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Mark D. Sullivan, MD, PhD; Mark J. Edlund, MD, PhD; Lily Zhang, MS; Jürgen Unützer, MD, MPH; Kenneth B. Wells, MD, MPH

Arch Intern Med. 2006;166:2087-2093.

Background  Use of opioids for chronic noncancer pain is increasing, but standards of care for this practice are poorly defined. Psychiatric disorders are associated with increased physical symptoms such as pain and may be associated with opioid use, but no prospective population-based studies have addressed this issue.

Methods  Analysis of longitudinal data from 6439 participants in the 1998 and 2001 waves of Healthcare for Communities, a nationally representative telephone community survey.

Results  Two hundred thirty-seven subjects (3.6%) reported regular prescription opioid use in 2001. In unadjusted logistic regression models, respondents with a common mental health disorder in 1998 (1165 [12.6%]; major depression, dysthymia, generalized anxiety disorder, or panic disorder) were more likely to report opioid use in 2001 than those without any of these disorders (odds ratio [OR], 4.43; 95% confidence interval [CI], 3.64-5.38; P<.001). Risk was increased for initiation (OR, 3.26; 95% CI, 2.44-4.34; P<.001) and continuation (OR, 2.30; 95% CI, 1.02-5.17; P = .04) of opioids. Respondents reporting problem drug use (136 [2.0%]; OR, 3.57; 95% CI, 2.32-5.50; P<.001) but not problem alcohol use (401 [6.5%]; OR, 0.73; 95% CI, 0.43-1.24; P = .25) reported higher rates of prescribed opioid use than those without problem use. In multivariate logistic regression models controlling for 1998 demographic and clinical variables, common mental health disorder (OR, 1.96; 95% CI, 1.47-2.62; P<.001) and problem drug use (OR, 2.98; 95% CI, 1.68-5.30; P<.001) remained significant predictors of opioid use in 2001.

Conclusions  Common mental health disorders and problem drug use are associated with initiation and use of prescribed opioids in the general population. Attention to psychiatric disorders is important when considering opioid therapy.

Author Affiliations: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Drs Sullivan and Unützer); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Dr Edlund); Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles (Ms Zhang and Dr Wells).

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