Depression and Substance Abuse

Chronic pain patients with depressive symptoms may be at risk for substance misuse

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Depression in patients with access to an opioid prescription can lead to misuse through self-medication. Doctors should screen chronic opioid therapy patients for depression.

A recent study found that patients on chronic opioid therapy who also have depressive symptoms are at risk of misusing their opioid prescriptions.

The patients in the study had no history of substance abuse, but the more serious their depression—the greater the risk of misuse.

"Talk to a therapist if you are experiencing depression."

Mark Sullivan, MD, PhD, professor of psychiatry at the University of Washington School of Medicine, and a team of researchers looked into links between depression and opioid misuse in patients who needed to take opioids for pain management.

Kaiser Permanente – Northern California and the Group Health Cooperative provided the patient data for the study.

Researchers phone interviewed 1,334 patients with chronic opioid therapy (COT) for non-cancer pain. None of the patients had any history of substance abuse.

Each patient was evaluated for depression and asked three questions:

Did they take their opioid for any symptoms other than the physical pain the medication was prescribed for? Did they increase their doses themselves? Did they give or get opioids from others?

Patients who had depressive symptoms were 1.8 to 2.4 times more likely to misuse opioids by taking them for something other than their physical pain.

Patients with depressive symptoms were also 1.9 to 3.1 times more likely to increase their prescribed dosage without a doctor's approval.

Authors concluded that there was a link between patients with depressive symptoms who take opioids for COT and the misuse of opioids.

They suggested that prescribing healthcare professionals be aware of depressive symptoms as a risk factor for misuse of opioids, even when the patient has no history of substance abuse. 

This study was published in the July/August issue of Annals of Family Medicine. The study was funded by a grant from the National Institute for Drug Abuse, no conflicts of interest were found.

Reviewed by: 
Review Date: 
July 22, 2012
Last Updated:
March 22, 2013