The DOI matches its Crossref record; 75 of the 75 references it cites were found in a registry or an index.
Depression Effects on Long-term Prescription Opioid Use, Abuse, and Addiction
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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In the citing paper
“Long-term opioid use increases the incidence, recurrence, and risk of treatmentresistant depression. 10”
In the citing paper
“Sullivan etal. report that patients with depression are more likely to initiate opioid therapy, transition to long-term use, and continue opioids at lower levels of pain intensity. 10”
In the citing paper
“prior studies have already shown associations between depression and long-term opioid use at lower levels of pain intensity and higher levels of physical function among patients with depression compared to patients without depression.”
Citations
Cites
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De Facto Long-term Opioid Therapy for Noncancer Pain
Korff, M. V., Saunders, K. W., Ray, G. T., Boudreau, D. M., Campbell, C. I., Merrill, J. O., Sullivan, M. D., Rutter, C. M., Silverberg, M. J., Banta‐Green, C. J., et al. (2008) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318169d03b · Cited by 663
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Cited by
Sorted by citations
CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022
Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7103a1 · Cited by 1,886
Goplen, C. M., Verbeek, W., Kang, S. H., Jones, C., Voaklander, D. C., Churchill, T. A., & Beaupré, L. A. (2019) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-019-2619-8 · Cited by 254
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Association of opioid misuse with anxiety and depression: A systematic review of the literature
Rogers, A. H., Zvolensky, M. J., Ditre, J. W., Buckner, J. D., & Asmundson, G. J. G. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.101978 · Cited by 93
Metadata
- Authors
- Sullivan, M. D.
- Affiliations
- University of Washington (US)
- Corresponding author
- Sullivan, Mark D.
- ORCID
- Sullivan, Mark D.
- Venue
- The Clinical Journal of Pain
- Published
- 2018-09
- Volume
- 34
- Issue
- 9
- Pages
- 878-884
- ISSN
- 0749-8047 (ISSN-L)
- 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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