Association Between Mental Health Disorders, Problem Drug Use, and Regular Prescription Opioid Use

Abstract

Common mental health disorders and problem drug use are associated with initiation and use of prescribed opioids in the general population. Attention to psychiatric disorders is important when considering opioid therapy.

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

“…The observation that patients having spinal fusion showed the highest prevalence of opioid abuse and dependence was not surprising given that opioids play an increasingly pivotal role in the long-term management of chronic back pain, which is the primary reason for patients to undergo such procedures [13,14]. Patients with mental health and nonopioid substance use disorders had greater odds of abusing or being dependent on opioids, thus confirming the generalizability of previous studies to orthopaedic surgical inpatients [16,17,46,49,55]. Quality and safety initiatives aimed at reducing opioid misuse in the orthopaedic setting should primarily target this at-risk population, and be particularly implemented at urban teaching hospitals in the Northeast and West that function as ''safety net'' providers.…”

“…On the basis of clinical plausibility and available evidence [1,17,18,27,48,49], we selected several comorbidities that potentially could act as confounders in the associations between opioid abuse and dependence and postoperative events: AIDS and HIV infection, tobacco use, chronic anemia, alcohol abuse and dependence, depression, anxiety, and nonopioid drug abuse and dependence. The nonopioid drugs-illicit and prescription drugs used illicitly-considered were cannabis (ICD-9-CM codes 305.2x, 304.3x), hallucinogens (ICD-9-CM codes 305.3x, 304.5x), sedatives/hypnotics/anxiolytics (ICD-9-CM codes 305.4x, 304.1x), cocaine (ICD-9-CM codes 305.6x, 304.2x), amphetamines (ICD-9-CM codes 305.7x, 304.4x), antidepressants (ICD-9-CM code 305.8x), and other/unspecified substances (ICD-9-CM codes 305.9x, 304.6x, 304.8x, 304.9x) [33].…”

Risk Factors in Opioid Treatment of Chronic Non-Cancer Pain: A Multidisciplinary Assessment

“…In contrast, patients with a personal or family history of substance abuse, and with one or more psychosocial issues are at greater risk of developing addiction, especially if the treatment is not carefully structured (Ballantyne, 2007). The psychosocial factors considered to be most predictive of opioid abuse are the presence of psychiatric disorders (Compton et al, 1998;Sullivan et al, 2006) and a personal and/or family history of substance abuse or drug abuse (Dunbar & Katz, 1996;Schieffer et al, 2005). A significant correlation has been found between chronic pain, mood disorders and aberrant drug use: patients with chronic pain report higher levels of anxiety and depression than patients with other medical conditions, and the incidence of mood disorders has been shown to be higher in patients at high risk of opioid misuse or dependence (Bair et al, 2003;Dersh et al, 2002;Fishbain, 1999 Using logistic regression, the authors showed that panic attacks, high trait anxiety and the presence of a personality disorder are able to explain the 38% variance in potential abuse of prescribed opioids.…”

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

“…[27][28][29][30][31] For this reason, the hospital physician may be unaware of a patient's drug or alcohol use or mental illness, all risk factors for opioid misuse. [32][33][34] Unfamiliarity between the hospital physician and the patient, and variability in opioid prescribing by hospital physicians, may contribute to chronic opioid use.…”