Table 2:

Coding scheme

Behaviors that mapped onto DSM-5 criteria for Opioid Use Disorder

Taking the opioid in larger amounts and for longer than intended Asking for increase in opioid dose Using more opioid (medication) than prescribed Overdosing Receiving medication from others Taking opioids for symptoms other than pain Taking non-prescribed opioids Hoarding Inaccurate pill count Continuing meds even when pain is stable Spending a lot of time in activities necessary to obtain the opioid, use the opioid, or recover from its effects Altering police reports Altering prescriptions Forging prescriptions Bringing someone to ask for dose increase Using multiple pharmacies Multiple prescribers Request to change providers ER visits Patient rep used to ask for opioids Sending someone else to pick up prescriptions Recurrent opioid use resulting in a failure to fulfill major obligations at work, school, or home Missing appointments Continued use despite persistent or recurring social or interpersonal problems caused or exacerbated by opioid use Fired by pain teams Interpersonal problems Motor vehicle crashes Arrests or legal issues Anger or aggression Recurrent opioid use in situations where it is physically hazardous Motor vehicle crashes Falls Continued opioid use despite having persistent or recurrent physical or psychological problem that is likely to have been caused by or exacerbated by the substance Oversedation Overdosing Slurred speech Psychic effects of meds reported Unwillingness to explore other medications despite adverse effects of current medication Side effects unmanageable Motor vehicle crashes Falls Pain uncontrolled or unmanageable DSM criteria: withdrawal Signs of withdrawal DSM criteria: tolerance Tolerance

Behaviors that suggest deception Altering police reports Altered urine Diversion Refusal or resistance to bring pills for pill count Changing from pick up to mail prescriptions Forging prescriptions Lying Profile picture removed Using multiple pharmacies Suspicion for faking or exaggerating pain Altering prescriptions Requesting refills after hours Attends drop-in clinic (not follow up) for prescription refill Allergies to multiple opioids Arriving late OR leaving early for appointments Bringing someone else to ask for dose increase Pain behaviors Sending someone else to pick up prescriptions Missing appointments

Signs of diversion Altering police reports Altering prescriptions Arrests or legal issues Buying opioids from street or non-medical avenues Diversion Forging prescriptions Police report problems Selling prescriptions Stealing Lost or stolen meds Sharing medications

Non-Adherence to treatment plan Non-compliance with urine drug test Refusal or resistance to bring pills for pill count Altered urine Inaccurate pill count Inappropriate serum drug test Inappropriate urine screen Urine drug screen negative for medication prescribed Urine drug screen positive for substances not prescribed Urine positive for illicit drugs Urine positive for prescription drugs not prescribed Positive for cocaine Positive for marijuana