rodríguez-Marín J, Pérez-Carbonell A. Withdrawal symptoms predict prescription opioid dependence in chronic pain patients. Drug Alcohol Depend. 2019;195:27-32.