Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse.
OBJECTIVE
Opioid misuse in the context of chronic opioid therapy (COT) is a growing concern. Depression may be a risk factor for opioid misuse, but it has been difficult to tease out the contribution of co-occurring substance abuse. This study aims to examine whether there is an association between depression and opioid misuse in patients receiving COT who have no history of substance abuse.


METHODS
A telephone survey was conducted at Group Health Cooperative and Kaiser Permanente of Northern California. We interviewed 1,334 patients on COT for noncancer pain who had no history of substance abuse. Patients were asked about 3 forms of opioid misuse: (1) self-medicating for symptoms other than pain, (2) self-increasing doses, and (3) giving to or getting opioids from others. Depression was evaluated by the 8-item Patient Health Questionnaire (PHQ-8).


RESULTS
Compared with patients who were not depressed (PHQ-8 score 0 to 4), patients with moderate depression (PHQ-8 score 10 to 14) and severe depression (PHQ-8 score 15 or higher) were 1.8 and 2.4 times more likely, respectively, to misuse their opioid medications for non-pain symptoms. Patients with mild (PHQ-8 score 5 to 9), moderate, and severe depression were 1.9, 2.9, and 3.1 times more likely, respectively, to misuse their opioid medications by self-increasing their dose. There was no statistically significant association between depression and giving opioids to or getting them from others.


CONCLUSIONS
In patients with no substance abuse history, depressive symptoms are associated with increased rates of some forms of self-reported opioid misuse. Clinicians should be alert to the risk of patients with depressive symptoms using opioids to relieve these symptoms and thereby using more opioids than prescribed.
Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA.
Alicia
A
Grattan
Mark D
MD
Sullivan
Kathleen W
KW
Saunders
Cynthia I
CI
Campbell
Michael R
MR
Von Korff
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D002140:California / Q000453:epidemiology; D002908:Chronic Disease; D016001:Confidence Intervals; D003863:Depression / Q000139:chemically induced* / Q000523:psychology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011594:Psychometrics; D012307:Risk Factors; D057566:Self Report; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult; D016903:Drug Monitoring
D000701:Analgesics, Opioid