Incident and long-term opioid therapy among patients with psychiatric conditions and medications: A national study of commercial health care claims

Patrick D. Quinn, Kwan Hur, Zheng Chang, Erin E. Krebs, Matthew J. Bair, Eric L. Scott, Martin E. Rickert, Robert D. Gibbons, Kurt Kroenke, Brian M. D'Onofrio

Research output: Contribution to journalArticlepeer-review

81 Scopus citations


There is growing evidence that opioid prescribing in the United States follows a pattern in which patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10,311,961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions (ie, opioid and nonopioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (ie, antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior attention-deficit/hyperactivity disorder medication prescriptions (hazard ratio [HR] = 1.53; 95% confidence interval [CI], 1.48-1.58) to approximately 3-fold for prior nonopioid SUD diagnoses (HR = 3.15; 95% CI, 3.06-3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95% CI, 8.20-9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.

Original languageEnglish (US)
Pages (from-to)140-148
Number of pages9
Issue number1
StatePublished - Jan 1 2017

Bibliographical note

Funding Information:
Interest statement The authors have no conflicts of interest to declare. This project was supported by National Institute on Drug Abuse grant number K99DA040727 and, in part, by the Indiana Clinical and Translational Sciences Institute, which is funded by National Center for Advancing Translational Sciences grant number TL1TR001107. This material is the result of work supported with resources and the use of Veterans Affairs facilities in Indianapolis and Minneapolis. The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government. MarketScan is a registered trademark of Truven Health Analytics Inc.

Publisher Copyright:
© 2016 International Association for the Study of Pain.


  • Adverse selection
  • Epidemiology
  • Health insurance claims
  • Prescription opioid analgesics


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