Study Correlates Chronic Pain, Mental Illness With Opioid Overdose
A new study shows that almost two-thirds of individuals who died from an opioid overdose had a diagnosed chronic pain condition and about one-third had dual diagnoses of chronic pain and a mental illness. Researchers at Columbia University Medical Center reviewed over 13,000 opioid-related deaths from 2001 to 2007, looking at health service patterns before opioid-related death among nonelderly adults in the Medicaid program. The study was published online this week in the American Journal of Psychiatry.
“The frequent occurrence of treated chronic pain and mental health conditions among overdose decedents underscores the importance of offering substance use treatment services in clinics that treat patients with chronic pain and mental health problems. Such a strategy might increase early clinical intervention in patients who are at high risk for fatal opioid overdose,” said researcher Mark Olfson, MD, professor of psychiatry at CUMC. The risk of overdose for people with such diagnoses are higher because they are more likely to receive and fill prescriptions for both opioids and benzodiazepines, a combination of medications known to increase the risk of depressed breathing. Doctors, researchers and public health agencies have been calling for greater safety measures for those patients whose conditions support use of these medications and for whom alternative treatments are ineffective.
The study also indicates that keeping people in treatment could significantly decrease the rate of opioid overdoses. Although about 33 percent of those who died had been diagnosed with a drug use disorder in the year before their death, fewer than 5 percent had such a diagnosis made within the last month of their life. “Because clinical diagnoses generally indicate [ongoing] treatment, this service pattern suggests that dropout from drug treatment is common before fatal opioid overdose. Improving treatment retention with contingency management or other effective behavioral interventions might help lower the risk of fatal overdose in these patients,” said Dr. Olfson.
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In addition to demonstrating an opportunity to avoid/head off overdoses by making treatment more available to people who have diagnoses of chronic pain and a psychiatric illness,
A review by researchers at CUMC of over 13,000 opioid-related deaths found that almost two-thirds of individuals who died from an opioid overdose had a diagnosed chronic pain condition and about one-third had dual diagnoses of chronic pain and a mental illness. The study, which looked at health service patterns before opioid-related overdoses of nonelderly adults on Medicaid, and is the first to determine the proportions of individuals who died of an opioid overdose with chronic pain as well as diagnosis of mental illnesses such as depression and anxiety.
making treatment more available to those who have diagnoses of both chronic pain and a mental health condition and improving treatment retention
The researchers analyzed clinical diagnoses and filled medication prescriptions for more than 13,000 adults in the Medicaid program who died of an opioid overdose. During the last year of life, more than half of these individuals had been diagnosed with chronic pain. Many had also been diagnosed with depression and anxiety.
The study is the first to determine the proportion of those who died of an opioid overdose with chronic pain as well as diagnoses of mental illnesses such as depression an anxiety.
these findings point to the need for better education and monitoring of patients who struggle with both chronic pain and mental illness and for whom alternative treatments are ineffective.