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Leung J, Santo T, Colledge-Frisby S, Mekonen T, Thomson K, Degenhardt L, Connor JP, Hall W, Stjepanović D. OUP accepted manuscript. PAIN MEDICINE 2022; 23:1442-1456. [PMID: 35167694 PMCID: PMC9340651 DOI: 10.1093/pm/pnac029] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/21/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Abstract
Objective To review evidence from longitudinal studies on the association between prescription opioid use and common mood and anxiety symptoms. Design We conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methods We searched PubMed, Embase, and PsycINFO for search terms related to opioids AND (depression OR bipolar OR anxiety OR post-traumatic stress disorder [PTSD]). Findings were summarized narratively, and random-effects meta-analyses were used to pool effect sizes. Results We identified 10,290 records and found 10 articles that met our inclusion criteria. Incidence studies showed that people who used prescription opioids had an elevated risk of any mood outcome (adjusted effect size [aES] = 1.80 [95% confidence interval = 1.40–2.30]) and of an anxiety outcome (aES = 1.40 [1.20–1.80]) compared with those who did not use prescription opioids. Associations with depression were small and not significant after adjustment for potential confounders (aES = 1.18 [0.98–1.41]). However, some studies reported an increased risk of depressive symptoms after increased (aES = 1.58 [1.30–1.93]) or prolonged opioid use (aES = 1.49 [1.19–1.86]). Conclusions Mental health should be considered when opioids are prescribed because some patients could be vulnerable to adverse mental health outcomes.
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Affiliation(s)
- Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | | | - Tesfa Mekonen
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kate Thomson
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Medicine and Dentistry, Griffith Health, Griffith University, Southport, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Herston, Australia
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Daniel Stjepanović
- Correspondence to: Daniel Stjepanović, PhD, NCYSUR, The University of Queensland, 17 Upland Road, St Lucia, Brisbane, QLD 4072, Australia. Tel: +61 7 3443 2534; Fax: +61 7 334 69136; E-mail:
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Streck JM, Parker MA, Bearnot B, Kalagher K, Sigmon SC, Goodwin RD, Weinberger AH. National Trends in Suicide Thoughts and Behavior among US Adults with Opioid Use Disorder from 2015 to 2020. Subst Use Misuse 2022; 57:876-885. [PMID: 35232317 PMCID: PMC9084338 DOI: 10.1080/10826084.2022.2046102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Suicide thoughts and behavior (STB) are associated with premature mortality and is disproportionately represented among those with opioid use disorder (OUD). Recent trends in STB among those with OUD are lacking. We investigated trends in STB among US adults with versus without OUD using six waves of cross-sectional, nationally-representative, epidemiological data. METHODS Data came from the 2015-2020 National Survey on Drug Use and Health (combined n = 241,675). We compared past-year STB outcomes (i.e., thoughts of seriously considering killing self (SI), suicide plan (SP), suicide attempt (SA)) among adults with versus without past-year OUD. Unadjusted and adjusted logistic regression tested the association between survey-year and past-year STB outcomes (i.e., SI, SP/SA) stratified by OUD status. RESULTS Between 2015 and 2020, 26% versus 4% of those with and without OUD, respectively, reported SI, 10% versus 1% reported a SP, and 6% versus 1% reported SA (all ps < 0.001). In adjusted analyses, across survey years, no changes in the prevalence of SI were observed for adults with or without OUD, and no changes were observed over time for SP/SA in adults with or without OUD. OUD severity and treatment status did not moderate the relationship between OUD and STB outcomes. CONCLUSIONS Among US adults, OUD was associated with thoughts of suicide and suicide behavior. The heightened prevalence of STB in adults with OUD has not changed in recent years. Screening for SI is needed among those reporting opioid misuse and should be routinely integrated into OUD prevention and treatment.
