Substance use disorders and psychiatric conditions may be associated with long-term opioid use

Written by Jonathan Wilkinson

A new report published by researchers from Indiana University (IN, USA) suggests a link between psychiatric conditions and risk of long-term opioid use. In recent years, there has been growing evidence in the USA that patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. In particular, it appears that those with substance use disorders and other psychiatric conditions have a higher chance of being prescribed opioids. This latest study examined health insurance claims and was published in the journal Pain.
The researchers used a national insurance database to identify over 10.3 million patients who filed insurance claims for opioid prescriptions between 2004 and 2013. They found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids. In particular, the association was stronger for long-term opioid use, as well as patients with a previous history of substance use disorders. In addition, the findings also indicated that outcomes that are generally viewed as harmful effects of opioid use, such as depression, suicidal behavior and motor vehicle crashes, are also predictors for patients who are at risk of long-term use of prescription opioids.

Although only 1.7% of patients with opioid prescriptions become long-term opioid users, the risk was higher for patients with mental health conditions or psychoactive medication use. For example, patients taking medication for ADHD demonstrated a relative increase in the rate of long-term opioid use of 1.5 times. For those patients with previous substance use disorders the increase was 3 times, but was almost 9 times for those with previous opioid use disorders.

This latest research reinforces the view that it is important to understand which patients select, or are selected for, opioid treatment. Other recent studies have suggested that “adverse selection” may be taking place in the prescription of opioid medications. 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.

In their report, the authors conclude: “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.”

Sources: Quinn PD, Hur K, Chang C et alIncident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims. Pain 158(1), 140–148 (2017);