Psychiatric Factors Linked to Increased Risk for Misuse of Opioid Medications

Lexa W Lee

March 01, 2007

March 1, 2007 (New Orleans) — The results of a prospective study of outpatients on opioid therapy for chronic noncancer pain suggest that psychiatric factors, including a history of mood disorders or psychological problems, are associated with an increased risk for misuse of prescription opioids.

"Future studies to elucidate the risk of medication misuse and aberrant drug behavior among this patient population are needed, which will lead to interventions to improve opioid compliance," the researchers, with lead author Ajay Wasan, MD, a psychiatrist and chronic pain researcher at Brigham and Women's Hospital, in Boston, Massachusetts, conclude.

Their results were presented here at the American Academy of Pain Medicine 23rd Annual Meeting.

Misuse Greater in Noncancer Pain

"Studies of this sort looking specifically at opioid misuse are rare," Dr. Wasan told Medscape. "We do know that misuse of these drugs is greater among noncancer patients than cancer patients." To date, though, there is little understanding of which patients with chronic noncancer pain are likely to be compliant with therapy.

In this multicenter study, the researchers examined the impact of psychiatric history and current psychological adjustment on aberrant drug-related behavior in patients who had been prescribed opioids for noncancer pain.

Based on their responses to the psychiatric subscale of the Prescription Drug Use Questionnaire, patients were classified as either high or low on psychiatric morbidity, the authors note. Patients also completed the Brief Pain Inventory, the Screener and Opioid Assessment for Pain Patients (SOAPP), and a newer questionnaire, the Current Medications Misuse Questionnaire (COMM).

Patients were followed for 5 months, after which a urine toxicology screen was done. The Prescription Opioid Therapy Questionnaire (POTQ), a tool that rates opioid-misuse behaviors, was completed by treating physicians. Combining the results from the POTQ, as well as SOAPP, COMM, and urine screens, patients were classified as positive or negative on the Aberrant Drug Behavior Index (ADBI).

Of 228 patients, 103 (45%) were rated low psych and 125 (55%) high psych. For the purposes of this study, more specific diagnoses were not made, Dr. Wasan noted. The average age of the high-psych patients was 48.6 years, significantly younger than the low-psych group, where the average age was 52.8 years; high-psych patients had also been taking opioids for longer periods than the low-psych group.

In addition, the SOAPP and COMM scores of the high-psych group were significantly higher ( P
< .001), their urine toxicology screens were more frequently abnormal ( P
< .01), and their ADBI scores were significantly higher ( P
< .001).

The researchers concluded that psychiatric factors, such as a history of mood disorders, psychological problems, and psychosocial stressors, may place patients at risk for the misuse of prescription opioids.

More Specific Information Needed?

Commenting for Medscape, Geralyn Datz, PhD, a clinical psychologist at Forrest General Hospital, in Hattiesburg, MS, agreed with these findings but added, "It's important to get more specific about the mood disorders and psychological problems. Poor problem solvers who use illicit substances are likely to have mood disorders and a history of drug abuse. We call them 'chemical copers.' That this issue is being examined is itself a strength of this study, but it's necessary that it be examined using a multidisciplinary approach."

The study was funded by the National Institutes of Health National Institute of Drug Abuse.

American Academy of Pain Medicine 23rd Annual Meeting: Abstract151.


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