title: Mental health disorders and long-term opioid use among adolescents and young adults with chronic pain.
abstract: OBJECTIVE
  The purpose of this study was to examine the association between mental health disorders and subsequent risk for long-term opioid use among adolescents and young adults presenting with common chronic pain complaints (back pain, neck pain, headache, and arthritis/joint pain).
  
  
  METHODS
  Using claims data from January 1, 2001 to June 30, 2008, we conducted a longitudinal analysis of opioid use patterns among 13-24-year-old subjects presenting with a new episode of chronic pain. Long-term opioid use was defined as receiving >90 days of opioids within a 6-month period with no gap of >30 days in use of opioids in the 18 months after the first qualifying pain diagnosis. Mental health disorders were identified from claims in the 6 months before the first qualifying pain diagnosis.
  
  
  RESULTS
  Fifty-nine thousand seventy-seven youth met criteria for a new episode of chronic pain. Among these youth, 321 (.5%) met criteria for long-term opioid use, and 16,172 (27.4%) had some opioid use. After controlling for demographic and clinical factors, youth with preexisting mental health diagnoses had a 2.4-fold increased risk of subsequently receiving long-term opioids versus no opioids (odds ratio = 2.36, 95% confidence interval = 1.73-3.23) and a 1.8-fold increased likelihood of receiving long-term opioids versus some opioids (odds ratio = 1.83, 95% confidence interval = 1.34-2.50).
  
  
  CONCLUSIONS
  Mental health disorders are associated with increased risk for long-term opioid use among adolescents and emerging young adults. Further study is warranted to examine risks and benefits of long-term opioid use in this population.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA. laura.richardson@seattlechildrens.org
authors.forename: Laura P
authors.initials: LP
authors.lastname: Richardson
authors.forename: Joan E
authors.initials: JE
authors.lastname: Russo
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: McCarty
authors.forename: Andrea
authors.initials: A
authors.lastname: DeVries
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Edlund
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Martin
authors.forename: Mark
authors.initials: M
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006306:Health Surveys; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D010147:Pain Measurement / Q000187:drug effects; D012307:Risk Factors; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid