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Disproportionate longer-term opioid use among U.S. adults with mood disorders

Halbert, Brian T.; Davis, Roger B.; Wee, Christina C.

doi: 10.1097/j.pain.0000000000000650
Research Paper
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Adults with mood disorders frequently use prescription opioids. The factors associated with this increased use remain unclear. We used the Medical Expenditure Panel Surveys from 2005 to 2011 to measure the association of mood disorders with new opioid use and the transition to longer-term opioid use for a variety of pain conditions before and after controlling for patient characteristics and clinical disability. We analyzed 33,450 adults with likely acute or potentially chronic pain conditions who were not using opioids at baseline. Among respondents with likely acute pain conditions, those with mood disorders initiated opioids more frequently for that pain condition compared with those without mood disorders (19.3%, vs 17.2%, P = 0.01). After initiation, they also transitioned to longer-term opioid therapy more frequently (11.7% vs 5.3%, P < 0.01). Among respondents with potentially chronic pain conditions, adults with mood disorders initiated opioid therapy more frequently for their chronic pain condition (11.5% vs 9.2%, P < 0.01) and transitioned to longer-term therapy more frequently (36.8% vs 19.9%, P < 0.01). After adjusting for sociodemographics and clinical disability, there was no association between mood disorders and new opioid use for likely acute (adjusted odds ratio [aOR] 1.05 [0.92-1.20]) or potentially chronic pain (aOR 0.91 [0.80-1.03]). However, there remained a strong association between mood disorders and the transition to longer-term opioid use for likely acute (aOR 1.77 [1.15-2.72]) and potentially chronic pain (aOR 1.95 [1.42-2.68]). Targeting the transition to longer-term opioid use may help clinicians reduce potentially inappropriate opioid prescriptions in this high-risk population.

Supplemental Digital Content is Available in the Text.The higher rate of opioid initiation among persons with mood disorders is driven by clinical disability; however, their tendency to continue using opioids longer term is independent of their clinical disability.

aDivision of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

bDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

Corresponding author. Address: Beth Israel Deaconess Medical Center, Shapiro Building, 6th Floor, 330 Brookline Ave, Boston, MA 02215, USA. Tel.: 617-754-1432; 225-205-5728; fax 617-754-1440. E-mail address: bhalbert@bidmc.harvard.edu (B. Halbert).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received February 05, 2016

Received in revised form May 19, 2016

Accepted June 10, 2016

© 2016 International Association for the Study of Pain
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