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Incident and long-term opioid therapy among patients with psychiatric conditions and medications

a national study of commercial health care claims

Quinn, Patrick D.a,b,*; Hur, Kwanb; Chang, Zhengb,c; Krebs, Erin E.d,e; Bair, Matthew J.f,g,h; Scott, Eric L.i; Rickert, Martin E.a; Gibbons, Robert D.b; Kroenke, Kurtf,g,h; D'Onofrio, Brian M.a

doi: 10.1097/j.pain.0000000000000730
Research Paper
Editor's Choice

There is growing evidence that opioid prescribing in the United States follows a pattern in which patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10,311,961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions (ie, opioid and nonopioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (ie, antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior attention-deficit/hyperactivity disorder medication prescriptions (hazard ratio [HR] = 1.53; 95% confidence interval [CI], 1.48-1.58) to approximately 3-fold for prior nonopioid SUD diagnoses (HR = 3.15; 95% CI, 3.06-3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95% CI, 8.20-9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.

Patients with prior psychiatric diagnoses, psychoactive medications, motor vehicle crashes, and suicide attempts/self-injury were more likely to receive long-term opioids than those without.

aDepartment of Psychological and Brain Sciences, Indiana University, Bloomington, MN, USA

bCenter for Health Statistics, University of Chicago, Chicago, IL, USA

cDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

dVA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA

eUniversity of Minnesota Medical School, Minneapolis, MN, USA

fVA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA

gDepartment of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

hRegenstrief Institute, Indianapolis, IN, USA

iDepartment of Pediatrics and Communicable Diseases and Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA

Corresponding author. Address: Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th St, Bloomington, IN 47405, USA. Tel.: (812) 856-2588. E-mail address: (P.D. Quinn).

Portions of this research were presented at and were or will be published in abstracts for the 2016 American Pain Society (Austin, TX) and Translational Science (Washington, DC) meetings.

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 (

Received March 29, 2016

Received in revised form July 20, 2016

Accepted August 24, 2016

© 2017 International Association for the Study of Pain
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