Pathways between nonmedical opioid use/dependence and psychiatric disorders

Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Silvia S. Martins, Katherine M. Keyes, Carla L. Storr, Hong Zhu, Howard D. Chilcoat

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Background: While nonmedical use of opioids and psychiatric disorders are prevalent in the population, little is known about the temporal ordering between nonmedical opioid use and dependence and psychiatric disorders. Method: Data were gathered in a face-to-face survey of the United States conducted in the 2001-2002 (NESARC wave 1). Participants were household and group quarters residents aged 18 years and older (n = 43,093). Cox proportional hazards models with time-dependent covariates were used to investigate potential pathways between lifetime nonmedical opioid use/dependence and psychiatric disorders. Results: Preexisting psychiatric disorders (mood disorders, major depressive disorder, bipolar I disorder, anxiety disorders, panic and generalized anxiety disorders) were associated with an increased risk of nonmedical opioid use, with hazard ratios ranging from 2.2[95% CI = 1.6-3.1] (any anxiety disorder) to 3.1[95% CI = 2.4-2.4] (bipolar I disorder). Preexisting nonmedical opioid use was associated with an increased risk of onset of psychiatric disorders, with hazard ratios ranging from 2.8[95% CI = 2.2-3.6] (generalized anxiety disorder) to 3.6[95% CI = 2.6-4.9] (bipolar I disorder), adjusted for demographics and other illegal drug use. Nonmedical use of opioids led to the development of dependence more often among individuals with preexisting psychiatric disorders, hazard ratios were particularly strong for generalized anxiety disorder (HR = 10.8, 95% CI = 4.9-23.7) and bipolar I disorder (HR = 9.7, 95% CI = 5.4-17.3). Preexisting opioid dependence resulting from nonmedical opioid use was associated with an increased risk of onset of psychiatric disorders, with hazard ratios ranging from 4.9[95% CI = 3.0-7.9] (mood disorders) to 8.5[95% CI = 4.5-16.0] (panic disorder), adjusted for demographics and alcohol and/or other illegal drug dependence. Conclusions: Our findings support a general vulnerability to nonmedical opioid use and major psychopathologies, as well as evidence for a 'self-medication' model for dependence resulting from nonmedical opioid use with bipolar disorder and generalized anxiety disorder.

Original languageEnglish (US)
Pages (from-to)16-24
Number of pages9
JournalDrug and Alcohol Dependence
Volume103
Issue number1-2
DOIs
StatePublished - Jul 1 2009

Fingerprint

Opioid Analgesics
Psychiatry
Alcohols
Anxiety Disorders
Bipolar Disorder
Hazards
Preexisting Condition Coverage
Mood Disorders
Demography
Surveys and Questionnaires
Self Medication
Panic
Panic Disorder
Major Depressive Disorder
Psychopathology
Proportional Hazards Models
Pharmaceutical Preparations
Substance-Related Disorders

Keywords

  • Anxiety disorders
  • Mood disorders
  • Nonmedical opioid use
  • Opioid dependence resulting from nonmedical opioid use
  • Survival analysis

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Toxicology
  • Pharmacology
  • Pharmacology (medical)

Cite this

Pathways between nonmedical opioid use/dependence and psychiatric disorders : Results from the National Epidemiologic Survey on Alcohol and Related Conditions. / Martins, Silvia S.; Keyes, Katherine M.; Storr, Carla L.; Zhu, Hong; Chilcoat, Howard D.

In: Drug and Alcohol Dependence, Vol. 103, No. 1-2, 01.07.2009, p. 16-24.

Research output: Contribution to journalArticle

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