Association Between High-Potency Opioids, Depressive Symptoms in Older Adults

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Older adults with severe depressive symptoms are more likely to be taking high-potency opioid medications compared with older adults without such symptoms.

There is an association between severe depressive symptoms in older adults in the United States and the use of high-potency opioid medications, according to the results of a study published in the International Journal of Geriatric Psychiatry.

Using 2005 to 2013 data from the National Health and Nutrition Examination Survey, Jessica M. Brooks, PhD, from the Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, and colleagues conducted adjusted multiple linear regression models to determine whether there were links between use of prescribed opioids and depression among noninstitutionalized adults aged 50 years or older.

The investigators included 1036 subjects with prevalence rates for symptoms of minor depression (n=236; 22.8%), moderate depression (n=135; 13.0%), and severe depression (n=122; 11.8%) in the final analysis. Only severe depression showed a significant correlation with high-potency opioid use (odds ratio [OR], 2.27) after adjusting for gender, age, race/ethnicity, education, marital status, smoking status, body mass index, diabetes, arthritis, hypertension, and cancer. Covariates negatively associated with high-potency opioid use included age 80+ years (OR, 0.47), non-Hispanic black race (OR, 0.59), and other race/ethnicity (OR, 0.58).

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The investigators noted that US adults aged ≥50 years are more than twice as likely to report severe depressive symptoms while prescribed high-potency opioids. They also examined whether there were differences in the degree of association between high-potency opioid medication use and depression category as a result of arthritis diagnosis. Interestingly, those participants without arthritis were approximately 6 times more likely to experience severe depressive symptoms while receiving high-potency opioids than those with arthritis.

The investigators suggested that these results may indicate a tendency for physicians to prescribe high-potency opioids to older adults with pain-related diagnoses that are not responsive to nonopioid therapies, who also have preexisting severe depression or higher risks for the disorder. Other possibilities are that these patients are experiencing inadequate pain relief from opioids or that older adults with or at risk for depression may be seeking high-potency opioid prescriptions to relieve their symptoms.

The use of a cross-sectional data set prevents making any causal inferences, and the use of self-reported depression measures and sociodemographic and health assessments may have introduced bias into the analysis.

The investigators advocated that future research investigate the patterns between depressive symptoms and use of potent opioids in older adults by subtype of pain-related diagnoses, and that prescribing providers, geriatric psychiatry professionals, and behavioral health specialists work together to address the issues of pain and mental health in older patients.

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Brooks JM, Petersen C, Kelly SM, Reid MC. Likelihood of depressive symptoms in US older adults by prescribed opioid potency: National Health and Nutrition Examination Survey 2005-2013 [published online May 27, 2019]. Int J Geriatr Psychiatry. doi:10.1002/gps.5157

This article originally appeared on Psychiatry Advisor