VANCOUVER, B.C. – Psychiatric disorders are common among people taking opioid medications, Mark D. Sullivan, M.D., reported at the annual meeting of the American Psychosomatic Society.
Data from the first population-based investigation of psychiatric comorbidity among patients receiving regularly prescribed opioid medication suggest that common depressive or anxiety disorders may pose a greater clinical problem among candidates for chronic opioid therapy than does substance abuse, said Dr. Sullivan of the department of psychiatry at the University of Washington, Seattle.
Moreover, the findings also point to unmet needs for mental health care among patients routinely receiving prescribed opioids. “We need to carefully assess and treat mood and anxiety disorders in patients who are candidates for chronic opioid therapy,” Dr. Sullivan said.
Among 9,279 respondents to a nationwide telephone survey conducted in 1997–1998, 2.7% (252) reported regular use of prescribed opioids “at least several times a week for a month or more.” All respondents were assessed for common psychiatric disorders with the World Health Organization's Composite International Diagnostic Interview (CIDI) and for substance abuse via an adaptation of the CIDI for drugs and Alcohol Use Disorders Identification Test (AUDIT) for alcohol.
Common psychiatric disorders were present in 45% of the opioid users, compared with just 12% of the nonusers. Most common was major depressive disorder, in 29% vs. 9%, followed by panic disorder, in 18% vs. 3%.
Problem drug use was also more common among the regular opioid users (7% vs. 2%), but the proportions reporting problem drinking did not differ (7% vs. 6.5%), Dr. Sullivan reported.
Prior to adjustment for various demographic factors, patients with a mood or anxiety disorder were six times more likely than those without to be regular opioid users. When looking at the effects of individual psychiatric disorders, those with panic disorder were seven times more likely to receive opioids, while patients with depression, dysthymia, or problem drug use were approximately four times more likely to receive opioids.
And even after adjusting for significant demographic and clinical predictors of regular opioid use–including age, education, income, work disability, self-rated health, and chronic back pain and headaches–patients with a common psychiatric disorder were still more than three times as likely as those without psychiatric diagnoses to receive regular opioids, Dr. Sullivan said.