Prevalence and Trends of Opioid Use in Patients With Depression in the United States

Abstract

BackgroundDepression and prescription opioid use have a bi-directional relationship. Depression commonly co-occurs with chronic noncancer pain and is known to be associated with opioid use. Studies have found an increased risk of depression only in patients with opioid dependence. Other studies have found an increased risk of opioid misuse in depressed patients. In addition, chronic pain conditions can lead to depression without the use of opioids. MethodsWe used the National Health and Nutrition Examination Survey (NHANES) data collected over seven survey cycles spanning 14 years: 2005/2006-2017/2018. Included in our study were participants ≥18 years who completed the patient health (PHQ-9) questionnaire. Persons with documented use of opioids were considered to have chronic use of opioids. Relevant data files were merged, and analytical weights computed in keeping with the survey analytical guidelines. Prevalence measures are reported as proportions. Associations were assessed using the Chi-square test. Binary logistic regression was used to assess the trend in the prevalence of opioid use. We used STATA-16 for data analysis and p-values <0.05 were considered statistically significant. ResultsA total of 36,459 participants met the inclusion criteria. The prevalence of depression was 7.7% (95% CI: 7.3-8.2). The prevalence of any narcotic use was 6.0%. Among depressed individuals, Blacks: OR 0.71 (95% CI: 0.54-0.93) and Hispanics: OR 0.48 (95% CI: 0.34-0.67) were less likely to be on narcotics compared to non-Hispanic Whites. The prevalence of opioid use was stable over the first 12 years, followed by a significant drop in the last two years. ConclusionBeyond the risk for opioid misuse, and opioid use disorder, depression should also be considered when prescribing opioids. It is therefore important to implement a training to screen for depression in patients receiving opioids for pain management.

Opioid Consumption in Chronic Pain Patients: Role of Perceived Injustice and Other Psychological and Socioeconomic Factors

“…This result is partially consistent with Jamison et al, who reported that 40% of chronic pain patients treated with opioids suffer from additional affective disorders (depression and anxiety), which in turn are associated with a significantly increased misuse of opioids [36]. There are a number of studies demonstrating that people with psychological comorbidities such as depression and anxiety are prevalent among patients with chronic non-cancer pain [6,[48][49][50], and that they are more likely to receive long-term opioid therapy for non-cancer pain than those without such comorbidities [4]. One reason for that could be that mental health conditions and chronic non-cancer pain are closely correlated concerning severity [5].…”

What Are the Correlates of Global Variations in the Prevalence of Opioid Use Disorders? An Analysis of Data From the Global Burden of Disease Study, 2019

“…The single variable most significantly associated with the prevalence of OUD, even after correcting for other variables in multivariate analysis, was the estimated prevalence of depression. This finding is consistent with the conceptualization of the opioid crisis as being related to "despair" [12], with research in individuals showing that significant depressive symptoms are a robust predictor of opioid misuse [40][41][42], and with the bidirectional association between depression and opioid misuse [48]. At a more fundamental level, there appear to be genetic and neurobiological links between depression and opioid dependence [49,50].…”

Modelling the progression of illicit substance use patterns from real‐world evidence

“…58 In the United States population-based study NHANES data sets (2005/2006 to 2017/2018 cycles, mean age 46.5 years), the prevalence of narcotics use (primarily opioids) was 6%. 59 Narcotics use was more than threefold greater, 17.2% in the depressed group vs 5.0% in the nondepressed group. 59 The general patterns from these diverse studies 3,56,57,59 highlight the strong dependence of illicit substance use on age, and the increased risk of illicit substance use in males and in individuals with depression.…”

“…The prevalence of depression in the United States increased between 2015‐2019, and in 2020, the prevalence in young adults (18‐25 years) and in adolescents (12‐17 years) was around 17% 58 . In the United States population‐based study NHANES data sets (2005/2006 to 2017/2018 cycles, mean age 46.5 years), the prevalence of narcotics use (primarily opioids) was 6% 59 . Narcotics use was more than threefold greater, 17.2% in the depressed group vs 5.0% in the nondepressed group 59 …”

“…In the United States population‐based study NHANES data sets (2005/2006 to 2017/2018 cycles, mean age 46.5 years), the prevalence of narcotics use (primarily opioids) was 6% 59 . Narcotics use was more than threefold greater, 17.2% in the depressed group vs 5.0% in the nondepressed group 59 …”