Screen chronic opioids users for depression

Depression combined with chronic opioid analgesic use involves more symptoms and comorbidities than depression without chronic opioid use, according to a study of Department of Veterans Affairs patients seen.

Screening and treatment of depression in non-cancer pain patients may limit risk of persistent mood disorder and subsequent suicidal ideation. Opioid prescribing for pain management should be coupled with screening and treatment of emerging depression.

The researchers started with 500,000 VA patients and screened electronic health records for patients who visited the VA in the two years – with no opioid prescriptions or depression diagnoses on those visits – and followed up at least once between 2002 and 2012.

“Eligible patients were HIV free ... Eligible patients were free of psychiatric and substance use disorders before NDE (new depression episodes). Patients whose opioid use began after NDE and patients without NDE in follow-up were excluded,“ wrote Saint Louis University.

This process left the researchers with a sample size of 4,758 patients. Of those 4,314 developed NDE without receiving, 444 developed NDE after opioid use for more than 90 days.

Looking at raw figures prior to the application of inverse probability of treatment weighing (IPTW), the opioid use group was more likely than the nonopioid use group to have comorbid posttraumatic stress disorder, opioid, and other drug abuse/dependence.

With IPTW adjustment made, the differences in pain -related comorbidities went away. Opioid-using patients had higher depression severity as measured by Patient Health Questionnaire. They also were more likely to have had antidepressant treatment for at least 12 weeks.