Patients with serious mental illness are significantly more likely than their peers to receive chronic opioid medications, even after adjusting for medical comorbidities and chronic pain diagnoses, according to data published in BMC Psychiatry. Given the increased risk for opioid-related problems among patients with psychiatric diagnoses, the investigators advised a more cautious approach to prescribing that integrates expertise from mental health clinicians.

Ashli Owen-Smith, from the School of Public Health, Georgia State University, Atlanta, led study efforts to examine opioid prescribing trends among patients with psychiatric diagnoses based on electronic medical record data from the Mental Health Research Network, a series of research centers across 15 states. Patients with diagnoses of major depressive disorder (n=65,750), bipolar disorder (n=38,117), and schizophrenia or schizoaffective disorder (n=12,916) were matched by age, sex, and Medicare status with controls without a history of mental illness (n=129,644). The researchers extracted data on noncancer chronic pain diagnoses and prescription opioid dispensing for all participants and conducted multivariate analyses to calculate the odds of receiving a chronic pain diagnosis and of receiving opioids in patients vs controls.

Across patients and matched controls, mean age was between 42 and 44 years, and the majority were women (depression: 72%; bipolar disorder: 67%; schizophrenia: 44%). In multivariable analyses, major depressive disorder was associated with significantly increased odds of a chronic pain diagnosis (odds ratio [OR], 1.90; 95% CI, 1.85-1.95) and receiving chronic opioid prescriptions (OR, 2.59; 95% CI, 2.44-2.75). Compared with matched controls, patients with bipolar disorder also had increased odds of noncancer chronic pain diagnoses (OR, 1.71; 95% CI, 1.66-1.77) and chronic opioid dispensing (OR, 2.12; 95% CI, 1.97-2.28). Among patients with schizophrenia, however, a decreased risk of receiving a chronic pain diagnosis was observed (OR, 0.86; 95% CI, 0.82-0.90), and a schizophrenia diagnosis had no apparent effect on the odds of opioid prescription use.

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Even after adjustments for chronic pain levels and medical comorbidities, patients with mental illnesses remained at high risk for chronic opioid use. Study limitations included the use of opioid dispensing, rather than actual medication use, which may have affected certain associations. In addition, the results may not be generalizable to patients without access to payer-provided healthcare.

The investigators called for the engagement of mental health professionals in the pain management of patients with psychiatric illness. They noted that the “presence of pain significantly impacts individuals’ engagement in and adherence to their mental health treatment and is an important moderator of treatment-related outcomes with respect to both pharmacotherapy and psychotherapy.”

Reference

Owen-Smith A, Stewart C, Sesay MM, et al. Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness. BMC Psychiatry. 2020;20(1):40.