A wide range of pre-existing psychiatric and behavioral conditions, as well as the use of psychoactive drugs, could be important risk factors leading to long-term use of opioid pain medications, according to new research.
For the study, published in PAIN, the official publication of the International Association for the Study of Pain (IASP), researchers used a nationwide insurance database to identify 10.3 million patients who filed insurance claims for opioid prescriptions between 2004 and 2013.
“We found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids,” said Patrick D. Quinn, Ph.D., of Indiana University.
The association appears stronger for long-term opioid use, and especially for patients with a previous history of substance use disorders, the researchers discovered.
The study also suggests 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.
Overall, the findings suggested a “modest” increase in any opioid prescriptions for patients with previous 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 — or use of psychoactive medications.
About 1.7 percent of patients with opioid prescriptions become long-term opioid users, defined as six months or longer.
But the risk became substantially higher for patients with mental health conditions or psychoactive medication use, according to the researchers.
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, according to the study’s findings.
Amid the continuing opioid epidemic, it’s important to understand which patients are treated with these pain medications, the researchers noted.
Previous studies have suggested a pattern of “adverse selection” — where 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 behavioral conditions is widespread and relates to multiple diagnoses and psychoactive medications,” Quinn and his coauthors wrote in the study.
“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 researchers concluded.
Source: Wolters Kluwer Health