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History of Mental Health Conditions Increases Risk of Chronic Opioid Use Among Vets With RA

February 13, 2020

Veterans with rheumatoid arthritis (RA) who had a history of mental health conditions were at an increased risk of developing chronic opioid therapy, according to study findings published online in Clinical Rheumatology.  

“Patients with RA often receive opioid analgesics for pain management,” researchers explained. “We examined the association between mental health conditions and the risk of chronic opioid therapy. 

For the study, study authors used Veterans Health Administration databases (2001-2012) in order to identify a retrospective cohort of veterans with RA who initiated opioid use.  

Mental health conditions included anxiety (n = 1108, 12.9%), depression (n = 1912, 22.2%), bipolar disease (n = 131, 1.5%), and post-traumatic stress disorder (n = 768, 8.9%) and were identified by ICD coded diagnoses and use of specific medications,” they explained.  

The researchers observed study participants from opioid initiation through chronic opioid therapy—which was defined as the continuous availability of opioids for at least 90 days.

“Subgroup analyses examined whether the strength of the observed association varied by the duration of the initial opioid prescription,” study authors noted. 

Based on the criteria, 14,767 patients with RA with 22,452 episodes of opioid use initiation were identified. Additionally, mental health conditions were identified in 8607 (38.3%) of patients.  

Compared with patients who showed no signs of mental health conditions, the study findings showed that patients with mental health conditions are at a higher risk of developing chronic opioid therapy (469.3 vs 378.1 per 1000 person-years, adjusted hazard ratio [aHR] 1.18, 95% CI 1.09, 1.29). Notably, the study authors found that the risk was highest for patients with a history of opioid use disorder (aHR 1.94, 95% CI 1.09, 3.46) and also elevated for those with other substance use disorders (aHR 1.35, 95% CI 1.05, 1.73). 

The researchers found that regardless of the estimated daily dose, overall duration of the initial opioid prescription was independently linked with chronic opioid therapy.   

“History of mental health conditions and duration of the initial opioid prescription were associated with an increased risk of chronic opioid therapy among patients with RA,” they concluded.  

“Patients with RA and history of mental health disease, especially substance use disorders, who initiate opioid use have an increased risk of chronic opioid therapy. This study provides insight in an underrepresented population of mainly male patients with RA.

Julie Gould 


Liberman JS, D'Agostino McGowan L, Greevy RA, et al. Mental health conditions and the risk of chronic opioid therapy among patients with rheumatoid arthritis: a retrospective veterans affairs cohort study [published online ahead of print, 2020 Feb 8]. Clin Rheumatol. 2020;10.1007/s10067-020-04955-2. doi:10.1007/s10067-020-04955-2

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