Opioids With A History of Mental Illness

It may seem like common sense that people with a history of psychiatric illness would be more susceptible to developing an addiction, at least to those who work in the field of addiction medicine. However, many doctors do not look at a patient’s complete medical history before deciding whether to prescribe opioid painkillers, or not. Or so a new study has found. Such lapses regarding a patient's background can have devastating consequences on certain patients.

New research suggests that people with pre-existing psychiatric and behavioral conditions are at greater risk of long-term use of opioid pain medications, according to a press release. The findings highlight the need for providers to run complete histories on patients they are considering prescribing narcotics. The research was published in the Pain: The Journal of the International Association for the Study of Pain.

The researchers found that about 1.7 percent of patients prescribed opioids become long-term opioid users (six months or longer), according to the report. However, those with a history of mental health conditions or psychoactive medication use, became long-term opioid user at a much greater rate. The findings come from an analysis of data on prescriptions and health history for 10.3 million people, part of a nationwide insurance database, from 2004 to 2013.

"We found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids," study author Patrick D. Quinn, PhD, of Indiana University, Bloomington, and colleagues write. "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." 

In the field of addiction, it is quite common for people battling substance abuse to also have a co-occurring mental health disorder. Treatment becomes more complex because success depends on treating both the substance use and co-occurring disorder. So, it stands to reason that prescribing opioids to people who are already likely to be more susceptible to addiction, may not be a good choice. Looking for opioid alternatives when treating the pain of patients with history of mental illness or substance use, would have a positive effect all around.