Prescription Opioid Use Among Seriously Mentally Ill Veterans Nationally in the Veterans Health Administration

Abstract

Frequent prescription opioid use has been recognized as a growing problem but there have been no studies specifically among veterans with serious mental illness (SMI). National data from the Veterans Health Administration (VHA) during Fiscal Year 2012 show that VHA patients with SMI receive more opioid prescriptions than other veterans. Additionally, high numbers of opioid prescriptions is associated with greater use of anxiolytics/sedative-hypnotics, drug dependence and COPD-all of which pose an increased risk of respiratory depression and falls and warrant substantial caution and improved coordination between mental health and non-mental health prescribers to evaluate risk-benefit tradeoffs.

Chronic pain diagnoses and opioid dispensings among individuals with serious mental illness

“…The present study also found that individuals with MDD and BD diagnoses were over two times more likely to receive chronic opioid medication prescriptions compared to matched controls. This finding is consistent with prior literature which has similarly reported that opioids are more commonly prescribed (and prescribed at higher doses) in these populations compared to those without these mental health conditions, even after controlling for a wide array of other demographic and clinical risk factors (18,21,23,24). One explanation for this is that these individuals may present with greater pain severity (57), thereby increasing the likelihood that clinicians will prescribe an opioid and at a higher dose (58).…”

“…Evidence suggests that individuals with mental illness may be one population with particularly high rates of CNCP and may also be more likely to receive prescription opioids for their pain. Several studies have reported that individuals with depression and bipolar disorder, for example, have more frequent pain complaints, higher pain intensity and more pain chronicity (10)(11)(12)(13)(14)(15)(16)(17) and are also significantly more likely to receive long-term opioids, at a higher daily dose, and with greater days supplied compared with patients without mental illness (18)(19)(20)(21)(22)(23)(24). By contrast, evidence suggests that CNCP is less prevalent among individuals with schizophrenia compared to individuals without mental illness (25); to our knowledge, there have been no studies published to date that have examined opioid treatment patterns specifically among individuals with schizophrenia compared to controls.…”

“…This gap in the literature, in addition to other methodological limitations inherent in many prior studies -including small sample sizes (17,21) and limited generalizability (e.g., examining only military veterans) (16,19,23) -prompted the present study. Specifically, we investigated (1) whether individuals with major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia are more or less likely to receive a chronic pain diagnosis compared to individuals with no psychiatric diagnoses and (2) whether individuals with MDD, BD and schizophrenia are more or less likely to receive chronic prescription opioid medications compared to individuals with no psychiatric diagnoses using data from health care systems in the Mental Health Research Network (MHRN) that are representative of a large, geographically and racially/ethnically diverse population across the U.S.…”

Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness

“…Evidence suggests that individuals with mental illness may be one population with particularly high rates of CNCP and may also be more likely to receive prescription opioids for their pain. Several studies have reported that individuals with depression and bipolar disorder, for example, have more frequent pain complaints, higher pain intensity and more pain chronicity ADDIN EN.CITE ADDIN EN.CITE.DATA (10)(11)(12)(13)(14)(15)(16)(17) (10,(12)(13)(14)(15)(16)(17)(18) and are also significantly more likely to receive long-term opioids, at a higher daily dose, and with greater days supplied compared with patients without mental illness (19)(20)(21)(22)(23)(24)(25). By contrast, evidence suggests that CNCP is less prevalent among individuals with schizophrenia compared to individuals without mental illness (26); to our knowledge, there have been no studies published to date that have examined opioid treatment patterns specifically among individuals with schizophrenia compared to controls.…”

“…By contrast, evidence suggests that CNCP is less prevalent among individuals with schizophrenia compared to individuals without mental illness (26); to our knowledge, there have been no studies published to date that have examined opioid treatment patterns specifically among individuals with schizophrenia compared to controls. This gap in the literature, in addition to other methodological limitations inherent in many prior studies-including small sample sizes (12,22) and limited generalizability (e.g., examining only military veterans) (10,20,24)-prompted the present study. Specifically, we investigated (1) whether individuals with major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia are more or less likely to receive a chronic pain diagnosis compared to individuals with no psychiatric diagnoses and (2) whether individuals with MDD, BD and schizophrenia are more or less likely to receive chronic prescription opioid medications compared to individuals with no psychiatric diagnoses using data from health care systems in the Mental Health Research Network (MHRN) that are representative of a large, geographically and racially/ethnically diverse population across the U.S.…”