Why Are Patients with Mental Health Disorders Getting More Opioids?

By Brian Sites, MD    Jul 14, 2017

Brian Sites, MD

The United States is in the midst of a devastating opioid epidemic largely fueled by the massive increase in the prescriptions for opioid painkillers over the past 15 years.  The U.S., which represents a mere 5% of the world’s population, now consumes nearly 80% of the world’s opioids.  Despite this exposure to opioids, the Centers for Disease Control and Prevention (CDC) reports that the American experience with pain has not improved.  Our recent research aimed to understand if a particularly vulnerable population of patients (those with mental health disorders) are being prescribed opioids at a rate consistent with the general population.

Even when taking into account age, sex, race, health conditions, and pain levels, having a mental health disorder increases the likelihood that you will receive an opioid prescription by TWOFOLD.



Using national representative data, we found that DESPITE representing only 16 % of the overall U.S. adult population, people who suffer from mental health disorders – depression, anxiety, or mood disorders – are being prescribed over 50% of the country’s opioids.  This means that roughly 38.6 million people receive more than 60 million prescriptions for opioid painkillers a year from their doctors.  Even when taking into account age, sex, race, health conditions, and pain levels, having a mental health disorder increases the likelihood that you will receive an opioid prescription by TWOFOLD.

What does it mean?

  • This disproportionate prescribing to patients suffering mental health disorders is deeply concerning. We already know patients who suffer from these conditions are more vulnerable with respect to opioid abuse, overdose, addiction, and long-term use.
  • Additionally, the sheer magnitude of the prescribing suggests the possibility for either overprescribing or unnecessary prescribing in patients with mental health disorders.
  • The presence of a mental health disorder may actually influence the decision of a physician to prescribe an opioid, independent of pain.

What’s next?

  • We need to do more scientific research to understand the COMPLEX relationship between mental health, pain, and outcomes of treatment.
  • We need to reduce U.S. dependency on prescription opioids, and that strategy should first focus on this small subset of the American population that is consuming the majority of the prescription opioids.
  • Social policy and political leaders must help build the infrastructure needed to better diagnose and treat both pain and mental illness. Patients need reliable access to non-opioid alternatives such as cognitive behavioral therapy and the development of newer and safer drugs.

Reference

Davis MA, Lin LA, Liu H, Sites BD. Prescription opioid use among adults with mental health disorders in the United States. J Am Board Fam Med2017 Jul;30(4), 407-417. doi: 10.3122/jabfm.2017.04.170112


National coverage of this research can be found here:

Washington Post: Greater Opioid Use and Mental Health Disorders are Linked in a New Study

Huffington Post: More Than Half Of Opioid Prescriptions Go To People With Mental Illness

Kaiser News: Patients With Mental Disorders Get Half Of All Opioid Prescriptions

 


Brian Sites, MD, is the director of Regional and Orthopedic Anesthesiology at Dartmouth-Hitchcock Medical Center in Lebanon, NH. He is also a member of the ASRA Board of Directors.


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