Mental, behavioral health conditions increase rates of long-term opioid use

A new study, published in PAIN, has found that patients with substance abuse disorders and other psychiatric conditions are more likely to use opioid pain medications for longer terms.

Amid the growing opioid epidemic, the study aimed to identify patients at a higher risk of abusing opioid medications as a way for clinicians to prescribe appropriate medications for individual patients. Researchers evaluated more than 10 million insurance claims of patients who filled opioid prescriptions to analyze how the medication usage differed in patients with preexisting behavioral conditions and those without.

“In order to accurately assess opioid-related risk for these adverse outcomes, it is critical to understand which patients select or are selected for opioid therapy,” wrote Patrick Quinn and coauthors. “There is growing evidence that prescribing in the United States follows a pattern termed 'adverse selection.' That is, patients who are at the greatest risk of adverse outcomes, including those with preexisting substance use disorders—and opioid use disorders in particular—and other psychiatric conditions, may be more likely to be prescribed opioids for longer durations and in higher risk regimens than patients without these conditions.”

Compared to patients without, patients with psychiatric conditions had slightly higher odds of filling prescriptions for opioids. Overall, about 1.7 percent of patients who were prescribed opioids become long-term opioid users. This rate jumps when the patients have mental health conditions. Patients taking medication for attention deficit/hyperactivity disorder are 1.5 times more likely to develop an opioid dependence. Patients with a previous history of substance abuse disorders are three times more likely to develop an opioid dependency and those with previous opioid use disorders experience a nine times higher rate of repeating the opioid abuse.

"Our results add to existing evidence that the risk of long-term opioid receipt associated with [pre-existing] psychiatric and behavioral conditions is widespread and relates to multiple diagnoses and psychoactive medications," wrote Quinn and coauthors. “Our findings support the ideas that clinical practice has deviated from the 'careful selection' under which most clinical trials are conducted and that thorough mental health assessment and intervention should be considered in conjunction with the use of long-term opioid therapy."