Associations between Elevated Depressive Symptoms and Substance Use, Prescription Opioid Misuse, Overdose History, Pain, and General Health among Community Pharmacy Patients Prescribed Opioids

Abstract

Background: Individuals with pain prescribed opioids experience high rates of comorbid depression. The aim of this study was to characterize pain, substance use, and health status as a function of depressive symptom level in individuals filling an opioid prescription at a community pharmacy. Methods: Participants (N ¼ 1268) filling an opioid prescription enrolled in a study validating a prescription drug monitoring metric completed an online survey assessing sociodemographics, depressive symptoms, substance use, prescription opioid misuse, overdose history, general health, and pain severity and interference. Results: Approximately one-fifth (19.3%) had a positive depression screen result. In covariate-adjusted logistic regression analyses, individuals with a positive depression screen result were more likely to have moderate/high substance use risk scores for prescription opioids (adjusted odds ratio [AOR] ¼ 2.06; 95% confidence interval [CI], 1.51-2.79); street opioids (AOR ¼ 7.18; 95% CI, 2.57-20.01); cannabis (AOR ¼ 2.00; 95% CI, 1.34-3.00); cocaine (AOR ¼ 3.46; 95% CI, 1.46-8.22); tobacco (AOR ¼ 1.59; 95% CI, 1.18-2.15); methamphetamine (AOR ¼ 7.59; 95% CI, 2.58-22.35); prescription stimulants (AOR ¼ 2.95; 95% CI, 1.59-5.49); and sedatives (AOR ¼ 3.41; 95% CI, 2.43-4.79). Individuals with a positive depression screen were more likely to misuse prescription opioids (AOR ¼ 3.46; 95% CI, 2.33-5.15), experience a prior overdose (AOR ¼ 2.69; 95% CI, 1.76-4.11), report poorer general health (AOR ¼ 0.25, 95% CI, 0.18-0.35), and report moderate/severe pain severity (AOR ¼ 4.36, 95% CI, 2.80-6.77) and interference (AOR ¼ 6.47, 95% CI, 4.08-10.26). Conclusions: Individuals prescribed opioids with heightened depression were more likely to report other substance use, prescription opioid misuse, prior overdose, greater pain, and poorer health.

Reductions in sustained prescription opioid use within the US between 2017 and 2021

“…Our finding regarding the regional distribution of opioid prescribing behaviors is reasonably well aligned with prior studies on this topic, specifically with higher observed rates of opioid prescribing in the Southern US and the Midwest, as compared to New England and the Northeast 23 . The sociodemographic factors we identified as significantly associated with sustained prescription opioid use, especially during 2017–2019, are also similar to those encountered in previous works, including the influence of socioeconomic status 9 , 12 , 17 , 19 , 22 . We believe this consistency speaks to the external validity of our findings and their relevance to current health policy 24 .…”

“…Since the opioid crisis entered the popular consciousness in 2013, numerous efforts at the federal, state and local levels have been implemented to reduce the number of opioid medications circulating in the community and the prevalence of sustained prescription opioid use, non-prescribed opioid use and addiction 3 – 5 , 17 – 22 . While some putative success in reducing the number of opioid prescriptions was initially appreciated 3 , 4 , 12 , 13 , the ultimate effectiveness of these various initiatives has not been extensively studied in the context of COVID-19, especially in light of alterations in healthcare delivery that occurred due to the disruptions of the pandemic 6 , 7 , 12 , 20 .…”

“…Overall, we believe that our findings are encouraging as they demonstrate sizable reductions in sustained prescription opioid use in all census divisions, and for all sociodemographic and clinical subgroups considered, from 2017 to 2019 to 2020–2021. In particular, high-risk cohorts as characterized in the literature 9 , 12 , 17 , 19 , 22 , such as those of younger age and patients from lower socioeconomic strata, experienced significant reductions in the likelihood of sustained prescription opioid use during 2020–2021. Furthermore, it is also encouraging that as compared to the time period 2006–2014 14 , the total number of new sustained prescription opioid users in the Military Health System reduced substantially, from 117,118 in 2006–2014 to 11,648 during 2017–2021.…”

Nonfatal Overdoses Among Pregnant Individuals With Opioid Use Disorder

“…[5][6][7] Overdose history was ascertained using the OESWD (Overdose Experiences, Self and Witnessed-Drug Assessment) tool, a validated tool for assessing these events among individuals who use drugs. [8][9][10] Participants completed six questions about prior overdose events at study enrollment, which ranged between 7 and 32 weeks of gestation. We compared substances involved in the most recent event by overdose intentionality using Fisher exact test.…”

Subtypes in Patients Taking Prescribed Opioid Analgesics and Their Characteristics: A Latent Class Analysis

“…A review of the literature on risk factors identified several behavioral, mental, and health characteristics highly associated with pOUD, which were collected in our survey: hazardous alcohol consumption (25), daily smoking (26), consumption of cannabis (27), consumption of other illicit drugs (amphetamines, ecstasy, LSD, heroin and other opioids, cocaine, crack, hallucinogenic mushrooms) (28,29), depression, psychological treatment (16,17,19,30), and poor physical health status (31). All variables were dichotomized (yes/no).…”