Mental Health Disorders and Long-term Opioid Use Among Adolescents and Young Adults With Chronic Pain

Abstract

The purpose of this study was to examine the association between mental health disorders and subsequent risk for long-term opioid use among adolescents and young adults presenting with common chronic pain complaints (back pain, neck pain, headache, and arthritis/joint pain). Using claims data from January 1, 2001 to June 30, 2008, we conducted a longitudinal analysis of opioid use patterns among 13-24-year-old subjects presenting with a new episode of chronic pain. Long-term opioid use was defined as receiving >90 days of opioids within a 6-month period with no gap of >30 days in use of opioids in the 18 months after the first qualifying pain diagnosis. Mental health disorders were identified from claims in the 6 months before the first qualifying pain diagnosis. Fifty-nine thousand seventy-seven youth met criteria for a new episode of chronic pain. Among these youth, 321 (.5%) met criteria for long-term opioid use, and 16,172 (27.4%) had some opioid use. After controlling for demographic and clinical factors, youth with preexisting mental health diagnoses had a 2.4-fold increased risk of subsequently receiving long-term opioids versus no opioids (odds ratio = 2.36, 95% confidence interval = 1.73-3.23) and a 1.8-fold increased likelihood of receiving long-term opioids versus some opioids (odds ratio = 1.83, 95% confidence interval = 1.34-2.50). Mental health disorders are associated with increased risk for long-term opioid use among adolescents and emerging young adults. Further study is warranted to examine risks and benefits of long-term opioid use in this population.