Increased Use of Opioids for Chronic Pain in Patients with Mental-Health and Substance-Use Disorders

As the use of opioids to treat noncancer chronic pain has risen, there has been a concurrent increase in the abuse of these drugs. Individuals with mental-health (MH) or substance-use disorders (SUD) may be particularly vulnerable to opioid misuse. In this study, investigators analyzed Arkansas Medicaid and commercial-insurance databases from 2000 and 2005 to assess changes in opioid prescribing to patients with noncancer pain conditions (NCPC) and to determine whether such changes were associated with MH and SUD.

• In 2005, Medicaid enrollees were more likely to have an NCPC diagnosis than commercial insurance enrollees (34% versus 24%, respectively) and were more likely to have received at least 1 opioid prescription (63% versus 35%, respectively).

• In the 2 cohorts combined, the percentage of patients with NCPC who received an opioid prescription increased from 30% to 37% between 2000 and 2005; the percentage who received a >90-day supply increased from 4.2% to 5.6%.

• The percentage of enrollees with an MH and/or SUD diagnosis increased by almost 50% in both cohorts.

• Those with an MH and/or SUD diagnosis were more likely to have received an opioid prescription and to have received a >90-day supply.

Comments:

Although this study does not tell us much about prescription opioid abuse in the 2 cohorts, the strong association between an MH and/or SUD and opioid prescribing among individuals with chronic pain reinforces concerns about the increasing use of opioids. The increase in MH/SUD diagnoses may simply reflect an increase in diagnosis rather than prevalence, but it seems unlikely this would account for such a dramatic increase.

Darius A. Rastegar, MD

Reference:

Edlund MJ, Martin BC, Devries A, et al. Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study. Clin J Pain. 2010;26(1):1–8.