Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study

Abstract

There is evidence of greater opioid prescription to individuals in the US with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse pre-existing mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5 071 193 (48.4% female) adolescents and adults who were naïve to prescription opioid analgesics and followed them from 2007-2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3% −11.4%). Individuals with pre-existing self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders, had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1 298 083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%−7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1 482 462 adolescents and young adults, initiation and

Maternal prescribed opioid analgesic use during pregnancy and associations with adverse birth outcomes: A population-based study

“…We included maternal and paternal characteristics that were associated with subsequent receipt of POAs [20,49]. Specifically, maternal and paternal characteristics included pre-conception inpatient and outpatient diagnoses of opioid use disorder, non-opioid substance use disorder, schizophrenia or bipolar disorder, and definite or uncertain suicide attempts made according to International Classification of Disease (ICD) criteria; any pre-conception conviction of violent, nonviolent, drug or alcohol, or driving-related crimes; age at childbirth; highest level of education at year of birth; and country of origin.…”

A population‐based study of concurrent prescriptions of opioid analgesic and selective serotonin reuptake inhibitor medications during pregnancy and risk for adverse birth outcomes

“…However, in practice pregnant women often have co‐morbid conditions, which may cause them to use multiple medications 2 . Notably, individuals prescribed opioids for pain are more likely to also be prescribed selective serotonin reuptake inhibitor (SSRI) medications, 3,4 which are commonly used to treat depression and anxiety 5 . In vitro research using human liver tissue suggests that SSRIs decrease the metabolism of opioids, 6 and patient data have shown increased opioid plasma concentrations after SSRI administration 7 .…”

Opioid Prescriptions in Chronic Pain Rehabilitation. A Prospective Study on the Prevalence and Association between Individual Patient Characteristics and Opioids

“…Anatomical Therapeutic Chemical (ATC) codes were used to identify opioids prescribed between 1 July 2005 and 31 December 2017. In line with previous studies, we did not include opioids used for intravenous distribution, treatment of Substance Use Disorder (SUD) or other diagnoses that were not relevant for the aim of this study, e.g., cough [ 21 ]. For specifications of in- and excluded ATC codes, see Table S1 .…”

“…Several studies point to the importance of psychological factors. For example, general population studies show that preexisting mental health disorders are associated with increased likelihood of future opioid initiation and, especially, long-term opioid therapy (LTOT) [ 21 , 22 ]. In addition, patients’ own expectations about the likelihood of continuing regular opioid use have been found to predict long-term opioid use in patients with chronic pain who receive opioid therapy [ 23 , 24 ].…”