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BMC Psychiatry. 2020 Jan 31;20(1):40. doi: 10.1186/s12888-020-2456-1.

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

Author information

1
Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Urban Life Building, 140 Decatur Street, Suite 434, Atlanta, GA, 30303, USA. aowensmith@gsu.edu.
2
Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, USA. aowensmith@gsu.edu.
3
Health Research Institute, Kaiser Permanente Washington, Seattle, USA.
4
Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, USA.
5
Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Urban Life Building, 140 Decatur Street, Suite 434, Atlanta, GA, 30303, USA.
6
Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
7
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA.
8
Depart Behavioral Health Services, Henry Ford Health System, Detroit, USA.
9
Essentia Institute of Rural Health, Duluth, USA.
10
Center for Health Research, Kaiser Permanente Hawaii, Honolulu, USA.
11
Division of Research, Kaiser Permanente Northern California, Oakland, USA.
12
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA.
13
School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, USA.
14
A Central Western Massachusetts Healthcare, Leeds, MA, USA.
15
Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, USA.
16
Health Partners Institute, Minneapolis, USA.

Abstract

BACKGROUND:

Individuals 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.

METHODS:

Using 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.

RESULTS:

Multivariable 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.

CONCLUSIONS:

Individuals 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.

KEYWORDS:

Chronic non-cancer pain; Opioids; Serious mental illness

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