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Construct and Differential Item Functioning in the Assessment of Prescription Opioid Use Disorders Among American Adolescents

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Abstract

Objectives

To examine the psychometric properties of diagnostic criteria for prescription analgesic opioid use disorders (OUDs) and to identify background predictors of a latent continuum for OUD liability.

Method

Data were drawn from the adolescent sample of the 2006 National Survey of Drug Use and Health. Item response theory (IRT) and multiple indicators-multiple causes methods were used to examine DSM-IV criteria for OUDs in a subsample of adolescents who reported nonmedical prescription opioid use in the past year (N = 1,290).

Results

Among nonmedical users of prescription opioids, the criteria of OUDs were arrayed along a single continuum of severity. All abuse criteria were endorsed at a severity level higher than D1 (tolerance) and D5 (time spent) but lower than D3 (taking larger amounts) and D4 (inability to cut down). Differential item functioning in reports of dependence symptoms across adolescents' sex and race/ethnicity were identified: withdrawal, time spent, and continued use despite medical or psychological problems. Adjusting for the effects of differential item functioning and the demographic variables examined, female subjects were more likely than male subjects to exhibit a higher level of OUD liability.

Conclusions

Study findings do not support the DSM-IVs current hierarchical distinction between abuse of and dependence on prescription opioids. Abuse symptoms in adolescents are not necessarily less severe than those of dependence. There is evidence of some differential item functioning in the assessment of OUDs.

Section snippets

Study Sample

This study used data from the subsample of adolescents reporting the nonmedical use of prescription opioids (N = 1,290) in the public use file of the 2006 NSDUH.19 The NSDUH is the only ongoing survey that provides estimates of substance use and related disorders in the U.S. population. The survey's sampling frame covers approximately 98% of the total U.S. population aged 12 years or older and uses multistage area probability sampling methods to select a representative sample of the civilian

Nonmedical Opioid Users

Among the sample of adolescents aged 12 to 17 years, 7% (N = 1,290) reported nonmedical opioid use in the past year. Within this subsample, 15.1% met DSM-IV criteria either for opioid abuse (7.4%) or dependence (7.7%) in the past year. As shown in Table 1, 52% were female, and 67% were white.

Types of Opioids Used

Propoxyphene, hydrocodone, oxycodone, and codeine products were more commonly used than the other types of opioids: Vicodin, Lortab, Lorcet, or Lorcet Plus (for which lifetime use was reported by 52% of

Discussion

In this nationally representative sample of adolescent nonmedical opioid users, the criteria of OUDs were arrayed along a single continuum of severity. All abuse criteria were endorsed at a severity level higher than D1 (tolerance) and D5 (time spent) but lower than D3 (taking larger amounts) and D4 (inability to cut down). The abuse indicators clustered well with three dependence criteria (withdrawal, giving up activities, and continued use despite problems). These findings provide compelling

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  • Cited by (0)

    This work was supported by research grants from the U.S. National Institute on Drug Abuse of the National Institutes of Health to Dr. Wu (DA019623 and DA019901). The Substance Abuse and Mental Health Data Archive and the Inter-university Consortium for Political and Social Research provided the public use data files for National Survey on Drug Use and Health, which was sponsored by the Office of Applied Studies of the Substance Abuse and Mental Health Services Administration. The opinions expressed in this article are solely those of the authors and not of any sponsoring agency.

    Supplemental digital content for this article can be found online only. See text for specific links.

    The authors thank Amanda McMillan for editorial assistance.

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