TITLE

Drug Overdose in a Retrospective Cohort with Non-Cancer Pain Treated with Opioids, Antidepressants, and/or Sedative-Hypnotics: Interactions with Mental Health Disorders

AUTHOR(S)
Turner, Barbara; Liang, Yuanyuan
PUB. DATE
August 2015
SOURCE
JGIM: Journal of General Internal Medicine;Aug2015, Vol. 30 Issue 8, p1081
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Opioid analgesics and other psychoactive drugs may pose an even greater risk for drug overdose in persons with mental health disorders. Objective: The purpose of this study was to examine interactions of filled prescriptions for opioids, benzodiazepines, antidepressants, and zolpidem with mental health disorders in regard to drug overdose. Design: The study was a retrospective cohort review. Subjects: Subjects were national HMO beneficiaries aged 18-64 years, enrolled at least 1 year (01/2009 to 07/2012), who filled at least two prescriptions for Schedule II or III opioids for non-cancer pain. Main Measures: The outcome was the first inpatient or outpatient drug overdose after the first filled opioid prescription. Predictors were calculated in 6-month intervals and exactly 6 months before a drug overdose: opioid use (mean daily morphine-equivalent dose), benzodiazepine use (days' supply), antidepressant use (days' supply), zolpidem use (days' supply), mental health disorders (depression, anxiety/PTSD, psychosis), pain-related conditions, and substance use disorders (alcohol, other drug). Key Results: A total of 1,385 (0.67 %) subjects experienced a drug overdose (incidence rate 421/100,000 person-years). The adjusted odds ratios (AOR) for overdose among all subjects rose monotonically with daily opioid dose, but highest (AOR = 7.06) for persons with depression and a high opioid dose (≥100 mg) versus no depression or opioid use. Longer-term antidepressants (91-180 days) were protective for persons with depression, with 20 % lower AORs for overdose versus short-term (1-30 days) or none. For persons without depression, the AORs of overdose were increased for antidepressant use, but greatest (AOR = 1.98) for short-term use versus none. The AORs of overdose increased with the duration of benzodiazepine therapy among all subjects, with over 2.5-fold higher AORs for 91-180 days versus none. Conclusions: Opioids and longer-duration benzodiazepines were associated with drug overdose among all subjects, but opioid risk was greatest for persons with depression. Antidepressant use > 90 days reduced the odds of overdose for persons with depression, but all antidepressant use increased the risk for persons without depression.
ACCESSION #
108465553

 

Related Articles

  • Patterns of psychotropic drug use in a Spanish rural community. Vázquez-Barquero, J. L.; Diez Manrique, J. F.; Peña, C.; Arenal Gonzalez, A.; Cuesta, M. J.; Artal, J. A.; Vázquez-Barquero, J L; Peña, C // British Journal of Psychiatry;Nov89, Vol. 155, p633 

    Psychotropic drug use was investigated using a two-stage survey of a random sample of persons aged 17 and over from a rural Spanish community. It was found that 6.9%, 11.8% and 25.1% of the population were consuming psychotropic, analgesic and somatic medicines respectively. Women presented a...

  • Use of antidepressants soars.  // Therapy Today;Jul2009, Vol. 20 Issue 6, p4 

    The article reports on the increasing use of antidepressants in England. In 2007, a total of 36 million prescriptions were given out. According to politicians and experts working in the field of depression, it was important that alternative therapies should be made available to counter the...

  • Effect of Behavioral Activation Treatment on Fibromyalgia-Related Pain Anxiety Cognition. Lundervold, Duane A.; Talley, Chris; Buermann, Michael // International Journal of Behavioral Consultation & Therapy;Jan2006, Vol. 2 Issue 1, p73 

    Effects of Behavioral Activation Treatment (BAT) on pain anxiety, depression, and pain interference on a 43-year-old female with an 11-year history of chronic fibromyalgia pain are described. Analgesic, anxyiolytic, and antidepressant medications were stabilized prior to participation. Dependent...

  • LETTERS. Keifer, Amy; Catalana, Paul; Sibley, Jane; Russenberger, Jurg; Ross, Kelly; Enneking, Mike; Bostock, Sara; Smith, Jane M.; Kong, Grace; Belman, Isabelle; Deibler, Ruth; Tritt, W. John; Sarwar, Arush; Malhotra, Praveen K.; Properzi, Mauro; Manchanda, Jagmohan M.; McCartney, William A.; Jenkinson, Alan; Hucke, Dietrich // Time International (South Pacific Edition);11/24/2003, Issue 46, p8 

    Several letters to the editor are presented in response to the articles in previous issues that focus on disorders that affect many children and teenagers, issues surrounding psychotropic medication, mental health and children, and antidepressant, mood stabilizer or stimulant.

  • Hooked on antidepressants. Wolff, Jennifer // Self;Jul2004, Vol. 26 Issue 7, p136 

    Narrates the negative experience of the author from taking antidepressants in the U.S. Reason of the author for taking EffexorXr drug; Development of discontinuation syndrome by the author; Consultation of the author with a psychopharmacologist to treat her addiction to EffexorXR. INSET: STOP...

  • Organisational downsizing and increased use of psychotropic drugs among employees who remain in employment. Kivimäki, Mika; Honkonen, Teija; Wahlbeck, Kristian; Elovainio, Marko; Pentti, Jaana; Klaukka, Limo; Virtanen, Marianna; Vahtera, Jussi // Journal of Epidemiology & Community Health;Feb2007, Vol. 61 Issue 2, p154 

    Objective: Organisational downsizing is common in modern work life, but its effect on employees' mental health is not known. The authors examined whether working in downsizing organisations predicts use of psychotropic drugs among employees who remain in employment. Design, setting and...

  • Long term antipsychotic polypharmacy is common among Medicaid recipients with schizophrenia. Ananth, Jambur // Evidence Based Mental Health;May2005, Vol. 8 Issue 2, p55 

    The article discusses how prevalent is antipsychotic polypharmacy in people with schizophrenia. Between 1998 and 2000, the overall prevalence of antipsychotic polypharniacy was 40%, and the average duration of polypharmacy was 149 days. The prevalence of antipsychotic polypharmacy increased...

  • The K fix. Szalavitz, Maia // New Scientist;1/20/2007, Vol. 193 Issue 2587, p38 

    The article discusses research into the effects of ketamine upon severe depression, addiction, and reflex sympathetic dystrophy. Ketamine is a mind-blowing drug developed as an anaesthetic but better known as a club drug. Ketamine somehow reboots the brain's chemistry. As of January 2007,...

  • PRODUCT SPOTLIGHT.  // Behavioral Health Management;Mar/Apr2005, Vol. 25 Issue 2, p46 

    Features behavioral health-related products introduced in the U.S. market in March 2005. Advantage of using Cymbalta drug to elderly patients with depression; Key topics included in the book "Guide to State and Federal Drug-Testing Laws"; Advice on contacting major companies of the behavioral...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics