Associations between elevated depressive symptoms and substance use, prescription opioid misuse, overdose history, pain, and general health among community pharmacy patients prescribed opioids

Abstract

Background: Individuals with pain prescribed opioids experience high rates of comorbid depression. The aim of this study was to characterize pain, substance use, and health status as a function of depressive symptom level in individuals filling an opioid prescription at a community pharmacy. Methods: Participants (N = 1268) filling an opioid prescription enrolled in a study validating a prescription drug monitoring metric completed an online survey assessing sociodemographics, depressive symptoms, substance use, prescription opioid misuse, overdose history, general health, and pain severity and interference. Results: Approximately one-fifth (19.3%) had a positive depression screen result. In covariate-adjusted logistic regression analyses, individuals with a positive depression screen result were more likely to have moderate/high substance use risk scores for prescription opioids (adjusted odds ratio [AOR] = 2.06; 95% confidence interval [CI], 1.51–2.79); street opioids (AOR = 7.18; 95% CI, 2.57–20.01); cannabis (AOR = 2.00; 95% CI, 1.34–3.00); cocaine (AOR = 3.46; 95% CI, 1.46–8.22); tobacco (AOR = 1.59; 95% CI, 1.18–2.15); methamphetamine (AOR = 7.59; 95% CI, 2.58–22.35); prescription stimulants (AOR = 2.95; 95% CI, 1.59–5.49); and sedatives (AOR = 3.41; 95% CI, 2.43–4.79). Individuals with a positive depression screen were more likely to misuse prescription opioids (AOR = 3.46; 95% CI, 2.33–5.15), experience a prior overdose (AOR = 2.69; 95% CI, 1.76–4.11), report poorer general health (AOR = 0.25, 95% CI, 0.18–0.35), and report moderate/severe pain severity (AOR = 4.36, 95% CI, 2.80–6.77) and interference (AOR = 6.47, 95% CI, 4.08–10.26). Conclusions: Individuals prescribed opioids with heightened depression were more likely to report other substance use, prescription opioid misuse, prior overdose, greater pain, and poorer health.

Keywords:

• Prescription opioid use
• depression
• depressive symptoms
• substance use
• pain
• mental health
• overdose

Acknowledgments

The funder played no part in the conceptualization, execution, or authorship of this project or the decision to submit the manuscript for publication.

Disclosure statement

Dr Brown receives investigator-initiated support paid to the institution from Gilead Sciences, Inc. All other authors have no disclosures.

Additional information

Funding

This study was funded by the National Institute on Drug Abuse Clinical Trials Network (UG1DA013732; UG1DA049444).