Examining Rates of Long-Term Opioid Use in Youth With Psychiatric Disorders

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Adolescents with pre-existing mental health conditions are more likely to transition from opioid initiation to long-term opioid therapy.
Adolescents with pre-existing mental health conditions are more likely to transition from opioid initiation to long-term opioid therapy.

Adolescents with preexisting mental health conditions and treatments are substantially more likely than adolescents without such conditions to transition from opioid initiation to long-term opioid therapy according to the results of a study published in JAMA Pediatrics.1

In 2015, more than a quarter of a million adolescents were current users of nonmedical prescribed opioids and more than 33,000 Americans died of an opioid overdose.1,2 Of adolescents who report using heroin, 80% said that they began using nonmedical prescribed opioids before transitioning to heroin.2 

Patrick D. Quinn, PhD, of the Department of Psychological and Brain Sciences at Indiana University in Bloomington, Indiana and the Center for Health Statistics at the University of Chicago in Illinois, and colleagues extracted and analyzed data from nationwide healthcare claims from January 1, 2003 to December 31, 2014 on 1,224,520 new opioid recipients without cancer diagnoses age 14 to 18 at first receipt.1 They evaluated associations between preexisting mental health conditions and treatments and any opioid use and compared recipients with non-recipients matched by sex, calendar year, years of age at first enrollment, and months of enrollment.

The main outcomes were opioid receipt, defined as any opioid analgesic prescription claim, and long-term opioid therapy, defined as more than 90 days' supply within a 6-month period, with no supply gap longer than 32 days.1

Adolescents with anxiety, mood, neurodevelopmental, sleep, and nonopioid substance use disorders and most mental health treatments were significantly more likely to receive any opioid. Adolescents with preexisting nonopioid substance use disorders were 13% more likely to receive opioids, and adolescents with nonbenzodiazepine substance use disorders were 69% more likely to receive opioids.1 

While 3.0 per 1000 recipients transitioned to long-term opioid therapy within 3 years of receiving an opioid prescription, all psychiatric disorders and treatments were associated with an increased risk for transitioning to long-term opioid therapy . This ranged from an adjusted relative increase in the long-term opioid therapy  rate from a factor of 1.73 for attention deficit hyperactivity disorder to a 9-fold increase for opioid use disorder.1

The researchers suggested that given the limited evidence supporting the efficacy of opioid therapy for chronic pain in youths, research is required to understand potential harmful effects of long-term opioid therapy in adolescents, as well as the role that preexisting mental health conditions may play in adverse outcomes.

References

  1. Quinn PD, Hur K, Chang Z, et al. Association of mental health conditions and treatments with long-term opioid analgesic receipt among adolescents [published online March 12, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.5641
  2. Mason MJ. Association of psychiatric comorbidity with opioid prescriptions and long-term opioid therapy among US adolescents [published online March 12, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.5811
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