Are Adolescents with Mental Health Conditions More Likely to Receive Opioids?

Bottom Line: Adolescents with a wide range of preexisting mental health conditions and treatments were more likely to progress from an initial opioid prescription to long-term opioid therapy than adolescents without those conditions, although long-term opioid therapy was uncommon overall.

Why The Research Is Interesting: Opioid pain-relieving medications are the most common controlled medications prescribed to adolescents. Still, not much is known about long-term opioid therapy patterns or safety among adolescents.

Who and When: More than 1.2 million adolescents ages 14 to 18 without cancer with a first-time opioid prescription extracted from nationwide commercial health care claims data from 2003 through 2014

What (Study Measures): Mental health condition diagnoses and treatments recorded in inpatient, outpatient and prescription claims before an initial opioid prescription (exposures); receipt of an initial opioid prescription and long-term opioid therapy, which was defined as more than a 90-day supply within six months and no gaps in the supply of more than 32 days (outcomes)

How (Study Design): This was an observational study. Because researchers were not intervening for purposes of the study they cannot control natural differences that could explain the study findings.

Authors: Patrick D. Quinn, Ph.D., of Indiana University, Bloomington, and coauthors

Results: An estimated 3 of 1,000 adolescent opioid recipients transitioned to long-term opioid therapy within three years. Adolescents with a range of prior mental health conditions and treatments had substantially higher rates of transitioning from initial opioid receipt to long-term opioid therapy.

Study Limitations: The data capture only conditions diagnosed and recorded in included claims, the data cannot explain the severity of adolescents’ pain and mental health conditions, and the study was limited to commercially insured adolescents.

Study Conclusions: 

Related Material: The editorial, “Association of Psychiatric Comorbidity with Opioid Prescriptions and Long-Term Opioid Therapy Among U.S. Adolescents,” by Michael J. Mason, Ph.D., of the University of Tennessee, Knoxville, also is available on the For The Media website.

 

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamapediatrics.2017.5641)