title: Regular use of prescribed opioids: association with common psychiatric disorders.
abstract: Use of opioids for chronic non-cancer pain is increasing, but the clinical epidemiology and standards of care for this practice are poorly defined. Psychiatric disorders are associated with increased physical symptoms and may be associated with opioid use. We performed a secondary analysis of cross-sectional data from the Health Care for Communities (HCC) survey conducted in 1997-1998 (N=9279) to determine the association of psychiatric disorders and self-reported regular use of prescribed opioids within the past year. Regular prescription opioid use was reported by 282 (3%) respondents. In unadjusted logistic regression models, respondents with common mental disorders in the past year (major depression, dysthymia, generalized anxiety disorder, or panic disorder) were more likely to report regular prescription opioid use than those without any of these disorders (OR=6.15, 95% CI=4.13, 9.14, P< 0.001). Respondents reporting problem drug use (OR=4.75, 95% CI=2.52, 8.94, P<0.001), or problem alcohol use (OR=1.89, 95% CI=1.03, 3.40, P=.041) reported higher rates of prescribed opioid use than those without problem use. In multivariate logistic regression models controlling for demographic and clinical variables, the presence of a common mental disorder remained a significant predictor of prescription opioid use (OR=3.15, 95% CI=1.69, 5.88, P<0.001), among individuals reporting low pain interference (N=8307); but not (OR=1.27, n.s.) among those reporting high pain interference (N=972). Depressive, anxiety and drug abuse disorders are associated with increased use of regular opioids in the general population. Depressive and anxiety disorders are more common and more strongly associated with prescribed opioid use than drug abuse disorders.
authors.affiliation: Psychiatry and Behavioral Sciences, University of Washington, Box 356560, 1959 NE Pacific St., Seattle, WA 98195-6560, USA Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Edlund
authors.forename: Diane
authors.initials: D
authors.lastname: Steffick
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015897:Comorbidity; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid