Psychiatric, behavioral conditions linked to future long-term opioid use
Preexisting psychiatric and behavioral conditions and psychoactive medication use are associated with subsequent claims of prescription opioids, according to a study published in Pain.
The preexisting psychiatric and behavioral conditions include substance use disorders (SUDs), opioid use disorders (OUDs), suicide attempts and other self-injury, depression, and motor vehicle crashes.
Patrick D. Quinn, PhD, from the Department of Psychological and Brain services at Indiana University, and colleagues examined health insurance claims among 10,311,961 opioid recipients, ages 14 years and older (18 and older for motor vehicle crashes) who had at least 12 calendar months of continuous enrollment of a filled opioid prescription.
The researchers evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions. These include OUD, nonopioid SUD, depressive disorder, uncertain or definite suicide attempt or self-injury (combined), anxiety disorder, sleep disorder, and motor-vehicle crashes. Also included were psychoactive medications such as antidepressants and mood stabilizers.
The first objective was to estimate the extent to which prior psychiatric conditions, motor vehicle crashes, and psychoactive medications would predict claims for prescription opioids. The most common condition was depression, diagnosed in 8.5% of cases, while suicide-attempts and self injury were the least common conditions (0.1%). Patients with prior OUD or nonopioid SUD diagnosis had 16% or 11% greater odds, respectively, of receiving opioids than did patients without these conditions.
The second objective was to estimate the extent to which prior psychiatric conditions, motor vehicle crashes, and psychoactive medications would predict receipt of long-term opioids among opioid recipients. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior ADHD medication prescriptions (hazard ratio [HR], 1.53) to approximately 3-fold for prior nonopioid SUD diagnoses (HR, 3.15) and nearly 9-fold for prior OUD diagnoses (HR, 8.70). The probability of transitioning from first fill to long-term opioids was 1.3% by 1.5 years after the first prescription fill, 2.1% by 3 years, 3.7% by 6 years, and 5.3% by 9 years.
“Patients with prior psychiatric diagnoses, suicide attempts or other self-injury, and motor vehicle crashes were at greater risk of transitioning from an incident opioid prescription fill to receipt of long-term opioids than were patients without prior psychiatric conditions,” said the authors. “Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.”
Filed under: General Problems
If this report is accurately depicting the elements of this study, then i’d like to welcome the reader to another episode of Non-Sequitur Theater. For the younger reader, please allow me to suggest recalling Sesame Street’s educational jingle:
One of this things is not like the other,
One of these things is just not the same…
What does a set of psycho-behavioral elements in one cohort have to to do with another cohort that has suffered an MVA (motor vehicle accident) as an adult for purposes of predicting long term opioid utilization as it relates to a specific set of preexisting psychosocial behavior? I can understand a study that looks at the first cohort in terms of predicting long term opioid utilization. It could be helpful to know if certain abnormal, psychologically driven behaviors could predict opioid utilization down the line. The study seems to have been specifically designed as a means to determine if there is a correlation between certain abnormal psychologically driven behaviors and long term opioid utilization, The study doesn’t answer why this occurs or provide a mechanism of action. I’m not certain that it demonstrates if the relationship is casual or causal. It’s a very basic and preliminary exercise in determining what, if any useful predictor of relationship can be determined.
So what does the other cohort that has experienced an MVA as an adult have to do with the inclusion and examination of the first cohort? People who are in auto accidents include just as many healthy, well balanced people as any large, common social group. The A in MVA signifies “Accident”. The vast majority of MVA’s are not intentional. People can suffer anything from a good scare and soiled shorts all the way up to a violent and quick death. Now the dead aren’t the issue here of course. It’s that middle ground that is of interest. The normal expectation is that someone who suffers a reasonable amount of trauma is going to be in pain. The nature of the injury and the ability for medical science to facilitate complete. normal healing of the injury is what determines if the pain is short term or chronic and it it’s annoying, agonizing or somewhere inbetween. On it’s face it has nothing to do with the first cohort and the superficial raison d’être for the study. That’s what concerns me and sets of my BS detectors.
Now I can’t, for certain, know what the motives of the study’ authors are without a fair amount of investigation. I may deduce a reasonable motive, but i can’t know for sure without hearing the motive stated by the authors. I’d have to also assume that they are being truthful. Still, I have my experience based on over five decades on this little blue marble in space and how my government has used countless prevarications disguised as “Science” to convince enough of the right people to sign on as crew on the Good Ship B*ll Sh*t Du Jour to push through another oppressive, individual liberty strangling statute, policy guideline, etc. Public Safety, Save the Planet, It’s for the Children and more increasingly prevalent, “Sound Medicine” have been the tells anything gets trotted out to corral we, the mundanes, just a bit more. So, i have to say that this really smells like so many others that have gone before. I’m cynical enough now to not give the benefit of the doubt and adjudicate items like these as guilty until proven innocent. Why? Let me inform the reader of where I see this going.
