Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

Abstract

Objective: In North America, the prevalence of nonmedical prescription opioid use (NMPOU), and morbidity and mortality related to prescription opioid analgesics (POAs) has risen sharply. Epidemiologic studies have suggested a high prevalence of mental health and pain comorbidities in NMPOU samples. Given the potential importance for interventions, a narrative review was conducted on studies reporting data on the co-occurrence of NMPOU with mental health problems and pain symptoms in general, treatment, or special populations. Method:A search of MEDLINE, PubMed, PsycINFO, and Web of Science using defined search terms yielded 74 studies on NMPOU and mental health and (or) pain. Thirty-nine studies published between 1997 and 2009 were included in the review-based on the data they provided on NMPOU and mental health and pain comorbidities.Results: Our review found strong associations between NMPOU and the comorbidities of interest. Associations between NMPOU and mental health were strongest for depression (OR range 1.2 to 4.3) followed by anxiety disorders (OR range 1.2 to 3.0) in general and treatment populations. The prevalence of pain ranged from 14.5% to 61.5% in general, treatment, and street drug user samples reporting NMPOU. Conclusions:The extensive associations observed between NMPOU and mental health and pain comorbidities suggest that effective preventive or treatment interventions for NMPOU must consider and attend to these comorbidities. As POAs are widely available and used in North America, POAs may increasingly be used in nonmedical ways for pain or mental health problems not effectively diagnosed or treated.Can J Psychiatry. 2011;56(8):495-502. Clinical Implications• Mental health and (or) pain comorbidities are highly coprevalent in people engaging in NMPOU.• When observing NMPOU in patients, undiagnosed or untreated mental health and (or) pain must be examined as a possible cause.• People in need of medical POA care for pain should be screened for mental health problems. Limitations• A systematic review and meta-analysis is needed to further validate and add statistical precision findings.• NMPOU was inconsistently defined and operationalized across different studies.• Most studies were cross-sectional, thus directionality of the association cannot be determined.

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