Drug Overdose in a Retrospective Cohort with Non-Cancer Pain Treated with Opioids, Antidepressants, and/or Sedative-Hypnotics: Interactions with Mental Health Disorders
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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.
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Over reliance on prescription opioids as a frontline treatment for chronic pain contributed to a national epidemic including increased rates of opioid addiction, accidental overdose, and mortality.
“Over reliance on the use of prescription opioids as a frontline treatment for chronic pain contributed to a national epidemic including increased rates of opioid addiction, accidental overdose, and even mortality [16–20].”
From Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program (2024) · cites this paper as [20]
The Introduction reports a national rise in accidental overdose mortality involving opioid analgesics, and the Discussion associates opioid dose with overdose risk. The paper does not establish that reliance on opioids as a frontline chronic-pain treatment caused the national epidemic, or report increased rates of opioid addiction. (LLM, conf=0.86)
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- Authors
- Turner, B. J., & Liang, Y.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Corresponding author
- Turner, Barbara J.
- Venue
- Journal of General Internal Medicine
- Published
- 2015-02-04
- Volume
- 30
- Issue
- 8
- Pages
- 1081-1096
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4510211
- OpenAlex
- W1992700677
- Cited by
- 109
- References
- 29
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 7 · 2022: 10 · 2021: 11 · 2020: 11 · 2019: 13 · 2018: 17 · 2017: 14 · 2016: 11 · 2015: 3
- FWCI
- 16.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR001120)
- University of Texas Health Science Center at San Antonio
- National Center for Research Resources
- National Center for Advancing Translational Sciences (1UL TR001120)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- drug overdose, opioid analgesics, benzodiazepines, antidepressants, zolpidem, sedative-hypnotic drugs, mental illness, depression, opioid dose, substance use disorders, non-cancer pain, prescription drug misuse, benzodiazepine prescribing
- MeSH terms
- Zolpidem, Adolescent, Adult, Analgesics, Opioid, Antidepressive Agents, Mental Disorders, Benzodiazepines, Female, Humans, Hypnotics and Sedatives, Male, Middle Aged, Pain, Pyridines, Retrospective Studies, Young Adult, Drug Overdose
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