Bloomington, IN—Some of the harmful outcomes of opioid use, such as substance use disorders, depression, suicidal or self-injuring behavior, and motor vehicle crashes, are also predictors of which patients are at risk for long-term use of prescription opioids.
That’s according to a new study published recently in the journal Pain, which found that a range of pre-existing psychiatric and behavioral conditions and the use of psychoactive drugs could be important risk factors leading to long-term use of opioids.
For the study, Indiana University–led researchers used a nationwide insurance database to identify 10.3 million patients who filed insurance claims for opioid prescriptions between 2004 and 2013. At the same time, the analysists documented pre-existing psychiatric and behavioral conditions and use of psychoactive medications.
“We found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids,” write Patrick D. Quinn, PhD, of Indiana University in Bloomington, and colleagues.
Study authors suggest the association appears stronger for long-term opioid use, and especially for patients with a previous history of substance-use disorders.
Overall, the results indicate a “modest” increase in any opioid prescriptions for patients with previous psychiatric or behavioral conditions—defined as 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.
While 1.7% of patients with opioid prescriptions become long-term opioid users, using the drugs for 6 months or longer, the risk significantly increased for those with mental health conditions or psychoactive medication use.
Results suggest that 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. The increased rate for those with previous opioid use disorders was a whopping nine times, according to the study.
“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,” study authors explain, concluding, “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.”
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