Response to Ruan et al. Letter to the Editor: Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients

We appreciate the thoughtful comments of Ruan et al,1 regarding the definition of depression used in our recent study on the association between opioid use and depression recurrence.2 The authors argue that using International Classification of Diseases, Ninth Revision (ICD-9) code 311 is not an appropriate measure for major depression. Selecting an ICD-9 code for depression is multifactorial and partly influenced by whether patients were treated in specialty mental health care or primary care. We do not have enough information to distinguish between major depressive episode and the less specific clinical features of sadness and depressed mood related to ICD-9 code 311.

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