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

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 lowerbound population measure of substance use or for capturing frequent use among certain patient populations.