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More than half of all opioid prescriptions in the United States are written for people with anxiety, depression, and other mood disorders, according to a new study that questions how pain is treated in this vulnerable population.

People with mood disorders are at increased risk of abusing opioids, and yet they received many more prescriptions than the general population, according to an analysis of data from 2011 and 2013.

“We’re handing this stuff out like candy,” said Dr. Brian Sites, of Dartmouth-Hitchcock Medical Center, the senior author of the study. Opioid prescribing in the U.S. quadrupled between 1999 and 2015, and during that time over 183,000 people died from overdoses related to prescription opioids, according to the CDC.

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Sites said more research is needed to understand whether opioids are being overprescribed to adults with mood disorders.

“If you want to come up with social policy to address the need to decrease our out-of-control opioid prescribing, this would be the population you want to study, because they’re getting the bulk of the opioids, and then they are known to be at higher risk for the bad stuff,” he said.

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The study, published Monday in the Journal of the American Board of Family Medicine, tapped a U.S. health survey that gathered data from providers and facilities on prescription medications, health status, and basic demographics for about 51,000 adults. It found that 19 percent of the 38.6 million Americans with mood disorders use prescription opioids, compared to 5 percent of the general population — a difference that remained even when the researchers controlled for factors such as physical health, level of pain, age, sex and race.

The analysis showed that adults with mood disorders receive 51 percent of the opioid prescriptions distributed in the U.S., some 60 million prescriptions a year.

It’s unclear why such a discrepancy exists. Sites said it’s possible that patients with mood disorders respond to pain differently, spurring physicians to write more opioid prescriptions; previous research has shown that patients with a history of depression are at increased risk of developing chronic pain. Or physicians might be more sympathetic to patients with preexisting conditions, making them more likely to prescribe opioids. Sites also said that opioids might have a short-term antidepressant effect, which could motivate patients with mood disorders to seek prescriptions.

For Sites, the bottom line is that while opioid prescriptions can be appropriate for individual patients with mood disorders, the study raises concerns about overprescribing on a population scale.

“We need to understand if this massive prescribing level is appropriate in actually providing benefit commensurate with the risk,” said Sites, who collaborated with researchers at the University of Michigan.

He added that physicians need viable alternatives for treating pain, including cognitive behavioral therapy, acupuncture and acupressure, physical therapy, and massage.

“We don’t have the ability to refer and recommend those things easily,” he said, “So the easiest thing right now is to prescribe a pill.”

Jeffrey Scherrer, a professor and epidemiologist at Saint Louis University not involved in the study, was not particularly surprised by the results. “A lot of pain patients attribute their depression to their pain, but there’s a lot of evidence that depression is playing a role in both the experience of pain and the odds of getting an opioid,” he said.

For Dr. Mark Edlund, a senior public health analyst at RTI International who was also not involved in the study, it adds to a growing and worrisome body of evidence that people with mental health disorders who are at higher risk for abusing opioids are also more likely to receive opioid prescriptions.

“There’s an emphasis now on cutting back opioid prescribing,” he said. “Probably just as important is assuring that we’re prescribing the opioids to the right populations, and that we’re doing our risk-benefit analysis on each patient.”

  • Dr. Brian Sites, of Dartmouth-Hitchcock Medical Center, said. “We’re handing this stuff out like candy.” Then he needs to be arrested for improper medication ordering and usage abuse. Not even when I was working as a nurse, did “we” hand out pain relief mediations; like candy. I can’t imagine any real member of the medical family doing so at least in my 35+ years within it.

    Chronic pain exists, you can tell your patients all you want there are other means of coping with chronic pain. The honest truth is for chronic pain, opioids are the best treatment, it is the most affordable treatment, and my grandparents grew their own poppy plants. Before the Federal Government along with Big Pharm decided they could monitor and deal better with opioids then my grandparents and their ancestors in how brew pain relief. How about getting out of my Medicine Cabinet!

