“Given the limited support for the efficacy of opioid therapy for chronic pain among youths, research is needed to understand potential adverse effects of LTOT [long-term opioid therapy] among adolescents as well as the role that preexisting mental health conditions may play in harmful outcomes,” lead author Patrick D. Quinn, Ph.D., of Indiana University and colleagues wrote.
For the study, Quinn and colleagues analyzed data from the 2003-2014 Truven Health MarketScan Commercial Claims and Encounters (MarketScan) databases of commercial health care insurance claims. The researchers identified a cohort of more than 1.2 million adolescents aged 14 to 18 who received opioids for the first time during this period. The researchers then tracked this group from their first prescription until their first disenrollment or December 31, 2014 (whichever occurred first), to examine subsequent long-term opioid therapy (defined as more than 90 days’ supply within a six-month window having no gaps in supply of more than 32 days).
Associations between preexisting mental health conditions and treatments and any opioid receipt were examined by comparing adolescents who received any opioid analgesic with those who did not matched on sex, calendar year and years of age of first enrollment, and months of enrollment.
The authors found that 3.0 per 1,000 opioid recipients transitioned to long-term opioid therapy within three years of fulfilling an initial opioid prescription. “Although adolescents with a wide range of preexisting mental health conditions and treatments were modestly more likely than adolescents without those conditions or treatments to receive an initial opioid, the former had substantially higher rates of subsequent transitioning to LTOT [long-term opioid therapy],” the authors wrote.
“There is a clear need for mental health assessment among adolescents being considered for opioid therapy. Such an assessment may help inform decision making regarding pain treatment as well as illuminate the possible value of concomitant mental health interventions,” they concluded.
In an accompanying editorial, Michael J. Mason, Ph.D., of the University of Tennessee, Knoxville, wrote, “These findings are important clinically and provide a foundation for future research to test the efficacy and potential adverse effects of long-term opioid therapy for adolescents with and without comorbid diagnoses. This research has highlighted the need to address comorbidity by addressing the accompanying risk and protective factors—a challenging task but one that would provide immediate translational guidance for pediatric practitioners.”
For related information, see the Psychiatric News article “Many Prescription Opioids Go to Adults With Depression, Anxiety.”