Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse

Grattan, A.; Sullivan, M. D.; Saunders, K. W.; Campbell, C. I.; Von Korff, M. R.

doi:10.1370/afm.1371

Cited by 227Opioid Use Disorder TreatmentPain Management and Opioid UseSubstance Abuse Treatment and Outcomes

Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse

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Grattan, A., Sullivan, M. D., Saunders, K. W., Campbell, C. I., Von Korff, M. R.·2012·The Annals of Family Medicine

DOI 10.1370/afm.1371PMC PMC3392289

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Abstract

PURPOSE: Opioid misuse in the context of chronic opioid therapy (COT) is a growing concern. Depression may be a risk factor for opioid misuse, but it has been difficult to tease out the contribution of co-occurring substance abuse. This study aims to examine whether there is an association between depression and opioid misuse in patients receiving COT who have no history of substance abuse. METHODS: A telephone survey was conducted at Group Health Cooperative and Kaiser Permanente of Northern California. We interviewed 1,334 patients on COT for noncancer pain who had no history of substance abuse. Patients were asked about 3 forms of opioid misuse: (1) self-medicating for symptoms other than pain, (2) self-increasing doses, and (3) giving to or getting opioids from others. Depression was evaluated by the 8-item Patient Health Questionnaire (PHQ-8). RESULTS: Compared with patients who were not depressed (PHQ-8 score 0 to 4), patients with moderate depression (PHQ-8 score 10 to 14) and severe depression (PHQ-8 score 15 or higher) were 1.8 and 2.4 times more likely, respectively, to misuse their opioid medications for non-pain symptoms. Patients with mild (PHQ-8 score 5 to 9), moderate, and severe depression were 1.9, 2.9, and 3.1 times more likely, respectively, to misuse their opioid medications by self-increasing their dose. There was no statistically significant association between depression and giving opioids to or getting them from others. CONCLUSION: In patients with no substance abuse history, depressive symptoms are associated with increased rates of some forms of self-reported opioid misuse. Clinicians should be alert to the risk of patients with depressive symptoms using opioids to relieve these symptoms and thereby using more opioids than prescribed.

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Patients with high levels of anxiety and depression receiving opioid treatment for chronic pain are at increased risk of developing opioid misuse.
“Previous studies have consistently found that patients with high levels of anxiety and depression receiving opioid treatment for chronic pain are at increased risk of developing opioid misuse [80,81,82,83,84,85,86,87,88,89,90].”
From Pain acceptance creates an emotional context that protects against the misuse of prescription opioids: A study in a sample of patients with chronic noncancer pain (2021) · cites this paper as [85]
The Abstract reports that, among chronic opioid therapy recipients with no substance-abuse history, depressive symptoms were associated with increased rates of some forms of self-reported opioid misuse. The Opioid Misuse and Depression section says the causal relationship is difficult to determine. The paper does not establish that anxiety increases misuse risk or that patients subsequently develop misuse; page numbers were not supplied. (LLM, conf=0.88)
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Authors: Grattan, A., Sullivan, M. D., Saunders, K. W., Campbell, C. I., & Von Korff, M. R.
Affiliations: University of Washington (US)
Group Health Cooperative (US)
Kaiser Permanente (US)
ORCID: Campbell, C. I.
Venue: The Annals of Family Medicine
Publisher: Annals of Family Medicine
Published: 2012-07-01
Volume: 10
Issue: 4
Pages: 304-311
ISSN: 1544-1709 (ISSN-L)
1544-1717
DOI: 10.1370/afm.1371
PMC: PMC3392289
OpenAlex: W2100360240
Cited by: 226
References: 45
Citations by year: 2026: 2 · 2025: 4 · 2024: 5 · 2023: 12 · 2022: 13 · 2021: 17 · 2020: 44 · 2019: 28 · 2018: 22 · 2017: 18 · 2016: 19 · 2015: 14 · 2014: 12 · 2013: 10 · 2012: 6
FWCI: 12.97
Type: journal article
Language: en
Open access: diamond
doi.org
Locations: The Annals of Family Medicine (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute on Aging (R01AG034181)
National Institute on Drug Abuse (R01DA022557)
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, prescription opioid misuse, long-term opioid therapy, non-cancer pain, self-medication, dose escalation, opioid diversion, PHQ-8, depressive symptoms, opioid prescribing
MeSH terms: Adolescent, Adult, Aged, Analgesics, Opioid, California, Chronic Disease, Depression, Female, Humans, Male, Middle Aged, Psychometrics, Surveys and Questionnaires, Risk Factors, Statistics as Topic, Time Factors, Confidence Intervals, Odds Ratio, Drug Monitoring, Health Care Surveys, Substance-Related Disorders, Young Adult, Self Report

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Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse

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