Citation

Olfson M, Wall M, Wang S, Crystal S, Blanco C. Am. J. Psychiatry 2018; 175(6): 538-544.

Affiliation

From the Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York; Quartet Health, New York; the Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick; and the Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Md.

Copyright

(Copyright © 2018, American Psychiatric Association)

DOI

10.1176/appi.ajp.2017.17070808

PMID

29179577

Abstract

OBJECTIVE: This study analyzed health service patterns before opioid-related death among nonelderly individuals in the Medicaid program, focusing on decedents with and without past-year diagnoses of noncancer chronic pain.

METHODS: The authors identified opioid-related decedents, age ≤64 years, in the Medicaid program and characterized their clinical diagnoses, filled medication prescriptions, and nonfatal poisoning events during the 30 days and 12 months before death. The study group included 13,089 opioid-related deaths partitioned by presence or absence of chronic noncancer pain diagnoses in the last year of life.

RESULTS: Most decedents (61.5%) had received clinical diagnoses of chronic noncancer pain conditions in the last year of life. As compared with decedents without chronic pain diagnoses, those with these diagnoses were significantly more likely to have filled prescriptions for opioids (49.0% versus 17.2%) and benzodiazepines (52.1% versus 26.6%) during the last 30 days of life, while diagnoses of opioid use disorder during this period were uncommon in both groups (4.2% versus 4.3%). The chronic pain group was also significantly more likely than the nonpain group to receive clinical diagnoses of drug use (40.8% versus 22.1%), depression (29.6% versus 13.0%) or anxiety (25.8% versus 8.4%) disorders during the last year of life.

CONCLUSIONS: Persons dying of opioid-related causes, particularly those who were diagnosed with chronic pain conditions, commonly received services related to drug use disorders and mental disorders in the last year of life, though opioid use disorder diagnoses near the time of death were rare.

Language: en

Keywords

Chronic Pain Epidemiology; Drug Overdose Mortality; Epidemiology; Opioid Overdose; Opioid Poisoning; Opioid-Related Mortality; Psychoactive Substance Use Disorder