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“There exists a complex interaction of factors related to the patient, provider, and medical and social conditions that ultimately results in the decision to prescribe an opioid,” wrote study authors Matthew Davis, Ph.D., M.P.H., of the University of Michigan and colleagues.
“Our findings … suggest that there may be additional patient- and provider-related factors specific to those with mental illness that increase the likelihood of receiving prescription opioids,” they continued. “Such a relationship is particularly concerning because mental illness is also a prominent risk factor for overdose and other adverse opioid-related outcomes.”
Davis and colleagues performed their study using data from the 2011 and 2013 results of the Medical Expenditure Panel Survey, a national survey conducted by the Agency for Healthcare Research and Quality that gathers extensive information on health care use, including prescription medications, and expenditures.
They found that approximately 19% of adults with a mental health disorder were opioid users (defined as fulfilling at least two opioid prescriptions in a calendar year), compared with only 5% of adults without a mental health disorder. After adjusting for sociodemographic and health factors, adults with mental health disorders had more than twice the odds of being an opioid user (odds ratio=2.08). The higher risk of opioid use in adults with mental illness was evident across a range of pain types, such as cancer pain or muscular pain.
When extrapolating their data to the general population, Davis and colleagues estimated that 60 million of the approximately 115 million opioid prescriptions distributed each year (51.4%) go to the 38.6 million adults with mental health disorders.
John Renner, M.D., vice chair of APA’s Council on Addiction Psychiatry, commented on the study results. “The overlap between depression and chronic pain is well known. Once patients are given an opioid, they may notice a reduction in pain and an improvement in mood and then may be very resistant to stopping the opioid. Patients may not even be conscious of the improved mood, but they are more likely to try to continue the medication. I do not think that physicians deliberately prescribe an opioid because of the presence of mental illness; data seem to suggest that many primary care physicians aren’t screening for psychiatric symptoms.”
To read more about this topic, see the Psychiatric News article “APA Holds Congressional Briefing on Ending the Opioid Epidemic” and the Psychiatric Services article “Prescriptions Filled Following an Opioid-Related Hospitalization.”
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