Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness

Ashli Owen-Smith,Musu M Sesay,Bobbi Jo Yarborough,Brian Ahmedani,Stephen C Waring,Stacy A Sterling,Cynthia I Campbell,Christine Stewart,Greg Simon,Beth E Waitzfelder,John E Zeber,Jeffrey F Scherrer,Lisa R Miller-Matero,Sheryl M Strasser,Rebecca Rossom,Irina V Haller,Laurel A Copeland,Rulin C Hechter

doi:10.1186/s12888-020-2456-1

Abstract

BackgroundIndividuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia.MethodsUsing electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N = 65,750), BD (N = 38,117) or schizophrenia or schizoaffective disorder (N = 12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses.ResultsMultivariable models indicated that having a MDD (OR = 1.90; 95% CI = 1.85–1.95) or BD (OR = 1.71; 95% CI = 1.66–1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR = 0.86; 95% CI = 0.82–0.90). Having a MDD (OR = 2.59; 95% CI = 2.44–2.75) or BD (OR = 2.12; 95% CI = 1.97–2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications.ConclusionsIndividuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients. Future research is needed to evaluate the effectiveness of involving mental health clinicians in these efforts.

Highlights

Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have high rates of chronic non-cancer pain (CNCP) and are more likely to receive prescription opioids for their pain
Evidence suggests that CNCP is less prevalent among individuals with schizophrenia compared to individuals without mental illness [17]; to our knowledge, there have been no studies published to date that have examined opioid treatment patterns among individuals with schizophrenia compared to controls
Individuals with MDD were more likely to have higher Charlson comorbidity scores and greater healthcare utilization than matched controls without psychiatric illness; they were more likely to have any CNCP diagnosis (62.4% compared to 39.8% of controls) and to receive chronic opioid medications (10.1% compared to 2.4% of controls; see Table 1)

Summary

Introduction

Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have high rates of chronic non-cancer pain (CNCP) and are more likely to receive prescription opioids for their pain. There have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. Evidence suggests that individuals with mental illness may be one population with high rates of CNCP and may be more likely to receive prescription opioids for their pain. Evidence suggests that CNCP is less prevalent among individuals with schizophrenia compared to individuals without mental illness [17]; to our knowledge, there have been no studies published to date that have examined opioid treatment patterns among individuals with schizophrenia compared to controls

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