Article Figures & Data
Figures
- Figure 1
Percentage of weighted positive misuse in relationship to depression score.
PHQ-8 = 8-item version of the Patient Health Questionnaire, in which 0–4 = no, 5–9 = mild, 10–14 = moderate, and ≥15 = severe depression.
Tables
Variable No. (Unweighted) % Weighted Age, y 18–44 249 16.8 45–64 798 60.6 ≥65 287 22.7 Sex, female, % 907 69.0 Race African American 102 7.7 White 1,120 83.6 Asian 24 1.3 Other 88 7.4 Marital status Married/living as married 886 65.3 Never married 144 11.0 Widowed 91 7.3 Separated/divorced 217 16.5 Education Less than high school 79 5.0 High school graduate/trade school 419 32.2 Some college 543 40.4 College graduate 293 22.3 PHQ-8 scorea 0–4 341 31.2 5–9 388 31.1 10–14 299 19.6 ≥15 305 18.1 Average daily morphine-equivalent dose <50 mg 509 71.0 50–99 mg 414 16.6 ≥100 mg 416 12.4 Health plan site GHC 776 60.2 KPNC 558 39.2 Average pain severityb 0–2 36 3.4 3–5 551 46.4 6–7 464 30.8 ≥8 282 19.4 -
GHC = Group Health Cooperative; KPNC = Kaiser Permanente of Northern California; PHQ-8 = 8-item version of the Patient Health Questionnaire.
-
↵a Scored on a scale in which 0–4 = no, 5–9 = mild, 10–14 = moderate, and ≥15=severe depression.
-
↵b Scored on a range from 0–10 in which a higher score indicates worse pain.
-
- Table 2
Number (Unweighted) and Weighted Percentage of Patients Scoring Positive on 3 Misuse Types by Demographic and Clinical Characteristics
Non–Pain Symptoms Nonadherence Aberrant Behavior Variable No. % No. % No. % Age, y 18–44 91 47.3 144 59.0 57 27.8 45–64 299 41.5 356 39.6 113 16.7 ≥65 118 42.1 106 39.9 34 12.7 Sex Female 328 39.6 404 42.3 145 18.3 Male 180 49.7 202 44.3 59 16.2 Race African American 39 38.2 60 44.7 17 13.4 White 426 38.1 493 43.0 174 18.7 Asian 7 30.4 12 40.0 2 4.4 Other 31 35.6 39 41.9 10 13.0 Marital status Married/living as married 347 45.6 394 42.6 132 18.4 Never married 50 40.1 78 50.0 28 17.0 Widowed 32 34.1 34 40.0 12 18.7 Separated/divorced 79 36.5 99 42.1 31 13.8 Education Less than high school 37 59.7 32 39.1 10 15.9 High school graduate/trade school 179 49.6 195 44.9 67 21.7 Some college 192 36.4 274 45.2 80 17.1 College graduate 100 39.8 115 36.8 47 13.1 PHQ-8 scorea 0–4 102 36.9 119 27.3 46 15.5 5–9 139 40.2 173 42.6 45 12.3 10–14 131 47.2 146 54.3 57 23.4 ≥15 136 51.8 167 57.7 56 24.5 Average daily morphine-equivalent dose <50 mg 247 46.8 219 41.2 93 18.5 50–99 mg 134 34.0 203 47.8 66 17.0 ≥100 mg 127 29.9 184 46.2 45 13.6 Health plan site GHC 324 46 432 42.1 103 16.3 KPNC 184 37.4 264 44.2 101 19.6 Average pain severityb 0–2 11 57.9 14 39.1 7 32.9 3–5 202 41.0 235 38.5 85 15.9 6–7 175 40.4 215 43.9 73 17.7 ≥8 117 49.3 138 54.7 38 19.9 -
GHC = Group Health Cooperative; KPNC = Kaiser Permanente of Northern California; PHQ-8 = 8-item version of the Patient Health Questionnaire.
-
↵a Scored on a scale in which 0–4 = no, 5–9 = mild, 10–14 = moderate, and ≥15 = severe depression.
-
↵b Scored on a scale ranging from 0–10 in which a higher score indicates worse pain.
