Pain, Depression, and Opioid Misuse May Be Associated With Drug Overdoses

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Depression, younger age, opioid misuse, and the presence of any type of pain were found to be associated with an increased risk for lifetime alcohol and drug overdose.
Depression, younger age, opioid misuse, and the presence of any type of pain were found to be associated with an increased risk for lifetime alcohol and drug overdose.

Pain conditions may largely be underrecognized contributors to the overdose epidemic, according to a cross-sectional analysis published in the Journal of Addiction Medicine. Depression, younger age, opioid misuse, and the presence of any type of pain were found to be associated with an increased risk for lifetime alcohol and drug overdose in this study.

Patient data from a Michigan-based drug and alcohol residential rehabilitation center were collected for this cross-sectional analysis (n=739). Researchers evaluated associations among patient demographics, type of pain (eg, acute, chronic, or both), symptoms of depression, and misuse of opioids, and history of nonfatal alcohol or drug overdose.

In the adjusted multivariate logistic regression analyses, patients with an increased risk for nonfatal alcohol overdose were found to be more likely to have a history of chronic pain (odds ratio [OR], 2.60; 95% CI, 1.59-4.27) and illicit drug use (OR, 1.99; 95% CI, 1.07-3.68). Drug overdose occurrence was found to be associated with symptoms of depression (OR, 1.33; 95% CI, 1.14-1.55), opioid misuse (OR, 3.11; 95% CI, 2.51-3.86), and younger age (OR, 0.96; 95% CI, 0.94-0.97). Any type of pain was found to be associated with a greater number of lifetime alcohol overdoses (OR, 2.1; 95% CI, 1.6-2.8; P <.05) in a β-regression analysis. Patients with pain who reported a higher number of alcohol overdoses during their lifetime were also more likely to report combining several different drugs with alcohol prior to overdose.

Limitations of this analysis include the use of data from patients who attended a single site and the lack of information regarding the timing of overdose as it related to the onset and occurrence of pain.

“Patients may need education regarding the role of combining substances and how it can increase the risk of overdose, particularly when drinking alcohol,” the investigators concluded. “This type of information could be delivered through an evidenced-based psychosocial intervention to reduce overdose risk behaviors.”

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Reference

Fernandez AC, Bush C, Bonar EE, Blow FC, Walton MA, Bohnert ASB. Alcohol and drug overdose and the influence of pain conditions in an addiction treatment sample [published online August 29, 2018]. J Addict Med. doi: 10.1097/ADM.0000000000000451

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