Depression – A major but neglected consequence contributing to the health toll from prescription opioids?

Fischer, Benedikt; Murphy, Yoko; Kurdyak, Paul; Goldner, Elliot M.

doi:10.1016/j.psychres.2016.06.053

Cited by 19 publications

(23 citation statements)

References 57 publications

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“…Symptoms of depression and anxiety also have been studied regarding long-term physical health outcomes in rheumatoid arthritis (596), showing that baseline and persistent symptoms of depression and anxiety were associated with poorer health outcomes over time, as well as reduced treatment response. The role of psychological status also has been described in outcomes of surgical, interventional, and non-interventional techniques (579)(580)(581)(582)(583)(584)(585)597,598,599,603,604). Psychological treatment with inclusion of pharmacological therapy or psychotherapy is one of the components of effective chronic pain management.…”

Section: Psychological Evaluationmentioning

confidence: 99%

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Kaye²,

et al. 2017

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Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ).

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Section: Psychological Evaluationmentioning

confidence: 99%

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Kaye²,

et al. 2017

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“…There is a larger debate regarding the causality of these variables, specifically whether mental illness precedes drug use, drug use precedes mental illness, or both have a -common cause‖ (see Fischer, Murphy, Kurdyak, & Goldner, 2016). Obviously, the current undertaking contributes nothing to that larger debate.…”

Section: Discussionmentioning

confidence: 99%

Playing with Fire: The Relationship between Mental Disorders and Prescription Opioid Abuse in a Rural Juvenile Court Sample

Durkin¹,

Melton²,

Kilgallon³

2018

AIJSS

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The United States is in the ruthless grip of a terrible opioid epidemic that has hit rural areas especially hard. This horrible addiction often begins with the misuse of prescription opioids. This paper documents the relationship between co-occurring mental disorders and prescription opioid abuse in a sample of 99 youths involved with a juvenile court in a rural county in Ohio. Results indicate that juveniles who reported misusing prescription opioids were more likely than the other juveniles to report having any type of mental health problem, any type of externalizing problem, and any type of internalizing problem. Compared to other subjects, youths who reported opioid abuse were 2.5 times more likely to have symptoms consistent with a mood disorder (including depression) and more than 7 times more likely to report symptoms reflecting general anxiety disorder. Juveniles who reported misuse of prescription opioids were also more likely than their peers to report symptoms of ADD/ADHD and conduct disorder. Directions for future research and implications of the problem of prescription opioid abuse for juvenile courts are also considered.

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“…Likely due to the chronological aspects of these cohorts (with participants of at least 18 years of age in 2002–2013), illicit prescription opioid exposure was low, with heroin being the principally reported MOPr agonist. KMSK questionnaires also include separate forms for illicit use of prescription opioids, which may also be associated with substantial depression comorbidity . Future studies may examine dimensionally how exposure to illicit prescription opioids impacts depression comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Can a rapid measure of self-exposure to drugs of abuse provide dimensional information on depression comorbidity?

et al. 2017

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Background and Objectives Addictions to heroin or to cocaine are associated with substantial psychiatric comorbidity, including depression. Poly-drug self-exposure (e.g., to heroin, cocaine, cannabis or alcohol) is also common, and may further affect depression comorbidity. Methods This case-control study examined the relationship of exposure to the above drugs and depression comorbidity. Participants were recruited from methadone maintenance clinics, and from the community. Adult male and female participants (n=1,201) were ascertained consecutively by experienced licensed clinicians. The instruments used were the SCID-I, and Kreek-McHugh-Schluger-Kellogg (KMSK) scales, which provide a rapid dimensional measure of maximal lifetime self-exposure to each of the above drugs. This measure ranges from no exposure to high unit dose, high frequency, and long duration of exposure. Results A multiple logistic regression with stepwise variable selection revealed that increasing exposure to heroin or to cocaine was associated greater odds of depression, with all cases and controls combined. In cases with an opioid dependence diagnosis, increasing cocaine exposure was associated with a further increase in odds of depression. However, in cases with a cocaine dependence diagnosis, increasing exposure to either cannabis or alcohol, as well as heroin, was associated with a further increase in odds of depression. Discussion and Conclusions This dimensional analysis of exposure to specific drugs provides insights on depression comorbidity with addictive diseases, and the impact of poly-drug exposure. Scientific Significance A rapid analysis of exposure to drugs of abuse reveals how specific patterns of drug and poly-drug exposure are associated with increasing odds of depression.

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Depression – A major but neglected consequence contributing to the health toll from prescription opioids?

Cited by 19 publications

References 57 publications

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Playing with Fire: The Relationship between Mental Disorders and Prescription Opioid Abuse in a Rural Juvenile Court Sample

Can a rapid measure of self-exposure to drugs of abuse provide dimensional information on depression comorbidity?

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