  • I have Trigeminal Neuralgia and Trigeminal Neuropathic Craniofascial Pain Syndrome, which is an extremely painful illness affecting the facial nerves, it is 24/7/354 and the severe pain never stops. If you would like more information search the web and you will find information and also that it is called the suicide disease. I take an opioid for the severe, unrelenting pain.
    I’ve also had four surgeries, including brain surgery and upon discharge from the hospital I was not prescribed nor did I require additional pain relief medication beyond the opioid I was already taking, even when asked by my discharge physician.
    Additionally I am not depressed, it’s the few Drs that have seen me ONE time and they documented in my medical record (I keep copies of all my medical records), that I was depressed and once it is in my medical record it doesn’t just disappear. I also take a medication that can be used for either pain or depression and without even asking me “a high on his horse” pain management Dr that I have to see (only one in my HMO network) assumed I was taking it for depression, and not for pain, which is what I take it for.

  • Sadly the mass hysteria over use of opioids has resulted in people who truly need medical pain relief – simply not getting it. My wife had a C- section and when she was discharged from the hospital she was given a prescription for Percocet. Not one pharmacy in our town had it in stock. They pharmacist said he could order it and get it in a few days. Her suffering was horrifying. Imagine men- as many women know first hand – the pain of having your abdomen cut open, a baby removed then being stitched back up- that pain is very very real. Medicine is necessary to alleviate it. Pain is human suffering. Let’s keep our heads on straight and not panink or be lead into hysterics. People need pain relief – including Opiod pain relief- when they are suffering. My mother was a nurse and she had a great saying about narcotic pain relief – – Pain cancels addiction. For anyone whose suffered pain- there is no joy in taking pain medicine . It’s taken to help relief suffering. Let’s not allow patients to suffer barbarically.. when needed doctors must prescribe.

  • Chronic pain can be a huge factor in developing depression. This is a ‘who came first, the chicken or the egg ?’ kind of study. It once again, makes out those with verifiable need of pain control in with those out to abuse/get high. It’s an unfair statement regarding that 51%.

  • Opioids have always been around and people have died from using them. Were they also clinically depressed or in a depressed state? Some were and some weren’t. Just like today. People are living longer as technology and changes to the way we live life evolves. Unfortunately more people are bound to need opioids. If any company out there could produce a drug that isn’t addictive in some way don’t you think they would have by now? There are entreprenures out there who have brought about change through the years. I’m a 47 year old male with MS and have required 2 back surgeries in the past 2 years. I’m fused 2 levels in my lower back now and am unfortunately in more pain now than I was before but needed the surgeries as it was impinging on my nerve causing numbness and burning. Like one of the other responses, I require opioids to function from my conditions. I now feel like a criminal because I require them. My doctor feels handcuffed because the insurance now dictates what I can have. I have to pee in a cup like football players so they can make sure I’m not abusing. And still I have to jump through hoops to obtain medication when I’m titratting. The insurance company won’t take an un-sanctioned doctors advice on why I’ve had to order different mg tablets to get to the right dose. Maybe there needs to be better control and maybe there does need to be more collaboration with a persons doctors if the pain appears to not be coming from diagnostic testing. But stop making it harder for the ones that need it to make it through a day.

  • I lost my 27 year old daughter because of opiad addiction who suffered depression. I suffered from depress at 37 and was treated by a psychiatrist and antidepressant medication and I am functioning well. I kept telling her to tell her Dr. but she told me he wouldn’t listen to her. These Dr. s need to LISTEN TO THEIR PATIENTS!!!

  • As long as Dr.’s keep overprescribing this, the pharmaceutical companies have no incentive to research and develop anything else! Stop prescribing it! Big Pharma looses money, then they will develop something less addictive and harmful. They don’t care about dead people and their families. It’s the bottom line that is important. No brainer to most of us. Why does the news and medical field not get that?

