Medical News: AAPM: At Any Age Depression Dx Tracks Opioid Use - in Meeting Coverage, AAPM from MedPage Today

WASHINGTON -- Teens and young adults with mental health disorders may be more likely to become chronic users of opioid drugs, according to results of a large study reported here. The study of more than 59,000 chronic pain patients (ages 13-24) found that overall, 17.1% of chronic opioid users had a mental health or substance use diagnosis, compared with 10.6% among non-chronic users, and 8.2% for those who did not use opioids, Mark Sullivan, MD, professor of psychiatry and behavioral sciences at the University of Washington in Seattle, and colleagues reported. Their findings were presented in a poster session at the annual meeting of the American Academy of Pain Medicine. It is well-known that adults with mental health problems have a higher risk of suffering from chronic opioid use and abuse compared with those without mental health issues. Sullivan's group wanted to find out more about younger opioid users. "Since the group of adolescents are at the highest risk for opioid abuse, we felt it was important to focus on how these individuals get prescribed opioids for chronic pain," Sullivan told MedPage Today. The investigators looked at data from the HealthCore Integrated Research Database involving claims for 59,077 patients ages 13-24 years seen for a non-cancer related chronic pain condition (back/neck pain, headache, or arthritis/joint pain) from January 1, 2001 to June 30, 2008. Chronic opioid use was defined as receiving more than 90 days of opioids within a six-month period, with no gap in use of more than 30 days. The researchers found that 351 patients (0.5%) met criteria for chronic opioid use, while 6,172 (27.4%) had some opioid use but did not meet criteria for chronic opioid use, and 42,584 (72.1%) had no opioid use. The average age of the chronic users was around 20; and a little over half were male. Anxiety disorders and depression were the most common mental health diagnoses among chronic opioid users, at 8.1% and 5.9%, respectively. After controlling for demographic and clinical factors, patients with any mental health diagnosis had a more than two-fold increased risk for receiving chronic opioids compared to no opioids (OR 2.36, 95% CI 1.73 to 3.23) and a 1.8-fold increased risk for receiving chronic opioids versus some opioids (OR 1.83, 95% CI 1.34 to 2.50), Sullivan and colleagues reported. They also found that there were demographic predictors of chronic opioid abuse, including living in areas with lower education and a higher percentage of white residents. "It's consistent with overall substance abuse literature ... prescription drug abuse tends to be focused in rural, low-income, low-education white communities," said Sullivan. The researchers plan to expand their research and analyze the effects of various policy initiatives that are underway to help adolescent and young adult patients, including health system quality improvement, state-based prescription drug monitoring programs, and forthcoming Risk Evaluation and Mitigation Strategies for opioids from the FDA, he added. The results of the study carry an important message for physicians, Sullivan stressed. "We've documented that mental health diagnoses are predictive of opioid use, and I imagine that a lot of times opioid-prescribing physicians didn't even know about the mental health problems because they haven't asked about them. Doctors need to be inquiring about whether these patients have concurrent mental health problems, and if so they need independent treatment," he said. The study was funded by the National Institute on Drug Abuse and the Alcohol and Drug Abuse Institute at the University of Washington. Sullivan and the other authors made no financial disclosures.

Primary source: American Academy of Pain Medicine Source reference: Sullivan, MD "Initiation of Opioid Treatment Among Adolescents with Chronic Pain" AAPM 2011; Abstract 129.