TY - JOUR
T1 - Drug Overdose in a Retrospective Cohort with Non-Cancer Pain Treated with Opioids, Antidepressants, and/or Sedative-Hypnotics
T2 - Interactions with Mental Health Disorders
AU - Turner, Barbara J.
AU - Liang, Yuanyuan
N1 - Funding Information:
The work on this project was supported by an intramural grant from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 1UL TR001120. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Publisher Copyright:
© 2015, Society of General Internal Medicine.
PY - 2015/8/28
Y1 - 2015/8/28
N2 - Background: Opioid analgesics and other psychoactive drugs may pose an even greater risk for drug overdose in persons with mental health disorders. Objective: The purpose of this study was to examine interactions of filled prescriptions for opioids, benzodiazepines, antidepressants, and zolpidem with mental health disorders in regard to drug overdose. Design: The study was a retrospective cohort review. Subjects: Subjects were national HMO beneficiaries aged 18–64 years, enrolled at least 1 year (01/2009 to 07/2012), who filled at least two prescriptions for Schedule II or III opioids for non-cancer pain. Main Measures: The outcome was the first inpatient or outpatient drug overdose after the first filled opioid prescription. Predictors were calculated in 6-month intervals and exactly 6 months before a drug overdose: opioid use (mean daily morphine-equivalent dose), benzodiazepine use (days’ supply), antidepressant use (days’ supply), zolpidem use (days’ supply), mental health disorders (depression, anxiety/PTSD, psychosis), pain-related conditions, and substance use disorders (alcohol, other drug). Key Results: A total of 1,385 (0.67 %) subjects experienced a drug overdose (incidence rate 421/100,000 person-years). The adjusted odds ratios (AOR) for overdose among all subjects rose monotonically with daily opioid dose, but highest (AOR = 7.06) for persons with depression and a high opioid dose (≥100 mg) versus no depression or opioid use. Longer-term antidepressants (91–180 days) were protective for persons with depression, with 20 % lower AORs for overdose versus short-term (1–30 days) or none. For persons without depression, the AORs of overdose were increased for antidepressant use, but greatest (AOR = 1.98) for short-term use versus none. The AORs of overdose increased with the duration of benzodiazepine therapy among all subjects, with over 2.5-fold higher AORs for 91–180 days versus none. Conclusions: Opioids and longer-duration benzodiazepines were associated with drug overdose among all subjects, but opioid risk was greatest for persons with depression. Antidepressant use > 90 days reduced the odds of overdose for persons with depression, but all antidepressant use increased the risk for persons without depression.
AB - Background: Opioid analgesics and other psychoactive drugs may pose an even greater risk for drug overdose in persons with mental health disorders. Objective: The purpose of this study was to examine interactions of filled prescriptions for opioids, benzodiazepines, antidepressants, and zolpidem with mental health disorders in regard to drug overdose. Design: The study was a retrospective cohort review. Subjects: Subjects were national HMO beneficiaries aged 18–64 years, enrolled at least 1 year (01/2009 to 07/2012), who filled at least two prescriptions for Schedule II or III opioids for non-cancer pain. Main Measures: The outcome was the first inpatient or outpatient drug overdose after the first filled opioid prescription. Predictors were calculated in 6-month intervals and exactly 6 months before a drug overdose: opioid use (mean daily morphine-equivalent dose), benzodiazepine use (days’ supply), antidepressant use (days’ supply), zolpidem use (days’ supply), mental health disorders (depression, anxiety/PTSD, psychosis), pain-related conditions, and substance use disorders (alcohol, other drug). Key Results: A total of 1,385 (0.67 %) subjects experienced a drug overdose (incidence rate 421/100,000 person-years). The adjusted odds ratios (AOR) for overdose among all subjects rose monotonically with daily opioid dose, but highest (AOR = 7.06) for persons with depression and a high opioid dose (≥100 mg) versus no depression or opioid use. Longer-term antidepressants (91–180 days) were protective for persons with depression, with 20 % lower AORs for overdose versus short-term (1–30 days) or none. For persons without depression, the AORs of overdose were increased for antidepressant use, but greatest (AOR = 1.98) for short-term use versus none. The AORs of overdose increased with the duration of benzodiazepine therapy among all subjects, with over 2.5-fold higher AORs for 91–180 days versus none. Conclusions: Opioids and longer-duration benzodiazepines were associated with drug overdose among all subjects, but opioid risk was greatest for persons with depression. Antidepressant use > 90 days reduced the odds of overdose for persons with depression, but all antidepressant use increased the risk for persons without depression.
KW - opioid analgesics
KW - overdose
KW - psychotherapeutic drugs
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U2 - 10.1007/s11606-015-3199-4
DO - 10.1007/s11606-015-3199-4
M3 - Article
C2 - 25650263
AN - SCOPUS:84938075524
SN - 0884-8734
VL - 30
SP - 1081
EP - 1096
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 8
ER -