It is becoming more apparent that pain medications may be dangerous for more than one reason.

Carlos Luna

According to the National Institute of Mental Health, suicide rates across the country have increased by 24% from 1999-2014. While numerous biopsychosocial, environmental and sociocultural factors can increase the risk of suicide, the top biopsychosocial cause of suicides and attempted suicides is depression.

Coincidence?

The climb in suicide rates in America is taking place concurrent with the rise of the over-prescription of opioid drugs. Previous studies have shown a correlation between opioid use and suicide attempts/mortality.

Correlation does not mean causation. Opioids may cause depression and suicide, or depression may cause opioid use and suicide. What is clear is that the relationship between depression and opioids requires special attention from treating physicians.

A study, “Reducing Disability Durations and Medical Costs for Patients with a Carpal Tunnel Release Surgery Through the use of Opioid Prescribing Guidelines”, published in the Journal of Occupational and Environmental Medicine (JOEM), made two very important discoveries:

• 29% of cases observed, with a diagnosis of carpal tunnel release surgery, were prescribed an opioid contrary to evidence-based medicine (EBM) clinical practice guidelines.
• Depression was the most common risk factor for opioid abuse observed in the study population.

This means that nearly one out of every three cases received a prescription for opioids inappropriately for this medical condition. Nearly one-third of the study population experienced its first exposure to opioids unnecessarily and may have been subject to an increased risk of depression as a side effect.

A new research brief by ReedGroup epidemiologist Fraser Gaspar emphasizes that depression, the world's number one cause of disability, may not be trending in the right direction for patients in the acute and continuation phase due to lower rates of adherence to treatment.

These are disturbing trends that can only exacerbate the suicide rate.

The solution

This is not a campaign to encourage a complete blockade on pain medications. It is, however, a plea to society to urge medical professionals to rely more heavily on treatment that is supported by high quality evidence-based medicine.

Dr. Roman Kownacki of Kaiser Permanente acknowledged at HIMSS 2018 that at one point, providers in their system prescribed opioids to more than half of their patients.

In order to reset provider prescribing behavior, Kownacki and team streamlined the data that was being presented to physicians at the point of care through Clinical Decision Support (CDS) tools.

Access to trustworthy evidence-based medical practice and prescribing guidelines, applicable depression screening tools like the PHQ-9, and patient questionnaires made a significant difference helping to decrease new opiate prescriptions by 75%. The best part of the experience was that no adverse outcomes resulted in terms of cases being prolonged according Kaiser’s data.

Individuals grappling with depression experience substantial impairment, reduced quality of life, and decreased productivity at home and at work. As a society we must place more emphasis on the behaviors exhibited by patients and providers in the clinic.

Education, high-quality, evidence-based tools, and careful measure along the way will help us turn the tide on the opioid epidemic, lower depression rates and save lives from self-inflicted harm.

Carlos Luna is director of government affairs for ReedGroup, which publishes the American College of Occupational and Environmental Medicine treatment guidelines and drug formulary.