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Despite Risks, High Rate of Opioid Prescriptions For People With Mental Health Conditions

David Kessler via Flickr

During the last 15 years, the number of opioids sold in this country has quadrupled, contributing to an epidemic of addiction and overdose that has ravaged communities in New Hampshire and across the country. 

A new study from Dartmouth-Hitchcock Medical Center sheds light on who is receiving prescriptions for these pills, and finds that an unexpectedly high percentage are going to people with mental health disorders, despite the elevated risks that opioids pose for these patients.

“More than half of all prescriptions being prescribed in the United States are going to patients with mental health disorders, and the reason why this is so striking is because adults with mental health disorders only represent 16% of the population,” explains Dr. Brian Sites, who co-authored the paper being published next month in the Journal of the American Board of Family Medicine. “So there is a big discrepancy.”

What Sites, in part, finds so alarming about the findings, is that there was a reasonable expectation that people with known mental health conditions, such as depression or anxiety, would actually receive far fewer of these prescriptions than the general population.

“There was some concern that patients with mental health disorders may be under-prescribed opioids because of the fear of potential addiction and other side effects,” says Sites, a professor at Dartmouth’s Geisel School of Medicine.

Instead, despite the well-understood potential for harm and overdose to these patients, there appears to be an overreliance on opioids, rather than doctors first opting for non-addictive painkillers or other non-pharmacological options.

The research paper does not examine why patients with mental health disorders are receiving higher rates of opioid prescriptions. Sites says more investigation is needed to understand the complex relationship between physical pain, mental health and prescribing habits.

One possible cause for the higher prescription rates, though, is how these patients talk about their physical pain with their physicians.

“Some patients, particularly with depression, feel more pain and are more likely to talk about the pain that they are in, than somebody who isn’t depressed,” says Joshua Cole,  a psychiatrist at Seacoast Mental Health in Portsmouth.

The result, Cole says, is an empathetic response from physicians.

“As a doctor you want to heal people, you want to take away pain and suffering, and if you have somebody who has an orthopedic problem, or some other real legitimate pain problem, opiates solve the problem, and traditionally that’s what we’ve used.”

Brian Sites from Dartmouth says his goal with this research is to get the medical community talking about the best way to treat patients with these complicated conditions. It’s not to eliminate an important tool for patients in real physical pain.

“I don’t want to suggest that we should cut off opioids to people who have mental health disorders. I want to make sure that is very, very clear,” he says.

There are times when opioids are absolutely the right choice, according to Sites. It just appears as though doctors are too often choosing them for vulnerable patients.

Todd started as a news correspondent with NHPR in 2009. He spent nearly a decade in the non-profit world, working with international development agencies and anti-poverty groups. He holds a master’s degree in public administration from Columbia University.

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