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.

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.”

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  • Don’t they realize that anxiety is painful and chronic depression with no will to get up out of bed is the worse feeling ever. I have chronic all over body pain with high anxiety & severe depression. I also deal with suicidal thoughts on a regular basis. This is no way to live. I found that opiates relieve my pain and my anxiety & depression are manageable. I have been on more than fifteen antidepressants and have had my suicidal thoughts increase. Nothing has worked for me to where I can get up and face the world except low doses of opiates. For once in my life, I want to feel normal without taking something. If only the doctors and psychiatrists could walk a day in my shoes, they too would understand how much pain I endure physically and mentally. Is there anyone out there that understand that mental disorders are a source of pain?

  • Cowardice vs. Help. I have had three back surgeries, steroid injections and physical therapy. Currently have two herniated discs,and one that is completely disintegrated. My “doctor” Jeffrey Edward Peacock says he “won’t risk his license based on my past twenty year back history and depression.” If only for one day he could suffer both mentally/physically he might gain an inclining of our lives instead of “studying” it in a book. Thanks Dr. Jeffy.

  • I don’t think we should be judged. We should be heard out, given what we need for our minds n lives to get better and not judged. If we being a patient with psych diagnosis need them, we need them. If we get turned down because of our mental health diagnosis, I think that’s wrong.

  • Does a Dr really not understand that pain itself ,certainly chronic pain causes depression and moods disorders ? Is this for real ? Drs need to actually talk to there patients . I think I’m cancelling my faith in healthcare . Damn !

  • Obviously, this author was too lazy to look into the large body of research that shows opioids to be very beneficial for depression and anxiety. Many people will suffer as a result of this type of propaganda from the addiction treatment industry.

    • I agree 100%. I have had physical injuries (such as a broken leg) for which I was prescribed opiods (Oxycodone). While taking them I experienced a rush of optimism which helped me tackle issues I otherwise would have avoided. I bring this up because I also suffer from mood disorders (depression and anxiety) for which I have been treated for decades with anti-depressants such as amitriptyline and sertraline (Zoloft), as well as with anti anxiety drugs, such as xanax . The benefit of these medications? I cry much less than I used to. What good are medications if that’s all they can do?
      Ok. I understand. Certain people may be more inclined towards addiction. I defintely see that. However, as a patient, I have always been more afraid of becoming immune to medications that help me than I am of not being able to function without them. Thus I take the xanax (which can be addictive) sparingly. The doctor who prescribed it, and told me to use it only when needed, is asking why I don’t take it more often (and it’s a very small dosage). I sometimes wonder whether opioids would be more effective than the anti-depressants.

  • Behavioral approaches to chronic pain would seem to be a potentially valuable adjunct to medications. Can you comment further on behavioral therapy to treat chronic pain and whether you or readers here have found them opioid sparing?

  • This writer doesn’t understand what living in severe pain can do to a person. After a recent surgery, I am pain free and pill free for the first time in four years. I am not an addict, or drug dealer. I lived with an aneurism on my brainstem, irritating the occipital nerve for five years. It was like an icepick to the head, all day, every day. I would have killed myself long ago, if not for pain killers and sympathetic doctors, who wrote me a prescription with no medical evidence of my condition. I got lucky and found an amazing surgeon, who took a chance and saved me. I lot of people aren’t as lucky and are sentenced to a life time of agony. This article is going to hurt those who live with a pain you can’t imagine.

  • A serious ailment (initially misdiagnosed) at 20 required major surgery. I was hardly a long term opiate user, but my medical and nursing could hardly believe the amount of meds I needed pre- and post-op. It was just my metabolism, but as soon as the pain went away I stopped taking the meds. Amount of meds does NOT equal addiction.
    I’m 60 and have serious back issues, but I am not a candidate for back surgery (so say my long time neurosurgeon and orthopedists). My condition is pretty much the same as bone-on-bone arthritis which will only get worse as I age. I have lost weight to the point that that I do not need antihypertensives. I exercise (swim) as much as I can and use other non-medication therapies. Do you know folks people who are waiting for knee or hip replacements? Do doctors or the public tell them to tough it out? That’s what they tell me. My back is the equivalent of permanent bone-on-bone joints in my lower back but somehow i don’t “deserve” pain medication unless I have cancer.
    I finally had to retire from editing from home when the pain was so bad I couldn’t even get to the bathroom in time. I am almost bedbound, and people think I’m an addict. My pain management doctor doesn’t think so, but non-doctors in Washington, D.C. think they should dictate my meds.. What happened to the folks who used to protest that the govt. should stay out of my doctor’s office? I can’t be on my feet long enough to dress, bathe, etc., let alone do light housekeeping or short errands. What made it so noble for me to HAVE to suffer?

  • One of the benefits of this article is all of the comments from individuals who are suffering with (or have family members who are suffering with) chronic pain and their legitimate need for opioids.

  • One of the benefits of this article is all of the comments from individuals who are suffering with (or have family members who are suffering with) chronic pain and their legitimate need for opioids. It’s always easy when you are in a situation where you do not need something to not understand how others do. It’s not a weakness, nor a desire to be “high” that causes these individuals to use opioids, it’s simply the desire to live without pain!

    • This statement is so very true. Why should people with intractable pain have to suffer. Take a walk in these people’s shoes, and then let us talk addiction! Pain sufferers have rights, too.

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