University faculty uncovers higher rates of opioid prescription for mental health patients

Thursday, July 6, 2017 - 2:21pm

More than half of opioid prescriptions in the United States go to adults with mental health disorders, according to a new study published in the Journal of the American Board of Family Medicine.

Matthew Davis, co-author of the study and University of Michigan School of Nursing professor, said the study focused on the most common mental illnesses, such as anxiety and depression, and the association between having a disorder and opioid usage persisted through every subgroup.

“If you took a patient who has severe pain — one with a mental health disorder, one without — pound for pound the patient with a mental health disorder was more likely to be an opioid user,” Davis said. “This trend persisted across many different causes for opioid prescription, like back pain or cancer symptoms.”

The study, drawing on comprehensive national data, estimates that 18.7 percent of the 38.6 million U.S. adults with mental health disorders are prescribed opioids, compared with 5 percent of those without mental health conditions. The study also estimates that 51.4 percent of all opioid prescriptions go to those with disorders.

Prescription opioids are never prescribed for a mental health issue directly — common examples, such as fentanyl, OxyContin and Vicodin, are used for moderate and extreme pain relief. However, according to Davis, the link between mental health and opioid usage illuminates the complicated relationship between mental health and pain.

“People in severe pain are more likely to suffer from anxiety or depression, and you know, depression itself could be a side effect of opioid use,” Davis said. “But I think our findings point to the population being important to dig into a little bit more, to understand more about the complex relationship, so we definitely have more work to do.”

Though the study draws upon no conclusive answer to fixing the systemic problem of opioid prescriptions in the United States, Davis feels it is a starting point towards tackling a problem.

“To begin to reduce America's’ dependency on prescription opioids, you’ve got to know where to look,” he said.

The study also draws a link between prescription of opioid medication and addiction, in addition to the troubling nature of how these medications are disproportionately prescribed to those with mental health disorders.

“Such a relationship is particularly concerning because mental illness is also a prominent risk factor for overdose and other adverse opioid-related outcomes,” the study reports.

Students like Ryan Shea, a recent LSA graduate, expressed concern about the study's findings.

"I just feel like when you've got some kind of mental illness like that you're already in pain and might want to take something to escape, so there's something very counterintuitive about it," Shea said.

Opioids, which include the illegal drug heroin, are known for their addictive properties. National attention in recent years has turned to a surge in heroin usage and overdoses in the past several years. In June of 2016, University police officers began patrolling equipped with generic-brand versions of Narcan, a drug used to combat opioid overdoses after spikes in amount of drug overdoses in Washtenaw County in recent years.

The study does not examine the link between opioid prescription and heroin use, but it is a common narrative for addiction according to Marlene Radzik, the Washtenaw County Sheriff Office’s police services commander.

“Every story that I heard was the same: that their child had a sports injury and was given Vicodin or Oxycontin or in a car crash,” Radzik said in 2016. “Soon they're addicted, they’re buying pills off the street.”

Noting that the study does not examine abuse, Davis said of the link that “ultimately, it starts somewhere, and it starts with prescription in terms of it getting out to society.”

Davis also pointed to beneficial work being done at the University regarding these issues, such as anesthesiologist Charles Brummett, who put together outreach efforts such as the Opioid Take-Back event organizing guide, an event which helps communities educate about medication misuse.

“There are some positive things happening here at the University of Michigan,” Davis said. “Our study I think sort of points to a population that is a place to start with abuse and dependency, and there are some people who are working hard to make a change.”