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Opioid deaths linked to chronic pain and mental disorders

An unprecedented study by researchers at Columbia University Medical Center (CUMC) has investigated the nature of deaths from opioid overdoses. The study revealed that 60 percent of individuals who died as a result of opioid overdose were previously diagnosed with chronic pain, while a great number of fatalities also occurred in individuals who had psychiatric disorders.

The Center for Disease Control reports that the number of opioid-related deaths quadrupled between 1999 and 2015, jumping from 8,048 to 33,091.

The research team analyzed the clinical diagnoses and medication prescriptions of over 13,000 adults who died of an opioid overdose between 2001 and 2007. Over 50 percent of these individuals had been diagnosed with chronic pain, while many others had been diagnosed with depression and anxiety.

“The frequent occurrence of treated chronic pain and mental health conditions among overdose decedents underscores the importance of offering substance use treatment services in clinics that treat patients with chronic pain and mental health problems,” said study lead author Dr. Mark Olfson. “Such a strategy might increase early clinical intervention in patients who are at high risk for fatal opioid overdose.”

While nearly a third of those who died had been diagnosed with a drug use disorder in the year prior to death, less than one in twenty had been diagnosed with an opioid use disorder in the month before death.

“Because clinical diagnoses generally indicate treatment, this service pattern suggests that dropout from drug treatment is common before fatal opioid overdose,” said Dr. Olfson. “Improving treatment retention with contingency management or other effective behavioral interventions might help lower the risk of fatal overdose in these patients.”

More than half of the individuals who overdosed had filled prescriptions for opioids or benzodiazepines in the year before death, and many had filled prescriptions for both types of medications.

“This medication combination is known to increase the risk of respiratory depression, which is the unusually slow and shallow breathing that is the primary cause of death in most fatal opioid overdoses,” said Dr. Olfson. “In the years since, there has been an increase in the proportion of US overdose deaths involving benzodiazepines and opioids.” The authors urged providers to restrict the combination, in the lowest possible dose and duration, to those patients for whom alternative strategies have proven inadequate.

The study, “Service Use Preceding Opioid-Related Fatality,” is published in the American Journal of Psychiatry.

By Chrissy Sexton, Staff Writer

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