Study Shows Prescription Opioid Use among Patients with Recent History of Depression Increases Risk of Recurrence
BACKGROUND:
Pain and depression are highly comorbid, and patients with depression are more likely to use opioids even when functioning is good. Moreover, a growing body of literature suggests that patients with chronic non-cancer pain who are prescribed opioids are more likely to develop depression. This study examined whether patients in depression remission who were prescribed opioids for non-cancer pain had an increased risk of depression recurrence, after controlling for covariates. Investigators analyzed two patient populations: 5,400 Veterans treated in the VA healthcare system, and 842 patients treated by Baylor Scott & White Health (BSWH) – a non-profit integrated healthcare system located in Texas. All study participants had been free of opioid use for at least two years, had a diagnosis of depression, and experienced depression remission during follow-up. The observation period for VA patients was 2002 through 2012, and for BSWH was 2003 through 2012. Covariates measured included patient demographics, insurance coverage, psychiatric disorders, substance use disorder, physical comorbidities, and pain.
FINDINGS:
- Prescription opioid use among patients with a recent history of depression increased the chance of depression recurrence, and this effect was independent of pain diagnoses and pain intensity scores.
- Patients with remitted depression who were exposed to opioid analgesics at any point during the follow-up period were 77% to 117% more likely to experience a recurrence of depression than those who remained opioid free, after controlling for other factors.
- Among VA patients with depression remission, those who received opioids during follow-up were younger, had more psychiatric comorbidities, and had more painful conditions and higher pain scores than those who didn't receive opioids.
IMPLICATIONS:
- As of 2013, back pain and depression were ranked as number 1 and 2 in the top 10 causes of years lived with disability. The burden of disease due to these conditions may be increased if opioid treatment for chronic pain, especially back pain, leads to persistent depression. These study findings highlight a particularly challenging situation faced by clinicians and patients with pain – and point to the need for careful consideration of depression in the assessment of benefit and risk of opioid use.
LIMITATIONS:
- Opioid exposure was based on prescription fills, but it is impossible to know whether patients took their medications as prescribed.
- The algorithms for remission and recurrence are imperfect indicators of the course of disease. If consistently available for all patients, repeated monthly assessments of depression symptoms would allow for more precise measures of remission and recurrence.
AUTHOR/FUNDING INFORMATION:
Dr. Scherrer is a former HSR&D Career Development Awardee; he and Ms. Salas are part of the Harry S. Truman Memorial Veterans' Hospital in Columbia, MO. Dr. Copeland is part of the Central Texas Veterans Health Care System.
Scherrer J, Salas J, Copeland L, et al. Increased Risk of Depression Recurrence after Initiation of Prescription Opioids in Non-Cancer Pain Patients. The Journal of Pain. April 2016;17(4):473-82.
