Mental health plays role in long-term teen opioid use medpage today database data types

Adolescents with certain mental health conditions and treatments were slightly more likely to receive opioids, and much more likely to transition to long-term opioid therapy, data from a nationwide healthcare database found.

Commercially insured teens with a variety of mental health conditions and treatments, ranging from anxiety, mood neurodevelopmental, sleep and non-opioid substance use disorders had an increased risk of being treated with opioids (OR 1.13, 95% CI 1.10-1.16 for non-opioid substance use disorders to OR 1.69, 95% CI 1.58-1.81 for non-benzodiazepine hypnotics), reported patrick D. Quinn, phd, of indiana university in bloomington, and colleagues.Long-term opioid

While overall rates of long-term opioid therapy were low among recipients, adolescents with these pre-existing mental health conditions and treatments were more likely to transition to long-term opioid therapy, the authors wrote in JAMA pediatrics.


They noted prior research that found adults with mental health conditions, and those with pre-existing substance disorders, are the most likely to "receive prescribed opioids in greater quantities," but there is limited evidence about similar prescription patterns among adolescents, and long-term opioid therapy patterns or safety within this population.

Researchers examined data from 2003 to 2014 in the truven health marketscan commercial claims and encounters databases, national databases of commercial healthcare insurance claims.Long-term opioid they identified a cohort of adolescents (ages 14-18 years), who filled an initial opioid prescription without a cancer diagnosis. Long-term opioid therapy was defined as more than 90 days’ supply of opioids in a 6-month period, with no gaps in supply greater than 32 days. Mental health conditions were defined using ICD-9 codes.

Overall, 1,224,520 new adolescent opioid recipients were examined, about half of whom were girls with the median age 17 at first receipt. Median follow-up after first receipt was 625 days. Hydrocodone accounted for about 60% of opioids received among a little over 70% of recipients, followed by a little over 20% of recipients receiving oxycodone and about 19% receiving codeine.Long-term opioid

The authors characterized the relationship between opioids and mental health disorders as "generally weak in magnitude," with associations for suicide attempt or other self-injury, schizophrenia spectrum disorders, opioid use disorder, and opioid use disorder medications not statistically significant, they said.

Estimated cumulative incidence of long-term opioid use therapy was 3.0 per 1,000 recipients within 3 years (95% CI 2.8-3.1), which rose to 8.9 per 1,000 recipients (95% CI 14.2-18.0) within 6 years. All mental health conditions and treatments were associated with an increased likelihood of transitioning to long-term opioid therapy, such as:

mental health

An accompanying editorial by michael J. Mason, phd, of the university of tennessee in knoxville offered some advice to pediatric practitioners who may be dealing with patients who may be transitioning into long-term opioid therapy.

"Conducting clinical interviews and routine screening to identify factors associated with substance use and mental health issues should be a starting point for pediatric practitioners," he wrote, "in addition … Obtaining a profile of the adolescent’s close peer group or their peer network health (the sum of close peers’ risky and protective behaviors) would provide insight into important socially influenced risk and protective factors."

Long-term opioid

Mason added that age-related risk factors, such as onset of puberty, increase in exploratory behavior, and age of substance use initiation, should also be examined.

Study limitations include that it was based on claims data, and thus likely underestimated prevalence of substance use disorder and other mental health conditions. Also, only "claimed prescription fills" are recorded, not medications obtained via other means, and there was no way to confirm adolescents consumed these drugs through their filled prescriptions.

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