Adolescent mental disorders have repercussions for addiction

By Piriya Mahendra

Adolescents with mental health disorders are significantly more likely to become addicted to prescription opioid pain relievers than those without mental disorders, experts say.

A longitudinal analysis of 59,077 adolescents and young adults aged 13-24 years showed that those with mental health disorders were significantly more likely to be prescribed opioids for chronic back pain, neck pain, headache, or arthritis/joint pain than those without mental health disorders.

Adolescents with mental health disorders were also significantly more likely to become long-term opioid users than those who did not have a mental health disorder, report Laura Richardson (University of Washington, Seattle, USA) and team in the Journal of Adolescent Health.

Overall, 321 (0.5%) patients were long-term opioid users, 16,712 (27.4%) were nonchronic opioid users, and 42,584 (72.1%) did not use opioids. Long-term opioid use was defined as receiving more than 90 days of opioids within a 6-month period, without a gap of more than 30 days in opioid use within the first 18 months after qualifying pain diagnosis.

Long-term opioid use was significantly more common among men than women (OR=1.59), and in individuals older than 20.8 years than younger individuals (odds ratio [OR]=1.33). Long-term opioid use was also predicted by living in a poor community (median household income 75.1% in 2000; OR=1.65), but fewer residents who had attended college (<54.8% in 2008; OR=0.63).

After controlling for demographic and clinical factors, individuals with pre-existing mental health diagnoses were at a significant 2.36-fold increased risk for subsequently receiving long-term opioids versus no opioids.

Furthermore, participants with pre-existing mental health conditions were at a significant 1.8-fold increased risk for receiving long-term opioids versus nonchronic use.

"There are a number of reasons why adolescents and young adults with mental health issues are more likely to become long-term users of opioids," commented Richardson in a press statement.

"Depression and anxiety might increase pain symptoms and lead to longer treatment, and physicians may see depressed patients as being more distressed and may be willing to treat pain symptoms over a longer period of time."

Doctors should screen for mental health disorders before starting medications and consider referring patients with depression or anxiety for counseling or other mental health treatment, she added.

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