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Patients With Mental Disorders Get Half of All Opioid Prescriptions

June 30, 2017
The 16% of Americans who have mental health disorders receive over half of all opioids prescribed in the United States. Improving pain management among this population is critical to reduce national dependency on opioids, noted the authors.

Adults with a mental illness receive more than 50% of the 115 million opioid prescriptions in the United States annually, according to a study in the Journal of the American Board of Family Medicine.1 People with mental health disorders represent 16% of the US population. The results prompted researchers to suggest that improving pain management for people with mental health problems “is critical to reduce national dependency on opioids.”

The findings are worrisome, the researchers reported. They had expected that physicians were more conservative in prescribing these painkillers to people with mental illness.

“We are prescribing way too much opioids,” said Brian Sites, MD, MS, an anesthesiologist at Dartmouth-Hitchcock Medical Center in New Hampshire and one of the study’s researchers. “And that prescription behavior is resulting in significant morbidity in the country.”

“Because patients with mental health disorders are a vulnerable population, [they’re] probably more likely to develop addiction and abuse,” he added. Sites suggested that physicians consider using different criteria when prescribing opioids for people with mental illness.

“The opioids are prescribed primarily for pain,” but patients with mental illness find that the drugs alleviate their mental issues too, said Edwin Salsitz, MD, an attending physician in the Division of Chemical Dependency of Mount Sinai Beth Israel Medical Center in New York who was not involved in the study. And this, he said, is what can lead to long-term use.

Mood and Anxiety Disorders and Pain

Earlier pain research listed the overall prevalence of comorbid anxiety disorders and pain as ranging between 16.5% and 28.8%.13 Newer studies suggest that anxiety disorders may be present in up to 60% of patients with chronic pain.3
Earlier pain research listed the overall prevalence of comorbid anxiety disorders and pain as ranging between 16.5% and 28.8%.13 Newer studies suggest that anxiety disorders may be present in up to 60% of patients with chronic pain.3

The study found that nearly 19% of Americans with a mental health illness use prescription opioids, while the same is true for only 5% of those without a mental health condition.

According to the Centers for Disease Control and Prevention, the number of opioid sales in the US quadrupled from 1999 to 2015, yet the amount of pain adults experience remained the same. In addition to that, more than 183,000 people died from overdoses related to prescription opioid use during this time.

With no objective scale for measuring pain, doctors are hampered in treating patients with chronic discomfort.

“Since [pain is] a subjective phenomenon, it’s very difficult to measure those things and to treat because some patients [report] 10-out-of-10 pain forever,” Dr. Sites said.

Dr. Andrew Saxon, director of the Addiction Psychiatry Residency Program at the University of Washington, said that “most people with chronic pain who end up on opioids do have a co-occurring psychiatric disorder.” Yet too often the drugs don’t provide lasting relief, he said.

“We have found that opioids for most of these people in the long term improve their subjective sense of pain for a little bit, but they don’t usually improve people’s level of function,” said Dr. Saxon, who was not involved in this study.

Many opioid patients, and especially those with mental health issues, should be offered an alternative treatment, said Dr. Saxon, who also is chairman of the American Psychiatric Association’s council on addiction.

“It actually turns out … that the best treatment for chronic pain is going to be behavioral interventions, not medications,” he explained. That involves teaching people to understand the underlying cause of their pain and skills to better cope with it, the psychiatrist said.

Dr. Sites said alternatives to opioids could include cognitive behavioral therapy, acupuncture, meditation techniques, and physical therapy.

“The idea is that we want to improve the health and well-being of the patient. And if that’s not occurring, we need alternatives to opioids,” Dr. Sites said.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Last updated on: March 5, 2019
Continue Reading:
Co-Morbid Psychological Disorders in Interventional Pain Management

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