Withdrawal symptoms predict prescription opioid dependence in chronic pain patients

•Opioid analgesics withdrawal is strongly associated with DSM-5 opioid-use disorder.•Withdrawal intensity increases with the severity of opioid-use disorder and pain.•Withdrawal intensity increases with smoking and young age.•Prescription of anxiolytics and antidepressants with opioids increases withdrawal.•Escalation of withdrawal symptoms could predict POUD in chronic pain patients. The last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes substantial changes for prescription opioid-use disorder (POUD). After its removal as a criterion, the goal of this study was to estimate the prevalence of withdrawal symptoms in long-term users of prescription opioids and its association with the new DSM-5 POUD classification. Data were collected from 215 long-term consumers of opioid medication who were chronic non-cancer pain patients. Participants completed sociodemographic, Adjective Rating Scale for Withdrawal (ARSW), opioid treatment characteristics, POUD criteria (DSM-5), and pain intensity measurements. 26.6% of the participants were classified with moderate to severe POUD. Higher intensity of withdrawal symptoms was found in patients with moderate/severe POUD, younger age, and higher pain intensity (p