Cited by 109Opioid Use Disorder TreatmentPoisoning and overdose treatmentsSubstance Abuse Treatment and Outcomes

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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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Turner, Barbara J., Liang, Yuanyuan·2015·Journal of General Internal Medicine

DOI 10.1007/s11606-015-3199-4PMC PMC4510211

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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.

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Drug prescriptions preceding opioid-related deaths–a register study in forensic autopsy patients
Walde, J., Andersson, L., Johnson, B., & Håkansson, A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0285583 · Cited by 8
Exploring the Use of Chronic Opioid Therapy for Chronic Pain
Brooks, A. T., Kominek, C., Pham, T. C., & Fudin, J. (2015) · Medical Clinics of North America · doi:10.1016/j.mcna.2015.08.010 · Cited by 7
Overdoses in Patients on Opioids: Risks Associated with Mental Health Conditions and Their Treatment
Bair, M. J., & Bohnert, A. S. B. (2015) · Journal of General Internal Medicine · doi:10.1007/s11606-015-3332-4 · Cited by 7
Receipt of Substance Use Counseling Among Ambulatory Patients Prescribed Opioids in the United States
Evoy, K. E., Leonard, C. E., Covvey, J. R., Ochs, L. A., Peckham, A. M., Soprano, S. E., & Reveles, K. R. (2020) · Substance Abuse Research and Treatment · doi:10.1177/1178221819894588 · Cited by 5
Association between psychotropic drug use and prescription opioid use among older adults
Khan, S. R., Heller, D. A., Latty, L. L., Cadieux, R. J., LaSure, M., & Brown, T. V. (2020) · Geriatric Nursing · doi:10.1016/j.gerinurse.2020.04.017 · Cited by 5
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Choi, N. G., Choi, B. Y., DiNitto, D. M., Marti, C. N., & Baker, D. (2021) · Drug and Chemical Toxicology · doi:10.1080/01480545.2021.1984517 · Cited by 3
Does Preoperative Opiate Choice Increase Risk of Postoperative Infection and Subsequent Surgery?
Gonzalez, G. A., Corso, K., Miao, J., Rajappan, S. K., Porto, G. B. F., Anandan, M. A., O’Leary, M., Wainwright, J. V., Smit, R. D., Hines, K., et al. (2022) · World Neurosurgery · doi:10.1016/j.wneu.2022.11.044 · Cited by 3
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Naumov, A. V., Khovasova, N. O., Meshkov, A. D., Unkovskiy, A. V., К., Ф. Д., Kotovskaya, Y. V., & Ткачева, О. Н. (2025) · Russian Journal of Geriatric Medicine · doi:10.37586/2686-8636-2-2025-125-144 · Cited by 3
Sedative hypnotics overdose: Epidemiology, diagnosis and management
Sharma, S., Kukreti, P., & Kataria, D. K. (2018) · Indian Journal of Medical Specialities · doi:10.1016/j.injms.2018.04.009 · Cited by 4
Mental illnesses as a potential risk factor for non‐medical use of prescription opioids: a narrative review
Guzman, K. R. D., Puljević, C., & Snoswell, C. L. (2022) · Journal of Pharmacy Practice and Research · doi:10.1002/jppr.1781 · Cited by 2
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Sandbrink, F., & Schuster, N. M. (2024) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000001487 · Cited by 2
Impact of State Policies on Opioid Prescribing Among Surgery and Injury Patients: Controlled Interrupted Time‐Series Study, North Carolina, 2014–2019
Beltran, T. G., Pence, B. W., Fulcher, N., Dasgupta, N., Maierhofer, C., DiPrete, B. L., Marshall, S. W., Nocera, M., Proescholdbell, S., Wu, L.-T. T., et al. (2025) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.70144 · Cited by 2
The Place of Community Rescue Naloxone in a Public Health Crisis of Opioid Overdose
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Are we Truly “Safer-At-Home”? A Test of Contextual Effects on Mental Health and Drug Overdose Incidents During the COVID-19 Pandemic
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Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program
Haun, J. N., Fowler, C. A., Smith, B. M., Cao, L., Stroupe, K. T., Lapcevic, W. A., Saenger, M. S., Benzinger, R. C., & French, D. D. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-10816-4 · Cited by 2
“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].”
Background
The main provisions of the Methodological recommendations of management of patients in the elderly with osteoarthritis
Unkovskiy, A. V., К., Ф. Д., Naumov, A. V., & Khovasova, N. O. (2026) · Russian Journal of Geriatric Medicine · doi:10.37586/2686-8636-2-2026-208-218 · Cited by 1
Abordaje multifactorial del dolor crónico no neoplásico en Atención Primaria
Calvo-Mosquera, G., Rodríguez, D. C., & Cal, A. G. (2017) · FMC - Formación Médica Continuada en Atención Primaria · doi:10.1016/j.fmc.2017.05.003 · Cited by 1
Anticipating the effects of restricting high‐dose preparations of strong opioids in Australia: A population‐based analysis to inform the current policy debate
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Opioids in Pain
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Unintentional Opioid Overdoses Treated at University Clinic of Toxicology-Skopje in a Nine-Year-Period
Simonovska, N., Velik-Stefanovska, V., & Babulovska, A. (2021) · Acta Medica (Hradec Kralove Czech Republic) · doi:10.14712/18059694.2021.16 · Cited by 1
Opioid Overdose
Jones, J. D., Luba, R. R., Mumtaz, M., & Castillo, F. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197618431.013.30 · Cited by 1
Opioid-induced Somatic Activation: Prevalence in a Population of Patients with Chronic Pain
Barbour, A. B., Asbury, M. L., Riordan, P. A., Webb, J., & Prakken, S. (2020) · Cureus · doi:10.7759/cureus.7911 · Cited by 1
Facts About the Opioid Epidemic: Commentary on Oliver and Carlson.
Busch, D. (2021) · Pain Management Nursing · doi:10.1016/j.pmn.2021.01.006 · Cited by 1
Characteristics and patterns of opioid-related overdoses among veterans
Warfield, S. C. (2019) · doi:10.33915/etd.3902 · Cited by 1
Use of chart review tool and peer feedback to influence physician prescribing of controlled substances
Penti, B. (2016) · OpenBU (Boston University)
A Meta-analytic Review of Selected Adverse Drug Events (ADEs) of Long-term Prescription Opioids for Chronic Non-cancer Pain (CNCP)
Pelcowitz, M. J. (2016) · TSpace (University of Toronto)
Opioid Overdoses in Indiana: A Closer Look at Opioid Type
Kooreman, H. E. (2018) · IUScholarWorks (Indiana University)
Opioids: A Reason for Concern
Striefel, K. L. (2018) · NDSU Repository (North Dakota State University)

Authors: Turner, B. J., & Liang, Y.
Affiliations: The University of Texas at San Antonio Health Science Center (US)
Corresponding author: Turner, Barbara J.
ORCID: Turner, Barbara J.
Liang, Yuanyuan
Venue: Journal of General Internal Medicine
Publisher: Springer Science and Business Media LLC
Published: 2015-02-04
Volume: 30
Issue: 8
Pages: 1081-1096
ISSN: 0884-8734 (ISSN-L)
1525-1497
DOI: 10.1007/s11606-015-3199-4
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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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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