The Prescription Opioids and Depression Pathways Cohort Study

Area of Science:

• Medical research
• Clinical psychology
• Public health

Background:

• Previous studies suggest chronic opioid analgesic use (OAU) is linked to new depressive episodes and worsening depression.
• Existing evidence relies on retrospective data, limiting causal inference.
• A prospective cohort study addresses these limitations to examine the opioid-depression relationship.

Purpose of the Study:

• To prospectively investigate the association between chronic opioid analgesic use (OAU) and new depressive episodes.
• To explore the role of impaired functioning and social support in this relationship.
• To inform clinical practice regarding depression as a potential adverse effect of OAU.

Main Methods:

• A prospective cohort of 1500 adult patients with 30-90 days of OAU at baseline.
• Data collection includes diagnostic assessments, pain and functioning measures, and assessments of social support, sleep, and impulsivity at baseline and follow-up.
• Robust control for confounding by indication and detailed phenotyping of depression and opioid use disorder.

Main Results:

• Anticipated finding: Chronic OAU will be associated with a new depression phenotype, including anhedonia and somatic symptoms.
• This association is expected to be partly mediated by impaired functioning and low social support.
• The study aims to establish a clearer link between OAU and depression, independent of pain severity.

Conclusions:

• Despite decreased opioid prescriptions, millions still use them annually.
• If chronic OAU causes clinically significant affective disorders independent of pain, depression should be considered an adverse effect.
• Clinical care for chronic pain management needs to consider and adjust for potential depression associated with OAU.