It is becoming more apparent that pain medications may be dangerous for more than one reason. According to the National Institute of Mental Health, suicide rates across the country have increased by 24% from 1999-2014.(1) While numerous biopsychosocial, environmental, and sociocultural factors can increase the risk of suicide, the top biopsychosocial cause of suicides and attempted suicides is depression.(2)
The climb in suicide rates in America is taking place concurrent with the rise of the over-prescription of opioid drugs. Previous studies have shown a correlation between opioid use and suicide-attempts and mortality.(3) Correlation does not mean causation. Opioids may cause depression and suicide, or depression may cause opioid use and suicide. What is clear is that the relationship between depression and opioids requires special attention from treating physicians.
A study, “Reducing Disability Durations and Medical Costs for Patients with a Carpal Tunnel Release Surgery Through the use of Opioid Prescribing Guidelines”, published in the Journal of Occupational and Environmental Medicine (JOEM) made two very important discoveries:
- 29% of cases observed, with a diagnosis of Carpal Tunnel Release surgery, were prescribed an opioid contrary to evidence-based medicine (EBM) clinical practice guidelines; and
- Depression was the most common risk factor for opioid abuse observed in the study population.(4)
This means that nearly 1 out of every 3 cases received a prescription for opioids inappropriately for this medical condition; nearly one-third of the study population experienced their first exposure to opioids unnecessarily and may have been subject to an increased risk of depression as a side-effect.
A new research brief by ReedGroup Epidemiologist, Fraser Gaspar, PhD, MPH, emphasizes that depression, the world’s number one cause of disability, may not be trending in the right direction for patients in the acute and continuation phase due to lower rates of adherence to treatment.(5) These are disturbing trends that can only exacerbate the suicide rate.
This is not a campaign to encourage a complete blockade on pain medications. It is, however, a plea to society to urge medical professionals to rely more heavily on treatment that is supported by high quality evidence-based medicine.
Roman Kownancki, MD, Kaiser Permanente, acknowledged at HIMSS 2018 that at one point, providers in their system prescribed opioids to more than half of their patients.(6) In order to reset provider prescribing behavior, Kownacki and team streamlined the data that was being presented to physicians at the point of care through Clinical Decision Support (CDS) tools.
Access to trustworthy evidence-based medical practice and prescribing guidelines, applicable depression screening tools like the PHQ-9, and patient questionnaires made a significant difference helping to decrease new opiate prescriptions by 75%. The best part of the experience was that no adverse outcomes resulted in terms of cases being prolonged according the Kaiser’s data.
Individuals grappling with depression experience substantial impairment, reduced quality of life, and decreased productivity at home and at work. As a society we must place more emphasis on the behaviors exhibited by patients and providers in the clinic. Education, high quality evidence-based tools, and careful measure along the way will help us turn the tide on the opioid epidemic, lower depression rates, and save lives from self-inflicted harm.
- National Institute of Mental Health. “Suicide Rates; Trends over time”. NIMH.NIH.Gov. November 2017. Web. 2018. https://www.nimh.nih.gov/health/statistics/suicide.shtml
- Healthline. “Suicide and Suicidal Behavior”. Healthline.com. 2018. Web. https://www.healthline.com/health/suicide-and-suicidal-behavior#causes
- Ilgen MA, Bohnert AS, Ganoczy D, Bair MJ, McCarthy JF, Blow FC. “Opioid dose and risk of suicide.” Pain. 2016 May;157(5):1079-84. doi: 10.1097/j.pain.0000000000000484. PubMed PMID: 26761386; PubMed Central PMCID:PMC4939394.
- Gaspar FW, Kownacki R, Zaidel C, Conlon CF, Hegmann KT. JOEM. “Reducing Disability Durations and Medical Costs for Patients with a Carpal Tunnel Release Surgery Through the Use of Opioid Prescribing Guidelines”. JOEM Vol. 59, Number 12. Web. December 2017. https://journals.lww.com/joem/Fulltext/2017/12000/Reducing_Disability_Durations_and_Medical_Costs.8.aspx#O23-8
- Gaspar F. ReedGroup, Ltd. “Research Brief: The Negative Relationship between Depression Severity and Antidepressant Adherence.” ReedGroup.com. February 2018. Web. 20 February 2018. https://reedgroup.com/2018/02/20/research-brief-negative-relationship-depression-severity-antidepressant-adherence/
- Castles T. Healthcare Analytics News. “Health IT’s Role in the Opioid Epidemic? Get the Right Data to Providers at the Right Time”. March 2018. Web. 09 March 2019. http://www.hcanews.com/news/health-its-role-in-the-opioid-epidemic-get-the-right-data-to-providers-at-the-right-time