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Associations of mental health and family background with opioid analgesic therapy

a nationwide Swedish register-based study

Quinn, Patrick D.1; Rickert, Martin E.2; Franck, Johan3; Sariaslan, Amir4; Boersma, Katja5; Lichtenstein, Paul4; Larsson, Henrik4,6; D’Onofrio, Brian M.2,4

doi: 10.1097/j.pain.0000000000001643
Research Paper: PDF Only

There is evidence of greater opioid prescription to individuals in the US with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse pre-existing mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5 071 193 (48.4% female) adolescents and adults who were naïve to prescription opioid analgesics and followed them from 2007-2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3%-11.4%). Individuals with pre-existing self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders, had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1 298 083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%-7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1 482 462 adolescents and young adults, initiation and LTOT rates were greater for those with parental mental health history or lower childhood SES. Efforts to understand and ameliorate potential adverse effects of opioid analgesics must account for these patterns.

1Department of Applied Health Science, School of Public Health, Indiana University, Bloomington

2Department of Psychological and Brain Sciences, Indiana University, Bloomington

3Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

5Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden

6School of Medical Sciences, Örebro University, Örebro, Sweden

Correspondence concerning this article should be addressed to Patrick D. Quinn, Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th St., Room 116, Bloomington, IN 47408. Phone: (812) 855-9789. E-mail:

© 2019 International Association for the Study of Pain
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