Updated depressive model targets patients with prescription opioid use disorder

An updated version of an established model for major depressive disorder offers a “useful foundation” toward a comprehensive developmental model of prescription opioid use disorder, according to study results published in Journal of Clinical Psychiatry.

“Prior research has identified several risk factors for [prescription opioid use disorder], including but not limited to family history of substance use disorders (SUD), antisocial behavior and other SUD and psychiatric disorders,” Carlos Blanco, MD, PhD, of the National Institute on Drug Abuse in Maryland, and colleagues wrote. “However, risk factors seldom act in isolation. A natural next step is to develop a conceptual model that integrates risk factors and evaluates their joint and independent effects in the risk of [prescription opioid use disorder].”

Blanco and colleagues based their model on one initially developed to explain the etiology of major depressive disorder. This original model underwent previous adaptations to integrate a wide range of risk factors for addictive disorders, they noted. The researchers drew data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III and divided risk factors into four developmental tiers — childhood/early adolescence, late adolescence, adulthood and past-year. They used hierarchical logistic regression models to assess each risk factor’s independent contribution and built separate models to predict 12-month nonmedical prescription opioid use and risk for prescription opioid use disorder among individuals with 12-month nonmedical use.

The researchers adjusted for additional risk factors and found that the odds of past 12-month nonmedical use were increased by history of social deviance, use of drugs other than opioids in adulthood and trauma, as well as by past-year pain, tobacco use disorder, alcohol use disorder, an Axis I disorder other than substance use disorder and number of stressful events. History of prescription opioid use disorder in adulthood and pain, alcohol use disorder, tobacco use disorder and an Axis I disorder other than substance use disorders in the past year increased 12-month prescription opioid use disorder odds, the researchers wrote. Further, they noted an association between history of a substance use disorder other than prescription opioid use disorder and lower odds of prescription opioid use disorder.

“Our models suggest some potential targets for interventions,” the researchers wrote. “Because individuals in pain are at an increased risk [for prescription opioid use disorder], improved pain management and prescription practices and development of effective non-addictive analgesics could reach a large proportion of individuals at risk for nonmedical use of opioids and [prescription opioid use disorder].” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.