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Affiliation(s)
- Joanna M Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine (DGIM), Department of Medicine, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, Massachusetts, USA.,Department of Psychiatry, MGH/HMS, Boston, Massachusetts, USA
| | - Maria A Parker
- Department of Epidemiology & Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, USA
| | - Benjamin Bearnot
- Tobacco Research and Treatment Center, Division of General Internal Medicine (DGIM), Department of Medicine, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, Massachusetts, USA
| | - Kelly Kalagher
- Tobacco Research and Treatment Center, Division of General Internal Medicine (DGIM), Department of Medicine, Massachusetts General Hospital (MGH)/Harvard Medical School (HMS), Boston, Massachusetts, USA
| | - Stacey C Sigmon
- Department of Psychiatry, Vermont Center on Behavior & Health, University of Vermont, Burlington, Vermont, USA
| | - Renee D Goodwin
- Mailman School of Public Health, Columbia University, New York, New York, USA.,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, New York, USA
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
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Santo T, Campbell G, Gisev N, Tran LT, Colledge S, Di Tanna GL, Degenhardt L. Prevalence of childhood maltreatment among people with opioid use disorder: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 219:108459. [PMID: 33401031 PMCID: PMC7855829 DOI: 10.1016/j.drugalcdep.2020.108459] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Experience of childhood maltreatment (CM) is a risk factor for opioid use disorder (OUD). CM is also associated with comorbid mental disorders and poor treatment outcomes among people with OUD. To our knowledge, this is the first systematic review and meta-analysis to estimate the prevalence of CM among people with OUD. METHODS We searched MEDLINE, EMBASE, and PsycINFO to identify observational studies that evaluated CM among people with OUD from January 1990 to June 2020. Prevalence of each CM type, sample characteristics, and methodological factors were extracted from each eligible study. Random-effects meta-analyses were used to pool prevalence estimates. Stratified meta-analyses were used to assess heterogeneity. RESULTS Of the 6,438 publications identified, 113 studies reported quantitative CM data among people with OUD and 62 studies (k = 62; N = 21,871) were included in primary analyses. Among people with OUD, the estimated prevalence of sexual abuse was 41% (95% CI 36-47%; k = 38) among women and 16% (95% CI 12-20%; k = 25) among men. Among all people with OUD, prevalence estimates were 38% (95% CI 33-44%; k = 48) for physical abuse, 43% (95% CI 38-49%; k = 31) for emotional abuse, 38% (95% CI 30-46%; k = 17) for physical neglect, and 42% (95% CI 32-51%; k = 17) for emotional neglect. Sex, history of injecting drug use, recruitment methods, and method of assessing CM were associated with substantial heterogeneity. CONCLUSIONS People with OUD frequently report the experience of CM, supporting the need for trauma-informed interventions among this population. Future research should consider the impact of CM on OUD presentations and when assessment is appropriate, use of validated instruments.
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Affiliation(s)
- Thomas Santo
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia.
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia; School of Health and Sports Sciences, University of the Sunshine Coast, Sunshine Coast, QLD, 4556, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Samantha Colledge
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW, 2042, Australia; Faculty of Medicine, UNSW Sydney, Wallace Wurth Building, 18 High Street, Kensington, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
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Rosic T, Worster A, Thabane L, Marsh DC, Samaan Z. Exploring psychological symptoms and associated factors in patients receiving medication-assisted treatment for opioid-use disorder. BJPsych Open 2020; 6:e8. [PMID: 31910933 PMCID: PMC7001483 DOI: 10.1192/bjo.2019.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders. The impact of these symptoms on treatment outcomes is unclear. AIMS To determine the prevalence of psychological symptoms in a cohort of individuals receiving medication-assisted treatment for OUD and explore their association with patient characteristics and outcomes in treatment. METHOD Data were collected from 2788 participants receiving ongoing treatment for OUD recruited in two Canadian prospective cohort studies. The Maudsley Addiction Profile psychological symptoms subscale was administered to all participants via face-to-face interviews. A subset of participants (n = 666) also received assessment for psychiatric disorders with the Mini International Neuropsychiatric Interview. We used linear regression analysis to explore factors associated with psychological symptom score. RESULTS The mean psychological symptom score was 12.6/40 (s.d. = 9.2). Participants with psychiatric comorbidity had higher scores than those without (mean 16.8 v. 8.6, P<0.001) and 31% of those with psychiatric comorbidity reported suicidal ideation. Higher psychological symptom score was associated with female gender (B = 1.59, 95% CI 0.92-2.25, P<0.001), antidepressant prescription (B = 4.35, 95% CI 3.61-5.09, P<0.001), percentage of opioid-positive urine screens (B = 0.02, 95% CI 0.01-0.03, P<0.001), and use of non-opioid substances (B = 1.92, 95% CI 0.89-2.95, P<0.001). Marriage and employment were associated with lower psychological symptoms. CONCLUSIONS Psychological symptoms are associated with treatment outcomes in this population and the prevalence of suicidal ideation is an area of concern. Our findings highlight the ongoing need to optimise integrated mental health and addictions services for patients with OUD.
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Affiliation(s)
- Tea Rosic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University; and Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University; and Department of Medicine, McMaster University, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University; Department of Medicine, McMaster University; Departments of Pediatrics/Anesthesia, McMaster University; and Biostatistics Unit, Research Institute at St Joseph's Healthcare, Canada
| | - David C Marsh
- Northern Ontario School of Medicine; and Canadian Addiction Treatment Centres, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University; and Department of Medicine, McMaster University, Canada
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Beattie A, Marques EMR, Barber M, Greenwood R, Ingram J, Ayres R, Neale J, Rees A, Coleman B, Hickman M. Script in a Day intervention for individuals who are injecting opioids: a feasibility randomized control trial. J Public Health (Oxf) 2016; 38:712-721. [PMID: 28158697 DOI: 10.1093/pubmed/fdv161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Angela Beattie
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Elsa M R Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Rosemary Greenwood
- NIHR Research Design Service-South West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jennifer Ingram
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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