CHILD AND FAMILY HEALTH
Authors: Agbese E. , Stein B. , Dick A. , Druss B. , Sorbero M. , Liu G. , Leslie D. 
Published: August 2020

Research Objective

Opioid misuse, which frequently begins in adolescence, is a leading cause of unintentional injury and death among adolescents and young adults. While high rates of comorbid mood and anxiety disorders have been associated with opioid‐related problems (ORPs), studies have not examined treatments for these comorbid conditions, especially those that occur before the ORP diagnosis.

Study Design

Using a large national claims database, we identified individuals with an ORP in 2013 using International Classification of Diseases, Ninth Revision (ICD‐9) diagnosis codes. To adequately assess pre‐existing mental health diagnoses and treatments, we limited our sample to those continuously enrolled in the database for at least 24 months prior to their index ORP diagnosis date with no diagnoses for an ORP (N = 9,055). Using ICD‐9 codes, we identified mental health conditions present in the pre‐diagnosis period (attention‐deficit/hyperactivity disorder (ADD/ADHD), anxiety, conduct disorder, depression, personality disorder, other substance use disorder, and other mental health conditions). Procedure codes and pharmacy claims were used to identify receipt of mental health treatment. In addition, we calculated medication possession ratios (MPRs), defined as the total days a medication was dispensed to patients divided by the study period, for antidepressants, antipsychotics, and ADD/ADHD medications. We considered an MPR value greater than or equal to 0.80 adherent.

Population Studied

Patients 12‐25 years old enrolled in a private insurance plan and diagnosed with an opioid‐related problem in 2013.

Principal Findings

Overall, 55.2% (4998) of the cohort had a pre‐existing mental health condition. Diagnoses of depression (25.6%), anxiety (21.1%), and other substance use disorders (20.3%) were common. More than half of those diagnosed with a mental health condition (63.8% or 3,186) received any outpatient behavioral therapy. Among those who did, the average number of therapy visits was 14.06 (±21.25) out of the overall 31.49 (±33.06) outpatient visits in the two‐year period. Over half (2,933 or 58.68%) received any pharmacotherapy for their mental health conditions, with compliant patients ranging from 13.8% to 32.9% in the year preceding the ORP diagnosis, to 7.0% to 19.2% in the two years preceding the ORP diagnosis for the medication classes.

Conclusions

In a cohort of privately insured adolescents and young adults with ORP, pre‐existing mental health conditions were quite common (55.2%), with a high proportion (82.3%) receiving any treatment for their mental health conditions (behavioral therapy or pharmacotherapy). However, the frequency and duration of these treatments were low—less than 50% were considered adherent for any of the studied medication classes and behavioral treatment visits averaged 1 visit every other month for the two years preceding the ORP diagnosis.

Implications for Policy or Practice

The results of this study may inform clinicians, public health professionals, and policymakers about possible treatment gaps and opportunities that would be helpful in addressing the opioid crisis.

Primary Funding Source

National Institutes of Health.