Do Pre-Existing Psychiatric Conditions Impact Opioid Use?
In a study published in PAIN, study authors reported evidence of greater opioid receipt among commercially insured patients with a wide range of psychiatric conditions.
Increasing data point to the trend that patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy; such patients include those with substance use disorders and other psychiatric disorders.
A team of researchers, led by Patrick D. Quinn, Indiana University, Bloomington, MN, evaluated health insurance claims in over 10 million patients who filled opioid prescriptions. "Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of pre-existing psychiatric and behavioral conditions," stated Quinn. Conditions included opioid and non-opioid substance use disorders, suicide attempts or other self-injury, motor vehicle crashes, and depressive, and anxiety, and sleep disorders. Psychoactive medications included antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for substance use disorders, tobacco cessation, and attention-deficit hyperactivity disorder (ADHD).
The study data showed patients with all included psychiatric conditions and drugs had slightly greater odds of filling prescriptions for opioids, and substantially greater odds of long-term opioid therapy, compared to those without. The increases in risk for long-term opioid receipt ranged from approximately 1.5-fold for ADHD medication prescriptions (HR 1.53, 95% CI: 1.48–1.58) to approximately 3-fold for prior non-opioid substance use disorder diagnoses (HR 3.15, 95% CI: 3.06–3.24).
Close to a 9-fold increase in risk was seen for prior opioid use disorder diagnoses (HR 8.70, 95% CI: 8.20–9.24).
More research evaluating behavioral outcomes associated with opioid prescribing should consider pre-existing psychiatric conditions, the authors added.
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