A staggering number of people with mental health conditions are prescribed opioids, according to a new study.

Researchers from Dartmouth-Hitchcock Medical Center and the University of Michigan found that 51 percent of painkiller prescriptions are distributed to those who have also been diagnosed with depression and anxiety.

The study authors are uncertain why people with these mental health disorders are using these medications more frequently, but they have a few theories: Physician behavior may play a big role, as well as general health issues that are often coupled with mental illness.

The study, which was published in the Journal of the American Board of Family Medicine, gathered and analyzed national health data of over 51,000 Americans to make up a representative sample of the American population. The data included a person’s health status (which includes any illnesses like mental health conditions), prescription pill use, level of pain and basic demographics like age, sex and race. 

The results are concerning for multiple reasons: Previous research shows people with mental health issues are at an increased risk for abusing prescription opioids, for starters. The Dartmouth study found that 38.6 million people had a mood disorder in America. That group received approximately 60 million prescriptions for painkillers a year.

“Having a mental health disorder simply increased the likelihood that you would walk away from your doctor’s office with an opioid prescription twofold,” senior study author Dr. Brian Sites, a professor at Dartmouth’s Geisel School of Medicine, told HuffPost. “A small group of patients is getting the bulk of the country’s opioids. And they’re a vulnerable group to start with.”

Why this could be happening

The findings also highlight the already complex opioid crisis, Sites said. Opioid prescriptions in the United States have quadrupled from 1999 to 2015, according to the most recent data from the CDC. More than 183,000 people in that time period died from overdoses on those medications. And a new estimate suggests 500,000 people will die from them over the next decade.

One theory as to why the mental health population is being prescribed opioids in such high numbers is that chronic pain, which painkillers are often used to treat, increases the risk of depression and anxiety. So those who may be suffering from conditions like fibromyalgia or endometriosis may be using prescription medications to abate the pain of their disorders, and they also may be dealing with mental health issues related to those illnesses.

However, Sites said, the researchers did control the study for pain. Even if that element was removed, they still found a relationship between mental health issues and a higher number of prescription opioids.

A small group of patients is getting the bulk of the country’s opioids. And they’re a vulnerable group to start with.
Dr. Brian Sites, senior study author

Another, stronger guess Sites has as to why this trend is occurring is that doctors may be overcompensating for the symptoms of mental health issues. For example, a patient may come in describing the physical effects of mental illness ― painful headaches, extreme stress ― and the physician may prescribe painkillers as a short-term fix.

Sites says these medications can have an antidepressant effect for a brief period of time, but aren’t solutions for the longterm. However, patients may come back to their doctor for continued refills, and the physician may feel empathetic to their issues and give them the painkillers.

“This is a doctor event. These pills aren’t coming from a drug cartel,” Sites said. “This is about our health system and how we prescribe opioids.”

It’s important to note that these conjectures weren’t fully explored in this particular study, but they could provide some framework for future research, Sites said.

There are also some key limitations with the study: The data is observational, so there’s no real way of determining a cause and effect between mental health issues and opioid use. It’s also undetermined whether these opioid prescriptions were for health complaints related to mental illness or if they were for other issues. 

What can be done to fix the problem

The biggest takeaway from this data from a mental health perspective is that there needs to be more integration between primary care practices and behavioral health practices.

This includes having specialists available to offer treatment methods, such as cognitive behavioral therapy, specifically targeted for mental illness. That could mean the effects of these disorders can be managed more quickly because mental health professionals are readily available in the doctor’s office to help.

“Right now, if a doctor is meeting a patient and they have eight other patients waiting, the easiest, tactical thing to do is write a prescription,” Sites said. “But if you try to get involved with some of these other alternative therapies, it’s very hard. So we have to break those barriers down.”

Research also shows that patients are more likely to take such medications when there aren’t specialists nearby. A study published earlier this year found that the number of seniors in rural America who take at least three prescribed psychotropic drugs ― which includes opioids and antidepressants ― tripled over a recent nine-year period. The study showed that many of these prescriptions were given without a proper diagnosis.

This is a doctor event. These pills aren’t coming from a drug cartel.

Ultimately, Sites hopes the Dartmouth results prompt more research on mental health. The study may also serve as a wakeup call for both doctors and policy makers.

“We need to reduce the U.S. dependency on prescription opioids,” Sites said. “Social policy and political leaders, as well as physicians, need to help build an infrastructure to better diagnose and treat both pain and mental illness.”

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