Using ICD-10-CM codes to detect illicit substance use: A comparison with retrospective self-report

Details

• Alternative Title:
  Drug Alcohol Depend
• Personal Author:
  Rowe, Christopher L. ; Santos, Glenn-Milo ; Kornbluh, Wiley ; Bhardwaj, Sumeet ; Faul, Mark ; Coffin, Phillip O.
• Description:
  Background: ; Understanding whether International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes can be used to accurately detect substance use can inform their use in future surveillance and research efforts. ; Methods: ; Using 2015-2018 data from a retrospective cohort study of 602 safety-net patients prescribed opioids for chronic non-cancer pain, we calculated the sensitivity and specificity of using ICD-10-CM codes to detect illicit substance use compared to retrospective self-report by substance (methamphetamine, cocaine, opioids heroin or non-prescribed opioid analgesics), self-reported use frequency, and type of healthcare encounter. ; Results: ; Sensitivity of ICD-10-CM codes for detecting self-reported substance use was highest for methamphetamine (49.5 % 95 % confidence interval: 39.6-59.5 %), followed by cocaine (44.4 % 35.8-53.2 %) and opioids (36.3 % 28.8-44.2 %); higher for participants who reported more frequent methamphetamine (intermittent use: 27.7 % 14.6-42.6 %; ≥weekly use: 67.2 % 53.7-79.0 %) and opioid use (intermittent use: 21.4 % 13.2-31.7 %; ≥weekly use: 52.6 % 40.8-64.2 %); highest for outpatient visits (methamphetamine: 43.8 % 34.1-53.8 %; cocaine: 36.8 % 28.6− 45.6 %; opioids: 33.1 % 25.9-41.0 %) and lowest for emergency department visits (methamphetamine: 8.6 % 4.0− 15.6 %; cocaine: 5.3 % 2.1− 10.5 %; opioids: 6.3 % 3.0− 11.2 %). Specificity was highest for methamphetamine (96.4 % 94.3-97.8 %), followed by cocaine (94.0 % 91.5-96.0 %) and opioids (85.0 % 81.3-88.2 %). ; Conclusions: ; ICD-10-CM codes had high specificity and low sensitivity for detecting self-reported substance use but were substantially more sensitive in detecting frequent use. ICD-10-CM codes to detect substance use, particularly those from emergency department visits, should be used with caution, but may be useful as a lower- bound population measure of substance use or for capturing frequent use among certain patient populations.
• Subjects:
  • Adult
  • Analgesics, Opioid
  • Chronic Pain
  • Cocaine
  • Emergency Service, Hospital
  • Female
  • Heroin
  • Humans
  • Illicit Drugs
  • International Classification of Diseases
  More +
• Keywords:
  • Substance use
  • Heroin
  • Prescription opioids
  • Methamphetamine
  • Cocaine
  • Electronic health records
  • Diagnostic codes
  • Surveillance
• Source:
  Drug Alcohol Depend. 221:108537
• Pubmed ID:
  33621806
• Pubmed Central ID:
  PMC11008535
• Document Type:
  Text
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; K24 DA042720/DA/NIDA NIH HHSUnited States/ ; U01 CE002793/CE/NCIPC CDC HHSUnited States/ ; U01CE002793/ACL/ACL HHSUnited States/
• Genre:
  Journal Article
• Volume:
  221
• Download URL:
  https://stacks.cdc.gov/view/cdc/154178/cdc_154178_DS1.pdf
• File Type:
  [PDF - 102.81 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:3b0c95fc435d24d841a07694b3ba73c3f31796d9fe2ae3aa3b6850367e83353ebde7ccbfc4b60ec8685b2962a68b3290df1842a170764baf389a10add5d8b5a3