Many Prescription Opioids Go to Adults With Depression, Anxiety

There is a strong and reinforcing relationship between mental illness, pain, and the pain relief offered by opioids. Several studies have pointed to a higher use of opioids among people with a mental disorder, but this use has not been thoroughly examined.

A study published in the July issue of the Journal of the American Board of Family Medicine now suggests that over half of all opioid prescriptions for adults in the United States each year go to people diagnosed with a mood or anxiety disorder.

When extrapolated to the national population, these findings estimate that adults with a mood or anxiety disorder receive 60 million of the 115 million opioid prescriptions distributed annually.

“It’s important to state that this study looked at legal prescriptions; it did not assess or make any suggestions about mental illness and opioid abuse,” said lead investigator Matthew Davis, Ph.D., M.P.H., an assistant professor in the Department of Systems, Populations, and Leadership at the University of Michigan School of Nursing.

“But these prescriptions are how opioids get into society, so it’s important for us to quantify prescription flow at the national level to help guide clinical guidelines and policy decisions,” he told Psychiatric News.

Davis and his colleagues performed their analysis using data from the 2011 and 2013 Medical Expenditure Panel Survey (MEPS), a national survey conducted by the federal Agency for Healthcare Research and Quality that gathers extensive information on a person’s overall health, what health care services they use, and how much they pay.

The final sample consisted of responses from 51,891 adults in the United States. The authors then used both the respondents’ self-reports as well as clinical and pharmacy data to identify depression and/or anxiety diagnoses, opioid prescriptions, and the conditions associated with that prescription.

To examine the relationship between mood and anxiety disorders and prescription opioid use, the researchers focused on “opioid users”—individuals who had filled at least two opioid prescriptions in a year.

The authors found that 18.7 percent of adults with a mood or anxiety disorder filled multiple prescriptions for opioids in the past year, compared with only 5 percent of adults without such a diagnosis. After adjusting for sociodemographic and health factors, adults with a mood or anxiety disorder had 2.08-fold greater odds of being classified as opioid users.

This elevated risk of opioid use for adults with a mood or anxiety disorder was evident when looking at various subgroups of patients. Adults with a mood or anxiety disorder were more likely to be prescribed opioids for mild, moderate, or severe pain, as well as for different types of pain such as pain from cancer or a musculoskeletal condition. For instance, those with a mood or anxiety disorder and severe pain were nearly twice as likely to be opioid users as those without a mood or anxiety disorder diagnosis (45.3 percent compared with 24.1 percent, respectively).

“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,” said John Renner, M.D., a professor of psychiatry at Boston University School of Medicine and vice chair of APA’s Council on Addiction Psychiatry.

“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.”

The study authors did not report any funding for this research. ■