Cited by 196Opioid Use Disorder TreatmentPain Management and Opioid UseSubstance Abuse Treatment and Outcomes

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Depression Effects on Long-term Prescription Opioid Use, Abuse, and Addiction

Sullivan, Mark D.·2018·The Clinical Journal of Pain

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Abstract

Objectives: Treatment guidelines discourage long-term opioid treatment for patients with chronic pain and major depression, but this treatment occurs commonly, producing higher daily doses, longer duration, and more adverse events. Materials and Methods: Review of prospective cohort, retrospective cohort, and other observational studies of the relation between depression and opioid use, abuse, and addiction. Results: Depressed patients initiate opioid therapy slightly more often than nondepressed patients, but are twice as likely to transition to long-term use. This adverse selection of high-risk patients with depression into long-term high-dose opioid therapy seems to be a process of self-selection. Opioids may be used by patients with chronic pain and depression to compensate for a reduced endogenous opioid response to stressors. Depressed patients seem to continue opioid use at lower pain intensity levels and higher levels of physical function than do nondepressed patients. In studies that carefully control for confounding by indication, it has been shown that long-term opioid therapy increases the risk of incident, recurrent, and treatment-resistant depression. Depressed patients may tend to overuse opioids because they use them to treat insomnia and stress. Depression also seems to increase the risk of abuse or nonmedical use of prescription opioids among adults and adolescents. This increased rate of nonmedical opioid use may be the path through which depression increases the risk of opioid use disorder among patients with chronic pain. Discussion: It is not possible to understand long-term opioid therapy for chronic pain without understanding the close and multifaceted relationship of this therapy with depression.

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Authors: Sullivan, M. D.
Affiliations: University of Washington (US)
Corresponding author: Sullivan, Mark D.
ORCID: Sullivan, Mark D.
Venue: The Clinical Journal of Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2018-09
Volume: 34
Issue: 9
Pages: 878-884
ISSN: 0749-8047 (ISSN-L)
DOI: 10.1097/ajp.0000000000000603
OpenAlex: W2792478259
Cited by: 196
References: 75
Citations by year: 2026: 9 · 2025: 21 · 2024: 29 · 2023: 29 · 2022: 33 · 2021: 29 · 2020: 28 · 2019: 17 · 2018: 1
FWCI: 3.40
Type: journal article
Language: en
Open access: closed
Locations: Clinical Journal of Pain (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: depression, long-term opioid therapy, chronic pain, prescription opioid abuse, opioid use disorder, nonmedical opioid use, opioid dose escalation, insomnia, treatment-resistant depression, confounding by indication
MeSH terms: Analgesics, Opioid, Depression, Depressive Disorder, Humans, Opioid-Related Disorders, Behavior, Addictive

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Depression Effects on Long-term Prescription Opioid Use, Abuse, and Addiction

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