Amrita School of Dentistry, Amrita Vishwa Vidhyapeetham, Cochin, India.
National Library of Medicine, National Institute of Health, Bethesda, Maryland, United States of America.
PLoS One. 2023 Sep 26;18(9):e0286179. doi: 10.1371/journal.pone.0286179. eCollection 2023.
People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety.
Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012-2019) for adults aged 21-64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50-64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD.
Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs.
患有精神健康障碍（MHD），如抑郁症和焦虑症的人比没有 MHD 的人更容易出现物质使用障碍（SUD）。本研究评估了接受抑郁症和/或焦虑症药物治疗的患者在急性或慢性疼痛管理中使用阿片类药物处方的情况。
使用 IBM Watson MarketScan Medicaid 多州数据库中 21-64 岁成年人的医疗和药房数据（2012-2019 年），对 2450 万成年医疗索赔进行了横断面数据趋势分析。分析了门诊就诊中性别、年龄、种族、提供者类型、急性或慢性疼痛以及阿片类药物和抗抑郁药和/或抗焦虑药物处方的信息。对于在疼痛诊断后 14 天内接受阿片类药物处方的患者，使用 ICD-10-CM 代码将诊断归类为慢性疼痛（背痛、颈痛、关节痛和头痛）；或急性疼痛（牙科、耳鼻喉科和骨科相关疼痛）。近 800 万成年人至少有一次抗抑郁药或抗焦虑药物处方（MHD），其中 250 万人（32%）还被诊断为急性或慢性疼痛疾病（疼痛+MHD）。在疼痛+MHD 组中，34%（85 万人）在诊断后 14 天内接受了阿片类药物处方。患有慢性疼痛诊断的患者比患有急性疼痛的患者更有可能接受阿片类药物处方。在疼痛+MHD 的人群中，大多数年龄在 50-64 岁（35%），女性（72%）和非西班牙裔白人（65.1%）。近一半（48.2%）的 MHD 成人的阿片类药物处方由医生开具。与其他类型的医生相比，急诊室的医疗保健提供者（HCPs）为 MHD 患者开出牙科疼痛阿片类药物处方的可能性高 50%，而牙医开出牙科疼痛管理阿片类药物处方的可能性仅为前者的一半。尽管 2012 年至 2019 年期间，总体用于疼痛管理的阿片类药物处方有所减少，但患有 MHD 的成年人接受阿片类药物用于疼痛管理的水平几乎是没有 MHD 的成年人的两倍。
尽管 HCP 已经减少了对阿片类药物用于有 SUD 高风险患者的急性或慢性疼痛治疗，例如患有 MHD 的患者，但对于该 SUD 高风险人群，用于疼痛管理的阿片类药物的使用仍然保持在较高水平，这表明需要重新审视接受抗抑郁药或抗焦虑药物治疗的患者的疼痛管理指南。
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