Prescription opioid use and 12-month depression trajectories

Retrospective cohort studies indicate prescription opioids increase risk for depression. No prospective cohort studies have modeled prescription opioid use and depression trajectories. We determined whether daily vs. non-daily prescription opioid use was associated with more severe and worsening depression.

Participants with a new period of prescription opioid use were recruited from two health care systems. Those who enrolled were invited to complete twelve-monthly surveys over a year follow-up. Depression was measured with the PHQ-9, and opioid use was self-reported. From the 760 participants with 3 or more monthly surveys, we computed PHQ-9 latent growth trajectories. A 3-class solution best fit the data and revealed a severe-increasing depression trajectory, a moderate-stable, and a low-decreasing trajectory.

Participants were 53.6 ± 11.7 years of age, 68.5% were female and 70.5% identified as white race. Daily vs. non-daily opioid use was not significantly associated with depression trajectories. Higher emotional support (OR=0.92:95%CI:0.89-0.94) and ability to participate in social roles (OR=0.96; 95%CI:0.93-0.99) protected against, while pain related functional impairment (OR=1.39; 95%CI: 1.11-1.74), more pain sites (OR=1.20; 95%CI: 1.10-1.31) and smoking (OR=2.38; 95%CI:1.27-4.47) increased the likelihood of severe-increasing depression compared to low-decreasing depression.

The lack of an independent link between daily opioid use and worsening or more severe depression in this sample suggests that increased rates of depression in daily opioid-exposed patients may be a result of high risk patients receiving daily opioids rather than a direct effect of the opioid exposure. Screening for factors related to depression should improve safer opioid prescribing.