Pathways between nonmedical opioid use/dependence and psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Abstract

Background-While nonmedical use of opioids and psychiatric disorders are prevalent in the population, little is known about the temporal ordering between nonmedical opioid use and dependence and psychiatric disorders.Method-Data were gathered in a face-to-face survey of the United States conducted in the 2001-2002 (NESARC wave 1). Participants were household and group quarters residents aged 18 years and older (n=43,093). Cox proportional hazards models with time-dependent covariates were used to investigate potential pathways between lifetime nonmedical opioid use/dependence and psychiatric disorders.Results-Preexisting psychiatric disorders (mood disorders, major depressive disorder, bipolar I disorder, anxiety disorders, panic and generalized anxiety disorders) were associated with an increased risk of nonmedical opioid use, with hazard ratios ranging from 2.2[95% CI=1.6-3.1] (any anxiety disorder) to 3.1[95% CI= 2.4-2.4] (bipolar I disorder). Preexisting nonmedical opioid use was associated with an increased risk of onset of psychiatric disorders, with hazard ratios ranging from 2.8[95% CI=:2.2-3.6] (generalized anxiety disorder) to 3.6[95% CI=2.6-4.9] (bipolar I disorder), adjusted for demographics and other illegal drug use. Nonmedical use of opioids led to the development of dependence more often among individuals with preexisting psychiatric disorders, † Corresponding author: Silvia S. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptDrug Alcohol Depend. Author manuscript; available in PMC 2010 July 1. Published in final edited form as:Drug Alcohol Depend. Conclusions-Our findings support a general vulnerability to nonmedical opioid use and major psychopathologies, as well as evidence for a 'self-medication' model for dependence resulting from nonmedical opioid use with bipolar disorder and generalized anxiety disorder.

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

“…32,59,60 Multiple etiologies likely account for the comorbidities, and further research is required to elucidate the role of different causal directionalities.…”

“…The Huang et al 31 analysis of the US NESARC demonstrated that NMPOU was positively associated with mood disorders, anxiety disorders, and personality disorders. The Martins et al 32 analysis of the same data demonstrated that preexisting mood disorders and anxiety disorders increased the likelihood of NMPOU. Conversely, the Novak et al 33 analysis demonstrated that mood and antisocial personality disorders increased the likelihood of disordered NMPOU, and anxiety disorder increased the likelihood of nondisordered NMPOU, compared with no disorder.…”

Suicidal Ideation and Suicide Attempt Across Stages of Nonmedical Prescription Opioid Use and Presence of Prescription Opioid Disorders Among U.S. Adults

“…Given the extent of the problem, many studies have characterized individuals who use nonmedical prescription opioids to better understand the population of nonmedical prescription opioid users (Becker et al, 2008;Brands et al, 2004;Huang et al, 2006;Martins et al, 2009b;Sigmon, 2006). A strong association between psychiatric disorders and nonmedical prescription opioid use (Becker et al, 2008;Cicero et al, 2008) and disorders (Grella et al, 2009;Huang et al, 2006;Martins et al, 2009a) suggests the importance of addressing mental health problems among this population. A high risk for mental disorders motivates examination of risk for suicidal behavior (ideation and/or attempt), as mental disorders are among the strongest risk factors for suicidal ideation (Goldney et al, 2000).…”

Prescription drug monitoring program data tracking of opioid addiction treatment outcomes in integrated dual diagnosis care involving injectable naltrexone

“…Although the health, economic, and social consequences of the prescription opioid epidemic are broad,7, 8 people with mental illness and non‐opioid addictions show disproportionate risk of suffering serious complications of increased access to prescription opioids 9, 10, 11, 12. Pre‐existing mental illness is major risk factor for acquisition of opioid use disorders, and non‐medical opioid use that escalates to addiction is a risk factor for onset of mental illness 13. Whether produced by “Adverse Selection” where doctors are more likely to prescribe high risk opioid regimens to high risk (eg, mentally ill/addicted) patients,14, 15 or biological vulnerability to addictions in mentally ill brains,16, 17 strong linkages between mental illness and opioid addictions indicate the need to recognize and treat prescription opioid addictions in behavioral health settings.…”