Study: Half of Opioid Prescriptions Go to Patients With Depression and Other Mood Disorders

Those most likely to abuse opioids are most likely to receive them

A little more than half of all opioid prescriptions in the United States are written for patients with anxiety, depression, and other mood disorders, according to a new study described on the STAT website. The study found that patients with mood disorders are at increased risk of abusing opioids, and yet they received many more prescriptions compared with the general population, based on an analysis of data from 2011 and 2013.

“We’re handing this stuff out like candy,” said senior author Dr. Brian Sites of Dartmouth–Hitchcock Medical Center.

The study, published in the Journal of the American Board of Family Medicine, tapped a U.S. health survey that gathered data from providers and facilities on prescription medications, health status, and basic demographics for approximately 51,000 adults. The investigation found that 19% of the 38.6 million Americans with mood disorders use prescription opioids, compared with 5% of the general population—a difference that remained even when the researchers controlled for factors such as physical health, levels of pain, age, sex, and race.

The analysis found that adults with mood disorders receive 51% of the opioid prescriptions distributed in the U.S.––approximately 60 million prescriptions a year.

It’s unclear why such a discrepancy exists, according to the STAT report. Sites said it’s possible that patients with mood disorders respond to pain differently, spurring physicians to write more opioid prescriptions; previous research has shown that patients with a history of depression are at increased risk of developing chronic pain. Another possibility is that physicians might be more sympathetic to patients with pre-existing conditions, making them more likely to prescribe opioids. Sites also said that opioids might have a short-term antidepressant effect, which could motivate patients with mood disorders to seek prescriptions.

For Sites, the bottom line is that while opioid prescriptions can be appropriate for individual patients with mood disorders, the study raises concerns about overprescribing on a population scale.

“We need to understand if this massive prescribing level is appropriate in actually providing benefit commensurate with the risk,” he said.

Sites added that physicians need viable alternatives for treating pain, including cognitive behavioral therapy, acupuncture, acupressure, physical therapy, and massage.

“We don’t have the ability to refer and recommend those things easily,” he said, “So the easiest thing right now is to prescribe a pill.”

For Dr. Mark Edlund, a senior public health analyst at RTI International who was not involved in the study, the findings add to a growing and worrisome body of evidence that people with mental-health disorders who are at increased risk of abusing opioids are also more likely to receive opioid prescriptions.

“There’s an emphasis now on cutting back opioid prescribing,” he said. “Probably just as important is assuring that we’re prescribing the opioids to the right populations, and that we’re doing our risk–benefit analysis on each patient.”

Source: STAT; June 26, 2017.