Here is one possible direction that this could go in. I could be wrong, but I have a hunch that the MVA’s (if not already correlated to the first cohort in some fashion within the body of the study) are going to be correlated with that first cohort and the conclusion will be used, at a minimum, as a driving force for more “studies” to illustrate that those with a history of these psycho-behavioral diagnosis who are prescribed opioids are more likely than one who has not the preexisting issues to be involved in MVA’s while having some measurable quantity of opioids in their system. It’s generally accepted that unless one has developed a significant amount of tolerance to the common adverse effects (AE’s) normally associated with opioids such as the somnolence and the reaction time slowing effects, they are more likely to be involved in an MVA. The first cohort in the study will likely be concurrently utilizing other psychotropic agents such as antidepressants, ant-seizure drugs for Tx purposes other than seizure prophylaxis, mood stabilizing agents, etc. The additive and/or synergistic potential for the AE’s shared between the psychotropes and the opioids is also well documented qualitatively. Well, for the good of public safety, these concurrent utilizers of opioids like the subjects from the first cohort in the study should have their driving privileges revoked until they are free of opioids.
Thus Pronounceth The State:
“If your patient is not using opioids Dr. Healer, you should know that if you prescribe them opioids, you will be subject to reporting such to the State, including the time that you foresee the opioids required for their treatment, because The State has to suspend or possibly revoke their driving privileges. If you fail to report and knew, or should have known that they were also , then you will face civil, administrative and criminal penalties for your failure. You will suffer the Great Weight of the State.
I apologize for the Stalin-esque hyperbolic drama. Still I think the point that I hope is apprehended by the reader, is that this is one of those obscure studies that can and, imoho, is designed to declare that it;s fishing season for anything and everything that can be sold as even marginally reasonable for the promotion of the current agenda being force fed us the mundanes by the flks that presume to rule over us for the reason of more power and more cash in the Treasury. At the end of the day, that’s what it’s always about. Creating new and different enough window dressings to hide what should be obvious to anyone with at least average intelligence, critical thinking abilities and three or more decades on the marble is what we’re seeing here.
Right now, to preserve all the hard won, usurped Bill of Rights Guarantees, and all the money and property stolen at gunpoint under the color of authority, all the prison industry infrastructure and its employees and allied services, all that has been the result of the failed public policy measure known as The War on Drugs and it’s poster child, The DEA, a new scarecrow, boogeyman, i.e., Lie has to be conjured up. Daemon Opium Poppy and her children must be subjugated before we are murdered in our sleep by her diabolical and miasmic influence and power. Yeah, I know…so 19th century church camp meeting. It’s not pontificated like that anymore as it would be too strange and instantly held under suspicion here in 2017. No, it’s under the guise of the New Religion, Science.
The attitude that is within the 19th century rhetoric is still alive and well in 2017. It’s the same attitude held by those proselytizing to the neopuritanical mindset and the pathologically anxious folks in our midst. Between the various misguided secular and sectarian groups that want the State to enforce some pseudo-conservative version of their idyllic utopian society on everyone and groups like Mothers Against Everything, there are plenty of disciples waiting in the wings to allow the further forced minimization of opioids as a useful and necessary medicine in our society. The result is the further marginalization of the the human beings in the Chronic pain Community and the increase of the black market narcotic traffickers. It’s all over a plant that can be made into a medicine that has been utilized for several millennia in human history. If this sounds vaguely familiar, let the reader imagine themselves in the year 1970 and replace any reference to Opioids with the term Cannabis and the tem chronic pain with any number of diseases and symptoms and disorders that fit the old, 1970 scenario. Are we really that amnesiac as a people? Maybe the reader has heard this old chestnut; “Those that do not learn history are doomed to repeat it.”
Lespaul1963 I think you hit the nail directly on the head! Your thoughts,almost word for word went through my head while reading the article! I can fully see it happening since in so many ways it already is. Anyone who has blood work done after a MVA and is found to have any drug/medication in their system will be charged with driving under the influence and if you use medical marijuana with a card you can lose the right to own a firearm. We are being pushed to see a shrink if suffering from chronic pain. Psychotropic drugs are being pushed at an unheard of rate and again if you suffer chronic pain they are dam near shoved down your throat especially if you want any chance at medication for pain control. This should scare the crap out of anyone who wants to keep what little freedom we still have!