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Opioids for acute and chronic pain when receiving psychiatric medications

BACKGROUND: People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression...

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Autores principales: Janakiram, Chandrashekar, Okunev, Ilya, Tranby, Eric P., Fontelo, Paul, Iafolla, Timothy J., Dye, Bruce A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522028/
https://www.ncbi.nlm.nih.gov/pubmed/37751410
http://dx.doi.org/10.1371/journal.pone.0286179
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author Janakiram, Chandrashekar
Okunev, Ilya
Tranby, Eric P.
Fontelo, Paul
Iafolla, Timothy J.
Dye, Bruce A.
author_facet Janakiram, Chandrashekar
Okunev, Ilya
Tranby, Eric P.
Fontelo, Paul
Iafolla, Timothy J.
Dye, Bruce A.
author_sort Janakiram, Chandrashekar
collection PubMed
description BACKGROUND: People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety. METHODS AND FINDINGS: Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012–2019) for adults aged 21–64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50–64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD. CONCLUSIONS: Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs.
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spelling pubmed-105220282023-09-27 Opioids for acute and chronic pain when receiving psychiatric medications Janakiram, Chandrashekar Okunev, Ilya Tranby, Eric P. Fontelo, Paul Iafolla, Timothy J. Dye, Bruce A. PLoS One Research Article BACKGROUND: People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety. METHODS AND FINDINGS: Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012–2019) for adults aged 21–64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50–64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD. CONCLUSIONS: Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs. Public Library of Science 2023-09-26 /pmc/articles/PMC10522028/ /pubmed/37751410 http://dx.doi.org/10.1371/journal.pone.0286179 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Janakiram, Chandrashekar
Okunev, Ilya
Tranby, Eric P.
Fontelo, Paul
Iafolla, Timothy J.
Dye, Bruce A.
Opioids for acute and chronic pain when receiving psychiatric medications
title Opioids for acute and chronic pain when receiving psychiatric medications
title_full Opioids for acute and chronic pain when receiving psychiatric medications
title_fullStr Opioids for acute and chronic pain when receiving psychiatric medications
title_full_unstemmed Opioids for acute and chronic pain when receiving psychiatric medications
title_short Opioids for acute and chronic pain when receiving psychiatric medications
title_sort opioids for acute and chronic pain when receiving psychiatric medications
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522028/
https://www.ncbi.nlm.nih.gov/pubmed/37751410
http://dx.doi.org/10.1371/journal.pone.0286179
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