{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T07:06:44Z","timestamp":1788505604449,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In the US, over 200 lives are lost from opioid overdoses each day. Accurate and prompt diagnosis of opioid use disorders (OUD) may help prevent overdose deaths. However, international classification of disease (ICD) codes for OUD are known to underestimate prevalence, and their specificity and sensitivity are unknown. We developed and validated algorithms to identify OUD in electronic health records (EHR) and examined the validity of OUD ICD codes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Through four iterations, we developed EHR\u2010based OUD identification algorithms among patients who were prescribed opioids from 2014 to 2017. The algorithms and OUD ICD codes were validated against 169 independent \u201cgold standard\u201d EHR chart reviews conducted by an expert adjudication panel across four healthcare systems. After using 2014\u20132020 EHR for validating iteration 1, the experts were advised to use 2014\u20132017 EHR thereafter.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 169 EHR charts, 81 (48%) were reviewed by more than one expert and exhibited 85% expert agreement. The experts identified 54 OUD cases. The experts endorsed all 11 OUD criteria from the Diagnostic and Statistical Manual of Mental Disorders\u20105, including craving (72%), tolerance (65%), withdrawal (56%), and recurrent use in physically hazardous conditions (50%). The OUD ICD codes had 10% sensitivity and 99% specificity, underscoring large underestimation. In comparison our algorithm identified OUD with 23% sensitivity and 98% specificity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and relevance<\/jats:title><jats:p>This is the first study to estimate the validity of OUD ICD codes and develop validated EHR\u2010based OUD identification algorithms. This work will inform future research on early intervention and prevention of OUD.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5591","type":"journal-article","created":{"date-parts":[[2022,12,31]],"date-time":"2022-12-31T08:32:55Z","timestamp":1672475575000},"page":"577-585","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Development and validation of an electronic health records\u2010based opioid use disorder algorithm by expert clinical adjudication among patients with prescribed opioids"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3944-3912","authenticated-orcid":false,"given":"Shabbar I.","family":"Ranapurwala","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Injury Prevention Research Center, University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishrat Z.","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Injury Prevention Research Center, University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"Pence","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Injury Prevention Research Center, University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy S.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"},{"name":"North Carolina Translational and Clinical Sciences Institute, School of Medicine University of North Carolina at Chapel Hill  North Carolina USA"},{"name":"Department of Medicine, School of Medicine University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall","family":"Clark","sequence":"additional","affiliation":[{"name":"North Carolina Translational and Clinical Sciences Institute, School of Medicine University of North Carolina at Chapel Hill  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Chelminski","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li\u2010Tzy","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, School of Medicine Duke University  Durham North Carolina USA"},{"name":"Department of Medicine, School of Medicine Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence H.","family":"Greenblatt","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Korte","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Wolfson","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, Population, and Public Health, School of Medicine University of California  Riverside California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather E.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Medicine, School of Medicine Wake Forest University  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn A.","family":"Bowlby","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Capata","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Injury Prevention Research Center, University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2020.1318"},{"key":"e_1_2_11_3_1","unstructured":"CDC Health Advisory.Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID\u201019 Pandemic. Distributed via the CDC Health Alert Network. December 17 2020 8:00\u2009AM ET. CDCHAN\u201000438https:\/\/emergency.cdc.gov\/han\/2020\/han00438.asp."},{"key":"e_1_2_11_4_1","unstructured":"Substance Abuse and Mental Health Services Administration. (2019).Results from the 2018. National Survey on Drug Use and Health: Detailed tables. Rockville MD: Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration.https:\/\/www.samhsa.gov\/data\/."},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4564"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4650"},{"issue":"1","key":"e_1_2_11_7_1","first-page":"1","article-title":"Guideline for prescribing opioids for chronic pain\u2014United States","volume":"65","author":"Dowell D","year":"2016","journal-title":"MMWR"},{"key":"e_1_2_11_8_1","unstructured":"ChouR DeyoR DevineB HansenR SullivanS JarvikJ. G BlazinaI DanaT BougatsosC TurnerJ.The Effectiveness and Risks of Long\u2010Term Opioid Treatment of Chronic Pain. Evidence Report\/Technology Assessment No. 218. (Prepared by the Pacific Northwest Evidence\u2010Based Practice Center under Contract No. 290\u20132012\u201000014\u2010I.) AHRQ Publication No. 14\u2010E005\u2010EF. 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