Prescription Opioid Use among Adults with Mental Health Disorders in the United States

Background: The extent to which adults with mental health disorders in the United States receive opioids has not been adequately reported. Methods: We performed a cross-sectional study of a nationally representative sample of the noninstitutionalized U.S. adult population from the Medical Expenditure Panel Survey. We examined the relationship between mental health (mood and anxiety) disorders and prescription opioid use (defined as receiving at least 2 prescriptions in a calendar year). Results: We estimate that among the 38.6 million Americans with mental health disorders, 18.7% (7.2 million of 38.6 million) use prescription opioids. Adults with mental health conditions receive 51.4% (60 million of 115 million prescriptions) of the total opioid prescriptions distributed in the United States each year. Compared with adults without mental health disorders, adults with mental health disorders were significantly more likely to use opioids (18.7% vs 5.0%; P < .001). In adjusted analyses, having a mental health disorder was associated with prescription opioid use overall (odds ratio, 2.08; 95% confidence interval, 1.83–2.35). Conclusions: The 16% of Americans who have mental health disorders receive over half of all opioids prescribed in the United States. Improving pain management among this population is critical to reduce national dependency on opioids.

[1]  Roger B. Davis,et al.  Disproportionate longer-term opioid use among U.S. adults with mood disorders , 2016, Pain.

[2]  A. Bohnert,et al.  Understanding Risk Factors for Opioid Overdose in Clinical Populations to Inform Treatment and Policy , 2016, Journal of addiction medicine.

[3]  K. Bucholz,et al.  Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients. , 2016, The journal of pain : official journal of the American Pain Society.

[4]  E. Roughead,et al.  Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study , 2016, BMJ Open.

[5]  Roger Chou,et al.  CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. , 2016, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[6]  Roger Chou,et al.  Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. , 2016, The journal of pain : official journal of the American Pain Society.

[7]  R. Chou,et al.  CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. , 2016, JAMA.

[8]  Rose A Rudd,et al.  Increases in Drug and Opioid Overdose Deaths--United States, 2000-2014. , 2016, MMWR. Morbidity and mortality weekly report.

[9]  Stephanie E. Moser,et al.  Symptoms of Depression Are Associated With Opioid Use Regardless of Pain Severity and Physical Functioning Among Treatment-Seeking Patients With Chronic Pain. , 2015, The journal of pain : official journal of the American Pain Society.

[10]  Annesa Flentje,et al.  Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: mathematical modeling using a database of commercially-insured individuals. , 2014, Drug and alcohol dependence.

[11]  David Ring,et al.  Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma. , 2014, The Journal of bone and joint surgery. American volume.

[12]  Patrick Richard,et al.  The economic costs of pain in the United States. , 2012, The journal of pain : official journal of the American Pain Society.

[13]  T. Neylan,et al.  Association of mental health disorders with prescription opioids and high-risk opioid use in US veterans of Iraq and Afghanistan. , 2012, JAMA.

[14]  Jingwei Wu,et al.  Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. , 2011, The journal of pain : official journal of the American Pain Society.

[15]  Joel W. Cohen,et al.  The Medical Expenditure Panel Survey: A National Information Resource to Support Healthcare Cost Research and Inform Policy and Practice , 2009, Medical care.

[16]  Jingwei Wu,et al.  Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. , 2009, JAMA.

[17]  K. Wells,et al.  Association between mental health disorders, problem drug use, and regular prescription opioid use. , 2006, Archives of internal medicine.

[18]  Jiang He,et al.  Mortality prediction with a single general self-rated health question , 2006, Journal of General Internal Medicine.

[19]  E. Susser,et al.  The burden of mental illness. , 2006 .

[20]  S. Currie,et al.  Chronic back pain and major depression in the general Canadian population , 2004, Pain.

[21]  D. Mandell,et al.  National estimates of health services expenditures for children with behavioral disorders: an analysis of the medical expenditure panel survey. , 2003, Pediatrics.

[22]  W. Katon,et al.  Depression and pain comorbidity: a literature review. , 2003, Archives of internal medicine.

[23]  D. Turk,et al.  What factors affect physicians' decisions to prescribe opioids for chronic noncancer pain patients? , 1997, The Clinical journal of pain.

[24]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[25]  Recherche Op Rationnelle.  Practical Considerations on the Use of the Charlson Comorbidity Index with Administrative Data Bases , 1996 .

[26]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.