Psychiatric Conditions Linked to Long-Term Opioid Use
Psychiatric diagnoses increase risk of transitioning from incident to long-term opioids.
Preexisting psychiatric and behavioral conditions and psychoactive medication use are associated with subsequent claims of prescription opioids, according to a study published in Pain.1
The preexisting psychiatric and behavioral conditions include substance use disorders (SUDs), opioid use disorders (OUDs), suicide attempts and other self-injury, depression, and motor vehicle crashes.
Patrick D. Quinn, PhD, from the Department of Psychological and Brain services at Indiana University, and colleagues examined health insurance claims among 10,311,961 opioid recipients, ages 14 years and older (18 and older for motor vehicle crashes) who had at least 12 calendar months of continuous enrollment of a filled opioid prescription.
The researchers evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions. These include OUD, non-opioid SUD, depressive disorder, uncertain or definite suicide attempt or self-injury (combined), anxiety disorder, sleep disorder, and motor-vehicle crashes. Also included were psychoactive medications such as antidepressants and mood stabilizers.
The first objective was to estimate the extent to which prior psychiatric conditions, motor vehicle crashes, and psychoactive medications would predict claims for prescription opioids. The most common condition was depression, diagnosed in 8.5% of cases, while suicide attempts and self-injury were the least common conditions (0.1%). Patients with prior OUD or non-opioid SUD diagnosis had 16% or 11% greater odds, respectively, of receiving opioids than patients without these conditions did.
The second objective was to estimate the extent to which prior psychiatric conditions, motor vehicle crashes, and psychoactive medications would predict receipt of long-term opioids among opioid recipients. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior ADHD medication prescriptions (hazard ratio [HR], 1.53) to approximately 3-fold for prior non-opioid SUD diagnoses (HR, 3.15) and nearly 9-fold for prior OUD diagnoses (HR, 8.70). The probability of transitioning from first fill to long-term opioids was 1.3% by 1.5 year after the first prescription fill, 2.1% by 3 years, 3.7% by 6 years, and 5.3% by 9 years.
“Patients with prior psychiatric diagnoses, suicide attempts or other self-injury, and motor vehicle crashes were at greater risk of transitioning from an incident opioid prescription fill to receipt of long-term opioids than were patients without prior psychiatric conditions,” said the authors. “Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.”
- Quinn PD, Hur K, Chang Z, et al. Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims. Pain. January 2017. doi: 10.1097/j.pain.0000000000000730