Psychiatric risk factors for chronic prescribing of high-dose opioids

This large-scale study examined the relationship between the presence of psychiatric morbidity and chronic and high-dose opioid use. The results show that psychiatric disorders increase the risk of developing chronic high-dose opioid use in patients who were first prescribed prescription opioids.

Chronic and high-dose opioid use should be limited as much as possible, according to guidelines. Previous studies have suggested that the presence of psychiatric disorders may increase the risk of chronic high-dose opioid use. This historical cohort study used longitudinal data to examine the relationship between the presence of psychiatric morbidity and chronic, high-dose opioid use.

This study, which involved IQ Health researcher Dr. Femke Atsma, used the NIVEL Zorgregistraties Eerste Lijn. Data from 137,778 primary care patients in the Netherlands were analyzed. Cox-regression analyses were performed to examine the association between psychiatric disorders prior to a new opioid prescription and subsequent chronic high-dose opioid use over 2 years.

Results showed that in 2.0% of all patients with a new opioid prescription, use became chronic and high-dose during 2 years of follow-up. A psychiatric disorder before the onset of opioid prescription increased the risk of chronic and high-dose opioid use (HR = 1.74; 95%-BI 1.62-1.88). This was particularly true for psychotic disorders, impaired substance use, neurocognitive impairment and co-occurring psychiatric episodes. In addition, pharmacotherapy for psychosis, substance use disorders and mood and/or anxiety disorders increased the risk of chronic and high-dose opioid use.

It can be concluded that psychological disorders increase the risk of developing chronic high-dose opioid use in patients who were first prescribed prescription opioids. To reduce this risk, careful monitoring and optimal treatment of psychiatric disorders are crucial when starting opioid treatment.
 

Read the publication here: van der Hoorn MMC, Kalkman GA, Weesie YM, Atsma F, Schellekens A. Psychiatric risk factors for chronic high-dose opioid prescribing: registry-based cohort study. BJPsych Open. 2023 Apr 20;9(3):e74. doi: 10.1192/bjo.2023.54. PMID: 37078115; PMCID: PMC10134259