Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study.
OBJECTIVE
Use of prescription opioids for chronic pain is increasing, as is abuse of these medications, though the nature of the link between these trends is unclear. These increases may be most marked in patients with mental health (MH) and substance use disorders (SUDs). We analyzed trends between 2000 and 2005 in opioid prescribing among individuals with noncancer pain conditions (NCPC), with and without MH and SUDs.


METHODS
Secondary data analysis of longitudinal administrative data from 2 dissimilar populations: a national, commercially insured population and Arkansas Medicaid enrollees. We examined these opioid outcomes: (1) rates of any prescription opioid use in the past year, (2) rates of chronic use of prescription opioids (greater than 90 d in the past year), (3) mean days supply of opioids, (4) mean daily opioid dose in morphine equivalents, and (5) percentage of total opioid dose that was Schedule II opioids.


RESULTS
In 2000, among individuals with NCPC, chronic opioid use was more common among those with a MH or SUD than among those without in commercially insured (8% vs. 3%, P<0.001) and Arkansas Medicaid (20% vs. 13%, P<0.001) populations. Between 2000 and 2005, in commercially insured, rates of chronic opioid use increased by 34.9% among individuals with an MH or SUD and 27.8% among individuals without these disorders. In Arkansas Medicaid chronic, opioid use increased by 55.4% among individuals with an MH or SUD and 39.8% among those without.


CONCLUSIONS
Chronic use of prescription opioids for NCPC is much higher and growing faster in patients with MH and SUDs than in those without these diagnoses. Clinicians should monitor the use of prescription opioids in these vulnerable groups to determine whether opioids are substituting for or interfering with appropriate MH and substance abuse treatment.
Edlund
Mark J
MJ
Department of Psychiatry, Division of Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, USA. mjedlund@uams.edu
Martin
Bradley C
BC
Devries
Andrea
A
Fan
Ming-Yu
MY
Braden
Jennifer Brennan
JB
Sullivan
Mark D
MD
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001131:Arkansas / Q000453:epidemiology; D002908:Chronic Disease; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data / Q000639:trends; D008603:Mental Health; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods; D055553:Prescription Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
D000701:Analgesics, Opioid; D055553:Prescription Drugs