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Opioids more commonly prescribed to teens with mental health concerns
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Although rates of opioid prescribing for adolescents are low, those with anxiety, mood and neurodevelopmental disorders, as well as those with other mental health conditions and treatments, are more likely to be prescribed any opioid.
Additionally, these teens who are insured commercially are significantly more likely to receive long-term opioid therapy when compared with teenagers without pre-existing mental health conditions and treatment.
“Against the background of 33,091 total opioid overdose deaths in 2015 and increasing attention to opioid therapy for adults with chronic pain, identifying appropriate prescription practices and concomitant treatment needs for adolescents receiving opioids is essential,” Patrick D. Quinn, PhD, from the department of psychological and brain sciences at Indiana University, Bloomington, and the Center for Health Statistics at the University of Chicago, and colleagues wrote. “Yet little is known about long-term opioid therapy patterns or safety among adolescents.”
To assess connections between pre-existing adolescent mental health conditions requiring treatment and starting any opioid and long-term opioid therapy (LTOT), the researchers conducted a study that analyzed prescriptions for opioids for any condition other than cancer made for teenagers between the ages of 14 and 18 years. First receipts of prescription were collected from national commercial health care claims data between Jan. 1, 2003, and Dec. 31, 2014.
The relationship between opioid prescribing and pre-existing mental health conditions was examined by comparing recipients and nonrecipients based on sex, calendar year and age at first enrollment, in addition to months of enrollment. Quinn and colleagues used Cox proportional hazards regressions attuned for specific demographics to observe connections between mental health conditions, treatment and LTOT.
The researchers were exposed to diagnoses of mental health conditions and treatments that were logged in inpatient and outpatient settings, as well as the number of filled prescription claims before receipt of opioid treatment. For the purpose of the study, Quinn and colleagues defined opioid receipt as receiving any opioid analgesic prescription claim. They also defined LTOT as using more than 90 days’ worth of opioid analgesic within 6 months with no lapse in treatment lasting more than 32 days.
Of the 1,224,520 adolescents newly treated with opioids, the average age of these teens was 17 years (interquartile range, 16-18 years) and the majority were female (51%). Follow-up was received after first receipt by 625 days on average (interquartile range, 255-1,268 days).
Adolescents who were previously diagnosed with a mental health condition, including anxiety, mood, neurodevelopmental, sleep and nonopioid substance use disorders, and teens who received most mental health treatments were substantially more likely to be prescribed any opioid (OR, 1.13 [nonopioid substance use disorders; 95% CI, 1.10-1.16] to 1.69 [nonbenzodiazepine hypnotics; 95% CI, 1.58-1.81]).
For the 81.7% of adolescents who followed up within 6 months, the researchers observed a cumulative incidence of 3.0 per 1,000 recipients for LTOT 3 years after first opioid prescription (95% CI, 2.8-3.1). Adolescents with any pre-existing mental health condition and treatment exhibited high rates of LTOT (adjusted HR, 1.73 [attention-deficit/hyperactivity disorder; 95% CI, 1.54-1.95] to 8.90 [opioid use disorder; 95% CI, 5.85-13.54]).
“There is a clear need for mental health assessment among adolescents being considered for opioid therapy,” Quinn and colleagues wrote. “Such an assessment may help inform decision making regarding pain treatment as well as illuminate the possible value of concomitant mental health interventions. In addition, because of the associated overdose risk, benzodiazepine-opioid combined therapy has been strongly discouraged.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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