Trends in long-term opioid therapy for noncancer pain among persons with a history of depression

Braden, Jennifer Brennan; Sullivan, Mark D.; Ray, G. Thomas; Saunders, Kathleen; Merrill, Joseph; Silverberg, Michael J.; Rutter, Carolyn M.; Weisner, Constance; Banta-Green, Caleb; Campbell, Cynthia; Von Korff, Michael

doi:10.1016/j.genhosppsych.2009.07.003

« Previous Next »General Hospital Psychiatry
Volume 31, Issue 6 , Pages 564-570, November 2009

Trends in long-term opioid therapy for noncancer pain among persons with a history of depression

Jennifer Brennan Braden, M.D., M.P.H.
- Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195-6560, USA
- Corresponding author. Tel.: +1 206 543 3925; fax: +1 206 221 5414.
Mark D. Sullivan, M.D., Ph.D.
- Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195-6560, USA
G. Thomas Ray
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA 94612, USA
Kathleen Saunders, J.D.
- Center for Health Studies, Group Health Cooperative, Seattle, WA 98101-1448, USA
Joseph Merrill, M.D., M.P.H.
- Department of Medicine, Box 359780, University of Washington, Seattle, WA 98195-6560, USA
Michael J. Silverberg, Ph.D, M.P.H.
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA 94612, USA
Carolyn M. Rutter, Ph.D.
- Center for Health Studies, Group Health Cooperative, Seattle, WA 98101-1448, USA
Constance Weisner, DrPH, M.S.W.
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA 94612, USA
- Department of Psychiatry, University of California, San Francisco, CA 94143-0984, USA
Caleb Banta-Green, M.P.H., M.S.W, Ph.D.
- Alcohol and Drug Abuse Institute, Box 354805, University of Washington, Seattle, WA 98195-6560, USA
Cynthia Campbell, Ph.D.
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA 94612, USA
Michael Von Korff, Sc.D.
- Center for Health Studies, Group Health Cooperative, Seattle, WA 98101-1448, USA

Received 13 April 2009; accepted 8 July 2009. published online 28 August 2009.

Abstract

Objective

We report trends in long-term opioid use among patients with a history of depression from two large health plans.

Methods

Using claims data, age- and gender-adjusted rates for long-term (>90 days) opioid use episodes were calculated for 1997–2005, comparing those with and without a depression diagnosis in the prior 2 years. Opioid use characteristics were calculated for those with a long-term episode in 2005.

Results

Incident and prevalent long-term opioid use rates were three times higher in those with a history of depression. Prevalent long-term use per 1000 in patients with a history of depression increased from 69.8 to 125.9 at Group Health and from 84.3 to 117.5 at Kaiser Permanente of Northern California between 1997 and 2005. Those with a history of depression were more likely to receive a higher average daily dose, greater days supply, and Schedule II opioids than nondepressed persons.

Conclusion

Persons with a history of depression are more likely to receive long-term opioid therapy for noncancer pain than those without a history of depression. Results suggest that long-term opioid therapy for noncancer pain is being prescribed to a different population in clinical practice than the clinical trial populations where opioid efficacy has been established.

Keywords: Opioid, Pain, Depression, Pharmacoepidemiology