Psychiatric Conditions Increase Risk of Long-Term Opioid Use

A recent study found that patients with psychiatric conditions and on medication were more likely to fill prescriptions for opioids, and had a greater risk of prolonger opioid use than patients without psychiatric conditions.

Researchers collected data from the Truven Health MarketScan Commercial Claims and Encounters database from 2003 to 2013, and identified 10,311,961 individuals who filled opioid prescriptions, and followed-up until the first disenrollment of the patient, with the median length of 1.55 years. Hydrocodone prescriptions were filled by 62.5% of patients, oxycodone by 24.2%, codeine by 13.8%, tramadol by 13.3%, and propoxyphene by 10.1%.
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Long-term opioid use was defined by the researchers as patients filling prescription for more than 90 days within 6-months, and with no gaps of more than 32 days between the end of one prescription and the beginning of the next prescription. Patients were categorized by psychiatric conditions prior to filling the first opioid prescription.

Their results showed that patients with psychiatric conditions and medications had higher, but statistically modest, odds of filling prescriptions for opioids, and had significantly higher risk for long-term opioid use. Using the adjusted Cox regression model, researchers determined that patients with attention-deficit/hyperactivity disorder had approximately 1.5-fold risk for long-term opioid use, patients with nonopioid substance abuse disorder patients had a 3-fold risk, and patients with prior opioid use disorder had an almost 9-fold risk for long-term opioid use.

The study indicates that the risk for long-term opioid use is associated with psychiatric and behavioral conditions.

“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,” the researchers concluded.

—Melissa Weiss

Reference:

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 [published online December 2016]. Pain. doi:10.1097/j.pain.0000000000000730.