Prescription Opiate Abuse: High-Risk Populations

Prescription opiate abuse is a significant problem in the United States.

I have previously written about this issue in several previous posts.

One important factor for clinicians and patients is the need to identify high-risk populations that may be more vulnerable to opiate abuse and dependence.

One obvious group would be those with alcohol or another non-opiate abuse diagnosis. Additionally, some psychiatric disorders are associated with increased risk for substance abuse including opiate abuse.

Given these high-risk markers, it would be encouraging if there would be evidence prescription opiate use is limited in those with substance abuse or a primary psychiatric disorder.

Unfortunately, there is not much evidence for restriction of opiate prescribing in high-risk populations.

Daniel Hackman and colleagues found the opposite finding in a study of patients with a substance abuse or primary psychiatric diagnosis in a dual diagnosis clinic.

Patients (N=201) in this clinic had prescription drug use reviewed for a period of 12 months and found the following key findings:

• Subjects received an average of 4.0 prescriptions for an opiate by medical personnel not associated with the dual diagnosis clinic
• These prescriptions resulted in the dispensing of an average of 213 opioid pills
• Concurrent benzodiazepine prescriptions were also common in this population
• Medicare or Medicaid coverage was associated with higher rates of opiate prescription compared to patients without insurance coverage

There are several take-home messages from this study.

First, some high-risk populations for opiate abuse seem to be more likely to get prescription opiates from a medical provider. From the current study, it does not appear clinicians are restricting prescription opiates to those most likely to misuse or abuse these drugs.

Second, concurrent benzodiazepine and opiate prescription use is common in this dual diagnosis group. This is important because accidental overdose deaths commonly find the combination of opiates and benzodiazepines in toxicology analysis.

I am not suggesting that no legitimate reasons exist for careful opiate prescription use for the treatment of pain in those with a dual diagnosis. However, this population needs to be carefully assessed and monitored when prescribing opiates in the clinical setting.

Readers with more interest in this topic can access the free full-text manuscript by clicking on the PMID link in the citation below.

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Hackman DT, Greene MS, Fernandes TJ, Brown AM, Wright ER, & Chambers RA (2014). Prescription drug monitoring program inquiry in psychiatric assessment: detection of high rates of opioid prescribing to a dual diagnosis population. The Journal of clinical psychiatry, 75 (7), 750-6 PMID: 25093472