- While patients with recognized mental health issues comprise just over 15 percent of the US population, these individuals receive more than half of all opioid prescriptions from providers, according to a new study published in the Journal of the American Board of Family Medicine.
Adults with mental health disorders are more than twice as likely as those without mental health concerns to be users of prescription opioids.
The extremely high rate of prescription opioid use among a vulnerable population may be exacerbating the runaway epidemic of opioid dependence that has led to more than 160,000 deaths between 2000 and 2014.
“The identification of specific populations that rely heavily on opioids is of strategic importance for risk mitigation efforts,” wrote a team of researchers from the University of Michigan.
Population health management efforts related to curbing the flood of prescription opioids have largely focused on post-surgical patients or those who have recently experienced trauma, not necessarily on individuals whose existing mental health concerns may predispose them to using painkillers as a way to cope with their issues.
However, previous studies have suggested that patients with mental health concerns are more likely to take opioids and become dependent on them long-term, said the researchers.
“For example, adults with mood disorders are nearly twice as likely to use opioids long-term for pain. In fact, pain is very common among adults with mental health disorders, and the relationship between mental illness and opioid use is complex.”
Using the nationally representative Medical Expenditure Panel Survey (MEPS), the team examined data from 52,000 patients between 2011 and 2013.
MEPS participants are asked to recall their own health status at six-month interviews. Their input is supplemented by records from both providers and payers to develop a multi-faceted portrait of patient health, including mental health diagnoses, pharmacy records, and other key factors.
When the results were extrapolated to encompass the entire US population, the analysis found that 18.7 percent of adults with mental health disorders are also prescription opioid users. In contrast, only five percent of patients without mental health diagnoses used prescription opioids.
Of the approximately 115 million legal opioid prescriptions issued each year by healthcare providers, 51.4 percent were written for patients with mental health concerns.
Opioid users with mental health diagnoses tended to be older than non-opioid users with mental health issues. Users were more likely to be female, middle-aged, and white. They were also more likely to be divorced, separated, or widowed.
More than 18 percent of opioid users with mental health disorders had three or more comorbidities, the study found, compared to just 6.3 percent of prescription drug users without mental health disorders.
Sixty percent of the mental health population using opioids reported living with “severe pain” compared to just 16.2 percent of non-opioid users.
“Most notable was nearly twice the percentage of opioid users among adults with severe pain (45.3 percent of adults with mental health disorders were opioid users compared with 24.1 percent among those without mental health disorders),” the study added.
“The top 10 clinical diagnoses associated with prescription opioids for Americans with mental health disorders included musculoskeletal disorders, poorly defined conditions, or an otherwise missing diagnosis. The top 10 clinical diagnoses we identified among adults with mental health disorders account for 54.0 percent of the total opioids prescribed to this population, suggesting considerable variation in clinical diagnosis.”
Pain management can be challenging for providers, especially because there is no universal standard for how to measure the amount of pain an individual is experiencing. Patients with depression and anxiety are likely to report higher levels of pain than other individuals due to the physiological impacts of these diseases, but providers may not be able to separate the treatment of physical origins of pain from the distress caused by mental health concerns.
The results of the study indicate that the healthcare industry should place a more prominent focus on patient-centered techniques for curbing unnecessary prescriptions of powerful painkillers to patients with significant mental health concerns.
Mental illness is a “prominent risk factor” for accidental or intentional overdoses, the authors note, which makes it even more important for providers to have access to risk stratification and clinical decision support tools that can flag patients who may benefit more from alternative pain management strategies, especially if they suffer from multiple comorbidities.
“The high prevalence of mental health disorders coupled with prescription opioid use suggests that this population is critical to consider when addressing the issue of opioid use from a health system or policy perspective,” the study concludes.
“Although a number of important steps are already underway to address opioid use in this country, such as the recent Centers for Disease Control and Prevention opioid prescribing guidelines, improving treatment of comorbid mental health disorders and pain will be an important focus when trying to reduce the overall negative impacts of opioid use on patients and communities.”