Trends in long-term opioid therapy for noncancer pain among persons with a history of depression.
OBJECTIVE
We report trends in long-term opioid use among patients with a history of depression from two large health plans.


METHODS
Using claims data, age- and gender-adjusted rates for long-term (>90 days) opioid use episodes were calculated for 1997-2005, comparing those with and without a depression diagnosis in the prior 2 years. Opioid use characteristics were calculated for those with a long-term episode in 2005.


RESULTS
Incident and prevalent long-term opioid use rates were three times higher in those with a history of depression. Prevalent long-term use per 1000 in patients with a history of depression increased from 69.8 to 125.9 at Group Health and from 84.3 to 117.5 at Kaiser Permanente of Northern California between 1997 and 2005. Those with a history of depression were more likely to receive a higher average daily dose, greater days supply, and Schedule II opioids than nondepressed persons.


CONCLUSIONS
Persons with a history of depression are more likely to receive long-term opioid therapy for noncancer pain than those without a history of depression. Results suggest that long-term opioid therapy for noncancer pain is being prescribed to a different population in clinical practice than the clinical trial populations where opioid efficacy has been established.
Braden
Jennifer Brennan
JB
Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195-6560, USA. jkbrenn@u.washington.edu
Sullivan
Mark D
MD
Ray
G Thomas
GT
Saunders
Kathleen
K
Merrill
Joseph
J
Silverberg
Michael J
MJ
Rutter
Carolyn M
CM
Weisner
Constance
C
Banta-Green
Caleb
C
Campbell
Cynthia
C
Von Korff
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002140:California; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000639:trends; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D012189:Retrospective Studies; D014861:Washington; D055815:Young Adult
D000701:Analgesics, Opioid; D009020:Morphine