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Br J Psychiatry. 2018 Feb;212(2):103-111. doi: 10.1192/bjp.2017.25.

Impact of adherence to antidepressants on long-term prescription opioid use cessation.

Author information

1
Department of Family and Community Medicine,Saint Louis University School of Medicine,St. Louis,MissouriandHarry S. Truman Veterans Administration Medical Center,Columbia,Missouri.
2
Department of Psychiatry and Behavioral Health,University of Washington School of Medicine,Seattle,Washington.
3
Henry Ford Health System,Center for Health Policy and Health Services Research,Detroit,Michigan.
4
VA Central Western Massachusetts Healthcare System,Leeds,Massachusetts,Center for Applied Health Research,Baylor Scott & White Health,Temple,Texas and UT Health San Antonio,San Antonio,Texas.
5
Department of Psychiatry,Washington University School of Medicine,St. Louis,Missouri.
6
Saint Louis University Center for Outcomes Research,St. Louis,Missouri.
7
Department of Family and Community Medicine,Saint Louis University School of Medicine,St. Louis,Missouri.
8
The Bell Street Clinic, VA St. Louis Health Care System - John Cochran Division,St. LouisandDepartment of Psychiatry,Washington University School of Medicine,St. Louis,Missouri,USA.

Abstract

BACKGROUND:

Depression contributes to persistent opioid analgesic use (OAU). Treating depression may increase opioid cessation. Aims To determine if adherence to antidepressant medications (ADMs) v. non-adherence was associated with opioid cessation in patients with a new depression episode after >90 days of OAU.

METHOD:

Patients with non-cancer, non-HIV pain (n = 2821), with a new episode of depression following >90 days of OAU, were eligible if they received ≥1 ADM prescription from 2002 to 2012. ADM adherence was defined as >80% of days covered. Opioid cessation was defined as ≥182 days without a prescription refill. Confounding was controlled by inverse probability of treatment weighting.

RESULTS:

In weighted data, the incidence rate of opioid cessation was significantly (P = 0.007) greater in patients who adhered v. did not adhered to taking antidepressants (57.2/1000 v. 45.0/1000 person-years). ADM adherence was significantly associated with opioid cessation (odds ratio (OR) = 1.24, 95% CI 1.05-1.46).

CONCLUSIONS:

ADM adherence, compared with non-adherence, is associated with opioid cessation in non-cancer pain. Opioid taper and cessation may be more successful when depression is treated to remission. Declaration of interest None.

PMID:
29436331
DOI:
10.1192/bjp.2017.25

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