-
Effect OR (95% CI) P Value PHQ-8 scoresa PHQ-8: ≥15 vs 0–4 2.42 (1.46–4.02) .001 PHQ-8: 10–14 vs 0–4 1.75 (1.05–2.91) .031 PHQ-8: 5–9 vs 0–4 1.23 (0.80–1.90) .346 Age 1.00 (0.98–1.01) .80 Sex (female vs male) 0.56 (0.39–0.80) .002 Race (nonwhite vs white) 1.36 (0.87–2.12) .17 Marital status (nonmarried vs married) 1.08 (0.63–1.85) .79 Education 0.87 (0.76–0.99) .03 Average daily morphine-equivalent doseb 0.997 (0.995–0.999) .016 Health plan site (GHC vs KPNC) 1.55 (1.10–2.17) .012 Average pain severity 1.01 (0.92–1.11) .89 Effect OR (95% CI) P Value PHQ-8 scoresa PHQ-8: ≥15 vs 0–4 3.13 (1.91–5.12) <.001 PHQ-8: 10–14 vs 0–4 2.86 (1.76–4.64) <.001 PHQ-8: 5–9 vs 0–4 1.93 (1.259–2.95) <.001 Age 0.98 (0.96–0.99) .80 Sex (female vs male) 1.00 (0.98–1.01) .12 Race (nonwhite vs white) 0.76 (0.54–1.07) .25 Marital status (nonmarried vs married) 0.77 (0.49–1.20) .32 Education 0.76 (0.45–1.31) .55 Average daily morphine-equivalent doseb 0.96 (0.86–1.09) .56 Health plan site (GHC vs KPNC) 1.00 (1.00–1.00) .75 Average pain severity 1.10 (1.01–1.21) .032b Effect OR (95% CI) P Value PHQ-8 scoresa PHQ-8: ≥15 vs 0–4 1.80 (0.93–3.46) .080 PHQ-8: 10–14 vs 0–4 1.74 (0.90–3.32) .10 PHQ-8: 5–9 vs 0–4 0.79 (0.44–1.42) .43 Age 0.97 (0.95–0.99) <.001 Sex (female vs male) 1.02 (0.65–1.61) .93 Race (nonwhite vs white) 0.43 (0.24–0.79) <.001 Marital status (nonmarried vs married) 1.01 (0.52–1.93) .99 Education 0.82 (0.71–0.96) .013 Average daily morphine-equivalent doseb 0.998 (0.995–1.000) .026 Health plan site (GHC vs KPNC) 0.69 (0.44–1.08) .10 Average pain severity 0.94 (0.83–1.07) .34
The Article in Brief
Depression and Prescription Opioid Misuse Among Chronic Opioid Therapy Recipients With No History of Substance Abuse
Mark D. Sullivan , and colleagues
Background Opioid medications are commonly used to treat chronic noncancer pain, but they can be misused. This study examines whether there is an association between depression and misuse of opioids by patients with no history of substance abuse who are receiving chronic opioid therapy.
What This Study Found Patients are much more likely to misuse opioids if they are depressed. This study surveyed 1,334 patients with no history of substance abuse who were on long-term opioid therapy for chronic pain. Patients with moderate and severe depression were more likely to misuse their opioid pain medications for nonpain symptoms compared with patients who were not depressed. Patients with mild, moderate, and severe depression were 1.9, 2.9, and 3.1 times more likely, respectively, than patients who were not depressed to misuse their opioid medications by self-increasing their dose. Other risk factors for misuse include male sex, lower average daily dose, less education, younger age, higher pain severity, and white race.
Implications
- Clinicians should be alert to the risk of patients using opioids to relieve symptoms of depression.
- The authors call for future research to examine whether treatment of depression decreases the risk of opioid misuse.
Jump to section
Related Articles
Cited By...
- Predictors of controlled prescription drug non-medical and lifetime use among patients accessing public mental health services in Uganda: a cross-sectional study
- Risk factors for new-onset depression or anxiety following total joint arthroplasty: the role of chronic opioid use
- Opioid Medications Prescribing and the Pain-Depression Dyad in Primary Care: Analysis of 2014-2015 National Ambulatory Medical Care Survey (NAMCS) Data
- Intelligent Clinical Decision Support to Improve Safe Opioid Management of Chronic Noncancer Pain in Primary Care
- Opioid analgesic dependence: where do we go from here?
- Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations
- Opioid Misuse and Abuse: Risk Assessment and Management in Patients with Cancer Pain
- In This Issue: An Abundance of Interventions and Observations to Improve Care
- Opioids for Chronic Pain: First Do No Harm