Mental illness linked to increased risk of long-term opioid use

A study has found that pre-existing depression or anxiety disorders and the use of psychoactive drugs can increase the risk leading to long-term use of opioid pain medications.

The findings showed that increases in rates of long-term opioid use ranged from 1.5 times for patients taking medications for attention-deficit/hyperactivity disorder, to about three times for those with previous substance use disorders other than opioids, to nearly nine times for those with previous opioid use disorders.

The study is published in the journal of PAIN.

Researchers from Indiana University Bloomington in the United States identified 10.3 million patients who filed insurance claims for opioid prescriptions between 2004 and 2013.

The study looked at whether pre-existing psychiatric and behavioral conditions and use of psychoactive medications were predictors of later opioid use.

"We found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids," wrote the researchers.

The association appears stronger for long-term opioid use and especially for patients with a previous history of substance use disorders.

The results also suggest that some outcomes viewed as harmful outcomes of opioid use - substance use disorders, depression, suicidal or self-injuring behavior and motor vehicle crashes - are also predictors of which patients are at risk of long-term use of prescription opioids.

Psychiatric or behavioral conditions - depression or anxiety disorders, opioid or other substance use disorders, suicide attempts or other self-injury, motor vehicle crashes, and sleep disorders

The findings indicated that about 1.7 percent of patients with opioid prescriptions become long-term opioid users (six months or longer).

But the risk became substantially higher for patients with mental health conditions or psychoactive medication use.

"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 co-authors concluded.