A research team from Indiana University, Bloomington has concluded that the presence of a variety of pre-existing behavioral and psychiatric conditions may be predictors of long-term opioid use, and further, that patients presenting with these conditions may be more likely to receive opioid prescriptions. The findings are based on an analysis of over 10 million patient records involving insurance claims for opioid prescriptions issued between 2004 and 2013. Study author Patrick Quinn, PhD, commented "We found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids.” The conclusions are published in the journal PAIN®.
Patient risk assessment is recognized as critical to the management of epidemic of opioid abuse and misuse, and previous studies have suggested that patients who are at greater risk for adverse outcomes, including those with substance abuse and other psychiatric disorders, are more likely to receive prescriptions for opioids and more likely to take higher doses for longer durations. This pattern of “adverse selection” appears to be confirmed in the present study, and points to a defect in assessment practice that should be addressed. The authors conclude that, "Our findings support the ideas that clinical practice has deviated from the 'careful selection' under which most clinical trials are conducted and that thorough mental health assessment and intervention should be considered in conjunction with the use of long-term opioid therapy."
A news story about the findings, with link to the journal article, may be read here.
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