More than half of pain pill prescriptions written for people with mental illness

By Debbie Truong

More than half of 115 million prescriptions for pain pills each year are distributed to people with mental health disorders, according to research released earlier this year.

Adults with anxiety or depression receive 51.4 percent of prescriptions for opioids yearly, the analysis from researchers at the University of Michigan and the Geisel School of Medicine at Dartmouth found.

The study is one of the first to explore the link between mental illness and opioid use, justifying further examination of the connection between the two, the study’s authors say.

“This finding warrants urgent attention to determine if the risks associated with such prescribing are balanced with therapeutic benefits,” study co-author Brian Sites, an anesthesiologist at Dartmouth-Hitchcock Medical Center, said in a news release.

The findings were published in July by the Journal of the American Board of Family Medicine.

Using government survey data, researchers found that of the 38.6 million adults in the U.S. with mental health disorders, nearly 19 percent are prescribed pain pills each year.

Comparatively, five percent of people without mental health disorders are likely to be prescribed opioids, the research found.

CHART: The estimated number, in the millions, of U.S. adults with mental health disorders who are prescribed opioids

 

Credit: Data was compiled by researchers at the University of Michigan and the Geisel School of Medicine at Dartmouth.

 

The study also found these unifying demographics among opioid users with mental health disorders:

• • 75 percent were 45 or older vs. 60 percent of prescription opioid users who do not have a mental illness

• • They were more likely to be middle-aged, white and divorced, separated or widowed.

• • Adults with mental health disorders who use opioids are significantly less healthy than those who did not use opioids.

Researchers were troubled by the tendency for patients with mental illness to receive prescriptions for pain pills across varying levels of pain, suggesting those with mental health disorders may have a higher likelihood of receiving opioid prescriptions.

Sites noted in a news release that because pain is subjective, “the presence of mental illness may influence the complex dynamic between the patient, provider and health system that results in the decision to write an opioid prescription.”

“The expectation would be that physicians would be more conservative with their prescribing behaviors in the setting of mental illnesses and favor nonopioid alternatives,” the author wrote.

They also acknowledged the study’s limitations — the nature of the research didn’t examine if those with mental health disorders are more predisposed to using opioids than those without.

But the authors pointed to an earlier study from a group of Harvard researchers indicating that people with mood disorders were more likely to use opioids longer-term after receiving prescriptions for them, than those who did not have mood disorders.

The Center for Disease Control estimated that, between 2000 and 2014, more than 165,000 people died from prescription opioid overdoses alone.

But the overprescription of painkillers is also commonly blamed for pushing people into illicit opioid use, which includes substances such as heroin and fentanyl. Total opioid-related deaths between 2000 and 2015 were more than half a million, according to the CDC.

The rising toll of opioids

Despite growing public awareness, the body count has continued mounting.

Each day, 91 people in the U.S. die from an opioid overdose, according to the center. The number of overdose deaths in the country has quadrupled since 1999.

“This is unprecedented. This is an epidemic.”

The number of fatal overdoses rose in both Maryland and Virginia between 2015 and 2016, according to state data.

During a March forum in Henrico County, Va. former FBI director James Comey attributed the epidemic to the confluence of opioid overprescription and heroin that’s manufactured and sold by Mexican drug cartels flooding into U.S. streets. 

At the same event, Chuck Rosenberg, then the acting administrator for the Drug Enforcement Administration, said the scope of the crisis can’t be understated.

“We sometimes use words like ‘epidemic’ or ‘unprecedented’ or ‘historic’ in ways that are really not accurate,” he said. “This is unprecedented. This is an epidemic.”