Subjective Response to Opioids Predicts Risk for Opioid Use Disorder

Exposure to prescription opioids can lead to opioid use disorder (OUD) in some individuals, but we lack scalable tools to predict who is at risk. We collected retrospective data on the initial subjective effects of prescription opioids from 117,508 research participants, 5.3% of whom self-reported OUD. Positive subjective effects, particularly "Like Overall", "Euphoric", and "Energized", were the strongest predictors of OUD. For example, the odds-ratio for individuals responding "Extremely" for "Like Overall" was 36.2. The sensitivity and specificity of this single question was excellent (ROC=0.87). Negative effects and analgesic effects were much less predictive. We present a two-step decision tree that can identify a small high-risk subset with 77.4% prevalence of OUD and a much larger low-risk subset with 1.7% prevalence of OUD. Our results demonstrate that positive subjective responses are predictive of future misuse and suggest that vulnerable individuals may be identified and targeted for preventative interventions.