Depression, anxiety may up long-term opioid use risk: study

Pre-existing psychiatric and behavioural conditions such as depression, anxiety and sleep disorders as well as the use of psychoactive drugs may increase the risk of long-term use of opioid pain medications, a new study has warned.
This association appears stronger for long-term opioid use and especially for patients with a previous history of substance use disorders, researchers said.
Using an insurance database, researchers identified 10.3 million patients who filed insurance claims for opioid prescriptions between 2004 and 2013.
"We found that pre-existing psychiatric and behavioural conditions and psychoactive medications were associated with subsequent claims for prescription opioids," said Patrick D Quinn from Indiana University in the US.

The results also suggest that some outcomes viewed as harmful outcomes of opioid use - substance use disorders, depression, suicidal or self-injuring behaviour and motor vehicle crashes - are also predictors of which patients are at risk of long-term use of prescription opioids.
Overall, the results suggested a "modest" increase in any opioid prescriptions for patients with previous psychiatric or behavioural conditions (depression or anxiety disorders, opioid or other substance use disorders, suicide attempts or other self-injury, motor vehicle crashes and sleep disorders) or use of psychoactive medications.

About 1.7 per cent of patients with opioid prescriptions become long-term opioid users (six months or longer).

However, the risk became substantially higher for patients with mental health conditions or psychoactive medication use.
Relative 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.
Amid the continuing opioid epidemic, it is important to understand which patients select (or are selected for) treatment with these pain medications.
Previous studies have suggested a pattern of "adverse selection" - patients at greatest risk of harmful outcomes, including those with substance abuse and other psychiatric conditions, may be more likely to be prescribed opioids in higher doses and for longer durations.

"Our results add to existing evidence that the risk of long-term opioid receipt associated with [pre-existing] psychiatric and behavioural conditions is widespread and relates to multiple diagnoses and psychoactive medications," researchers said.
The study appears in the journal PAIN.