Patients with Depression, Pain Likely to be Prescribed Opioids

Patients with depression who present low back pain likely to receive double the dose of opioids.

Patients presenting low back pain who also had depression were more likely to receive a prescription for opioids, according to a new study published by PAIN Reports. These patients were also likely to receive higher dose prescriptions.

Determining opioid prescribing patterns may help determine if public health efforts to combat the opioid epidemic are successful.

"Our findings show that these drugs are more often prescribed to low back pain patients who also have symptoms of depression and there is strong evidence that depressed patients are at greater risk for misuse and overdose of opioids," said senior author John Markman, MD.

Low back pain is a leading cause of disability and the most common reason opioids are prescribed in the United States. These factors have played a role in the uptick in opioid misuse disorder.

Included in the study were data from the Medical Expenditure Panel Survey regarding opioid prescriptions from 2004 to 2009, which is when a steep increase in prescriptions for low back pain occurred.

This time period also preceded the introduction of abuse-deterrent opioids and new policies to address the opioid epidemic, according to the study.

Currently, many physicians will not prescribe opioids due to their addiction potential. Instead, some patients may explore nondrug approaches to pain management, such as yoga or acupuncture, which the National Institutes of Health reported were successful.

The authors discovered that patients with low back pain and depression were more than twice as likely to receive opioids compared with patients without depression. Patients with both conditions were also more likely to receive double the typical dose over the course of 1 year, according to the study.

These findings also suggest that researchers need to more fully understand the risks and benefits of opioids to treat pain versus other drugs, especially for patients with low back pain and depression.

"Excluding depressed patients may lead clinicians who rely on these studies to underestimate the risks of opioids when they are prescribed for low back pain in routine practice," Dr Markman concluded.