Many people who die from a prescription opioid overdose receive a diagnosis of chronic pain or a psychiatric condition within a year of their death.
That’s the findings of a new study.
The research provides a clearer view of the people affected by the opioid epidemic.
It could also help doctors identify those at high risk of an opioid overdose death, say researchers.
According to the Centers for Disease Control and Prevention (CDC), there were 33,091 opioid-related overdose deaths in 2015. The figures include prescription pain medications and heroin.
The deaths were about four times the 1999 level.
Many experts see prescription opioids as a key driver of the epidemic.
However, for people with chronic pain, these medications may provide relief that lasts months or years.
An estimated 5 to 8 million Americans use opioids for long-term management of their chronic pain.
What the study showed
In the new study, researchers looked at medical and prescription information for 13,089 people on Medicaid who died from an opioid overdose between 2001 and 2007.
The study was published late last month in the American Journal of Psychiatry.
Researchers found that 61 percent of people who died from an opioid overdose had been diagnosed with a chronic pain condition during the final year of life.
Many had also received a diagnosis of a mental health disorder.
Psychiatric illnesses are common among people who have both chronic pain and opioid use disorder.
A 2016 study in the Journal of Clinical Psychiatry found that many people who had both conditions currently met the diagnostic criteria for:
- Anxiety: 48 percent
- Mood disorder: 48 percent
- Non-opioid substance use disorder: 34 percent
The connection between all of these conditions is complicated.
People living with chronic pain may try to self-medicate with prescription — or other — opioids.
Mental illness can also lead to misuse of drugs.
And drug misuse may cause people to experience symptoms of mental illness.
Researchers also found that less than half of people who died from an opioid overdose had been diagnosed with substance use disorder in the past year.
Even fewer received a diagnosis with opioid use disorder.
Most people who received a diagnosis of a substance use disorder within the past year “did not appear to receive any substance use related services during the last 30 days,” write the authors.
These people may drop out of treatment or never start treatment once they’re diagnosed.
Increasing “engagement and retention in treatment for substance use disorders” could decrease the number of opioid-related deaths, write the authors.
Researchers only included people insured by Medicaid, a population at high risk of dying from an opioid overdose. The results may be different for people with private or no insurance.
The study also only included data through 2007. Patterns for medical diagnoses and prescriptions may be different after that point.
According to the National Institute on Drug Abuse (NIDA), prescription opioids were the largest cause of opioid overdose deaths from 2007 until 2014, until heroin surpassed them.
Over the past year, fentanyl and other non-methadone synthetic opioids shot past both.
Opioids involved in overdose deaths
Researchers in the new study found that 6 percent of people who died from overdoses had another overdose within the past year that was medically treated.
This was slightly higher in people with chronic pain.
More than half of the people who died from an opioid overdose had received a prescription for an opioid or a benzodiazepine, or both of those drugs, during the past year.
Benzodiazepines are mild tranquilizers. However, when combined with an opioid, they increase the risk of respiratory depression, coma, and death.
More than one-third of people had received an opioid prescription within 30 days of their death.
Also, people with a chronic pain diagnosis were more likely to be prescribed one of these drugs within the past year.
Because the data for the study comes from medical records, the researchers couldn’t tell if people were using their medications as prescribed by their doctor or if they were using opioids obtained illegally.
However, the medical records do show which drugs were involved in a person’s death.
Overall, prescription opioids were the most common cause of death. Methadone, other narcotics, fentanyl or other synthetic opioids, and heroin followed.
Benzodiazepine, cocaine, and alcohol were also involved in some deaths.
Some deaths may have involved more than one drug.
Among people with a chronic pain condition, the more common causes of death came from prescription opioids, methadone, fentanyl and other synthetic opioids, and benzodiazepines.
The study data doesn’t show how many people transitioned from prescription opioids to heroin, fentanyl, or other illegal drugs.
However, the NIDA reports that 75 to 80 percent of people who started misusing opioids in the 2000s say that their first opioid was a prescription opioid.
In the 1960s, more than 80 percent of heroin users started with heroin.
The authors of the new study say that the results may help doctors identify people who are at risk of dying from an opioid overdose.
Only a small number of people had a medically treated opioid overdose within a year of dying. Emergency departments that treated these patients could be more assertive in getting these people into treatment programs for substance use disorder. But this would still only catch a small number of those at risk.
Given that the many people who died from an opioid overdose were diagnosed with a chronic pain condition, doctors who treat these patients should also assess them for mental health or substance use disorders.
This might help prevent some of the thousands of opioid-related deaths each year.