    • One thing that is erroneous with this article is that extremely few people, if any, with just depression and anxiety are prescribed opioids. Anti-depressants and anxiety meds are used if other therapies like cognitive thinking, relaxation, talking, etc. BTW Big Pharma is wanting us to go to other drugs that are less effective and that they will make more money from because we have to take more of them.
      Chronic pain patients are being severely affected by this hysteria of an “opioid epidemic”. Chronic patients need these opioids in order to be able to function so many of them can work and be productive in the work force. There are many of us who being cut back or worse, taken off of these medications due to the ignorance of the FDA, CDC, DEA, states, etc. I personally know people who have had lost their jobs because of this. Now they are housebound or worse bedbound. How is that for a life? Suicides among chronic pain patients are skyrocketing because they can’t get the medications they need. Many are turning to the streets for the illegal stuff. What we need to do is try to rid the streets of illicit fentanyl, carfentanil. These drugs are coming from China, Afghanistan, Mexico, etc. Drug dealers selling “heroin” are substituting these two drugs for heroin. As you may or may not know these drugs are 50 – 100+ times more powerful than heroin and are cheaper for them to get. People take these thinking it is heroin then overdose and die. Coroners do their tests and see fentanyl and then say death due to prescription drugs. Most of the time they do not do a more extensive test that does show the difference between the legal and illegal kind.
      Then there are the politicians who want to “look” like they are trying to do something about the “Epidemic”. They are being pressured by people, like you, to place further restrictions on doctors, pharmacies, and patients. Every single study that has been done on chronic pain patients show that 94% to 99.5% do not misuse, become addicted to, or sell their medications. Since 2010 the amount of prescriptions for opioids has dropped significantly, however overdoses and deaths are still on the rise. Question, where are the drugs are coming from?……In case you didn’t know…..the street!!!! Being supplied from the aforementioned nations.
      BTW you right about one thing, not enough is being done in the way of research to treat pain. The NIH and other research centers are woefully underfunded.
      For right now, opioids for many people are the answer to their pain. Restricting and taking away those medications are like a death sentence. I do think that opioid prescriptions for acute pain (broken bones, post surgical pain, etc.) should be limited to three to seven days. Some acute pain patients have been prescribed too much in the past and did become addicted. However, most addicts either stole or bought their first doses off of the street.
      I ask of you to get off of the political hysteria and do research into chronic pain. You can look up atypical trigeminal neuralgia or polyneuropathy which are some of the conditions that I have.

  • people with depression r not being prescribed opiates. Ppl with pain r being prescribed opiates…when that pain doesn’t go away – ppl become depressed…doesn’t it make sense. Duh

    • Its people or so called Dr.,s that think they know how much pain people are in. When you,ve already had 2 surgery, s on L-5 . Now 10 yrs. later they recommend a fusion. Can’t do a third surgery ,cause it probably want work & could possible put me in a wheel chair. I’m only 45 yrs. old & feel like 80. Hurt waist down 24/7 & w/out meds I can’t hardly move. Drug addicts are addicts ,but when you hurt so bad sometimes you want to die. I wish I didn’t have take medication, but I want to live a normal life & it don’t make me addict. Also if your wife of 25 yrs. cheats on you & ask for divorce. I have 4 kids & a grandchild & also my youngest has Down syndrome . He can’t even talk . Any human would be depressed. There are people like me that needs medication. Why do they make it then??? For people like me that needs it & don’t need to be associated w/ an addict. I would like Dr.s to walk 1 day in my shoes .If you didnt have the meds. you would stick a gun in mouth & end it. As long as you moderate your intake . Then you’re not overdosing to catch a buzz . You,re just trying to life & most of y’all go home & drink alcohol ,which is way more of problem than opioids & all you gotta do is be 21 & stop @ any corner store everyday & drink yourself to death , just to get a buzz legally . Sick of this stupid conversation. Wake up

  • Agreed pod prior.

    Many people become depressed from the pain. You run through all those stress hormones and the stigma of it…pain feeds into depression. If people can not get break from the pain it would more miserable.

    I am ER Dr and this is my observation. I am seeing more and more people who are responsible functioning people who can no longer get help for pain being being treated poorly. The overdoses I see are multiple things! Alcohol, benzodiazepines, not their pain medication, synthetics and meth….9/10 not their meds. The people who have mental health and drug abuse have clear pattern that needs its own treatment course. They will abuse things however they can.

    Stop punishing those who are responsible-people taking responsibly are on same dose for years! It takes edge off, it’s not about euphoria; this takes increasing continually escalating doses.

    Ban alcohol-it kills, maims and ruins more people then anything else I see!
    Try telling a family member thier son or daughter was killed by drunk driving. I am sooooo tired of opiod epidemic news. We need to improve access to treatment for drug abuse but also stop punishing patients who need treatment for their pain. We are going back to dark ages in pain treatment. See how long you last when tragedy strikes and severe pain is your daily trail.

    I have seen farmers who work manual labor every day have surgery and need nothing for pain then go on and be in major accident to then require pain medication for significant damage that will never heal. One guy saved a child’s life and broke his own back in process. Now he is treated like an addict. Of course he is depressed. I am going to stop now-This article was one too much….

    • Thanks for caring. I know you make a difference in many many lives. Don’t let this frustrate you to the point that it changes your mood. Just keep being awesome!! 🙂 As a doctor, I guess you’re in a unique position to write to our law makers and let your voice be heard for those whose choices have been made for them but just knowing you CARE makes ME feel better!! I too was hit by a drunk driver….head on at 115MPH. I saw an ad once, “Not everyone dies from drunk drivers. They create a new handicap tag every 60 seconds.” I can’t even imagine what you see but I applaud and APPRECIATE you, truly!!!! Cheers!!!

    • Wow Laura you been through a lot!
      Thanks for your reply I appreciate it.

      I do advocate for my pain patients. if you take your time to look into each case 90% of the time you find the truth of the matter. Those who are trying to abuse the system or are lying to my face (including pretend passports and changed names or even fake blood in urine….) I can see the bs. I get angry though when I know this problem has made it so much harder for chronic pain people to get care. Why should they be treated like criminals or “weak” cause they had this happen? Such a difference between never ending pain and an acute isolated injury/illness.

      I am sure I get taken sometimes by people but I’d rather risk that then let someone suffer due to my bias. It is super tough in the ER not to get bitter. I literally get assaulted, cussed at, admin tears us up, people treating us like Burger King, JACHO yelling at us for having water in work station even though I have no breaks! I have helped save a life then family write a report for no sandwich (if going to surgery that would be dangerous). I just try to appreciate all the more those patients that are truely scared, lost, hurting, etc and not abusing me/staff.

  • Interesting that my comments and dozens of others were deleted. The same people that can’t take critical opinions by those who they’ve written about can dish out opinions not backed up by science and call it an article? “Those who close their ears to others have little faith in their own views.” AGAIN, I HOPE you NEVER know what I we through. EVERYTIME I have judged others God has BLESSED me to know what those people were feeling. I HOPE He doesn’t bless you as He has me. I USED to judge my mom for taking pain meds. Then, I felt REAL PAIN. I would go through everything all over again JUST to learn that one lesson. But I’ve learned hundreds of lessons. Horrible things create beautiful people, strong and empathetic people who can endure great tragedy. Academics USED to be my heroes…. Now I find them to be little more than books with an ego. “For that which has not suffered has not been found worthy of true love, trustworthiness, and honor among men. But that which is left to suffer and not find peace will wither away and never find out that it deserves happiness.” People who have chronic pain for a long time are shown to have changes in brain chemistry. Their chemical make-up changes. They start to live in a heightened state that makes them MORE sensitive to anxiety, depression, and other related cognitive dysfunctions. These things weren’t there BEFORE they were in pain, but AFTER. SUFFERING NEEDLESSLY CAUSES MENTAL HEALTH DYSFUNCTION. I HATE pain meds. I LOVE that our bodies FEEL pain. It’s what stops us from overdoing it & breaking down our joints further. But I know the difference between pain that I can manage and pain I can’t. After being in chronic pain for 13.5 years, my body and I have gotten to know each other WELL. And one more FACT, only 8% of overdoses are connected to people on prescription meds….so EVEN THOUGH 50% of us are mentally ill, only 8% of the overdoses are connected to prescribed meds. How interesting….Seems like we REALLY just want to be pain free.

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