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Prescription opioid use disorders are the second most common drug use disorder behind only cannabis use disorders. Despite this, very little is known about the help-seeking behavior among individuals with these disorders.
Unadjusted and adjusted hazard ratios are presented for time to first treatment-seeking by sociodemographic characteristics and comorbid psychiatric disorders. Having an earlier onset of prescription opioid use disorder and a history of bipolar disorder, major depression disorder, specific phobia and cluster B personality disorders predicted shorter delays to treatment. Although some comorbid psychiatric disorders increase the rate of treatment-seeking and decrease delays to first-treatment contact rates of treatment-seeking for prescription drug use disorder are low, even when compared with rates of treatment for other substance use disorders.
Given the high prevalence and adverse consequences of prescription drug use disorder, there is a need to improve detection and treatment of prescription opioid use disorder.
Although the therapeutic use of the opioids in the management of pain has long been established and opioids may even be underutilized at times Ballantyne, ; Trescot et al. It is estimated that the month prevalence of prescription opioid use disorders is 0. Prescription opioid use disorders represent the second most common drug use disorders, behind only cannabis use disorders, 1. Prescription opioid use disorders are associated with increased risk of several psychiatric and general medical disorders including cardiac arrhythmias and respiratory depression.
Prescription opioid use disorders also lead to substantial impairment in daily functioning and an increased risk of premature death Huang et al.
Probability and predictors of treatment-seeking for prescription opioid use disorders: a national study
In a claims-based analysis of 2 million employees and their dependents, individuals treated for opioid use disorders, including abuse and dependence, incurred 8. Despite the rising prevalence and extensive personal burden and societal costs, little is known about the timing and pattern of treatment-seeking for these disorders. A better understanding of the patterns and predictors of treatment-seeking for prescription opioid drug disorders is necessary to identify and address the modifiable barriers to treatment faced by this population Rogler and Cortes, Several studies have examined predictors of treatment-seeking of individuals with psychiatric disorders Adamson et al.
Among the common mental disorders, substance use disorders have the lowest probability of treatment contact during the first year following disorder onset and the longest delay from onset of the disorder to first treatment contact Olfson et al. In a community sample of adults with substance use disorders, approximately one-half of all lifetime cases had never established treatment contact. Lower rates of treatment for substance use disorders were associated with earlier age of disorder onset, male gender and racial-ethnic minority ancestry Kessler et al. Because these studies aggregated all drugs into a single analytic category, the specific patterns associated with prescription opioid use disorders remain unknown.
However, prior studies have suggested that the risk factors Blanco et al.
In the National Epidemiologic Survey on Alcohol and Related Conditions NESARCapproximately one quarter of respondents with prescription opioid use disorder reported having ever received drug abuse treatment at the time of the survey Blanco et al. analyses of the NESARC data or other epidemiological surveys have not examined delays to first treatment-contact, identified predictors of treatment-seeking, or estimated cumulative lifetime rates of treatment-seeking for prescription opioid drug disorder.
The primary goal of this study was to identify factors associated with delays in time to first treatment seeking for lifetime prescription opioid use disorder. A greater understanding of these factors may help inform service planning and help identify modifiable barriers to treatment access. Based on prior work Blanco et al. The target population of the — Wave 2 NESARC Grant, b, c was the civilian, non-institutionalized population 18 years and older, residing in households and group quarters e.
Blacks, Hispanics, and adults ages years were oversampled. Of the 43, respondents interviewed at Wave 1, 34, respondents Sample weights were developed to adjust for the sampling de as well as Wave 2 non-response.
Once weighted, data are representative of the US population for region, age, sex, race, and ethnicity. There were no ificant differences between Wave 1 and 2 respondents in terms of several baseline Wave 1 socio-demographic measures or the presence of any lifetime substance, mood, anxiety or personality disorder Grant, b. This structured interview was deed for administration by experienced professional lay interviewers.
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Wave 1 lifetime personality disorders assessments Cottler et al. Respondents were asked a series of DSM-IV personality disorder symptom questions about how they acted throughout their lives in different situations. To receive a DSM-IV diagnosis, respondents had to endorse the requisite of DSM-IV symptoms for the particular personality disorder and at least one symptom must have caused social or occupational dysfunction. Nationally representative samples seldom assess personality disorders but recent work suggests they have been important predictors of treatment-seeking Olfson et al.
Lifetime onset of substance use disorders and other axis I disorders were determined retrospectively by the earliest age in years at which respondents reported meeting criteria for each disorder. Respondents with a lifetime diagnosis of prescription opioid drug use disorder were also asked whether they had ever in their life seen a general medical, mental health, or human service professional for prescription opioid drug use disorders.
Affirmative responses were followed by a question to assess the age at which the respondent had first contacted a professional for prescription opioid drug use disorders. These two questions were used to determine the occurrence and timing of first treatment contact. Descriptive statistics of lifetime treatment seeking among individuals with prescription opioid use disorder, stratified by characteristics at time of assessment disorder a.
To assess the effects of sociodemographic and clinical characteristics on time to first prescription opioid treatment seeking, survival analysis with time-varying covariate models were performed. Retrospective follow-up time started at age of prescription opioid drug use disorder onset and terminated at age of first treatment contact. Personality disorders, divided in Cluster A, Cluster B and Cluster C, were coded as lifetime disorders with onset at age The median delay to Bf seeking wm lm am among those who sought treatment was 3.
There was no ificant difference in rates of treatment-seeking between males and in females OR: 0. In the unadjusted model, males HR: 0.
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After adjusting for potentially confounding effects of the other covariates, ificantly shorter delays in first prescription opioid drug use disorders treatment seeking were associated with being Asian HR: 5. Survival analysis of sociodemographic characteristics on the time to seeking treatment for major depressive disorder, unadjusted and adjusted analyses ab. Among those who sought treatment, the median delay from disorder onset to first treatment contact was 3. Having an Bf seeking wm lm am onset of prescription opioid use disorder and a history of psychiatric comorbidity including bipolar disorder, MDD, specific phobia or a cluster B personality disorder predicted shorter treatment delays to first treatment contact for prescription opioid use disorder.
Because our study is the first one to examine the cumulative probability of treatment-seeking among individuals with prescription opioid use disorder, it is not possible to compare our estimates with those of similar studies. However, our suggest that treatment-seeking rates are low compared to rates for other mental disorders, including to other substance use disorders.
For example, Kessler et al. The NCS-R further revealed that the lifetime cumulative probabilities of treatment-seeking were lower for alcohol abuse However, median delay to treatment was shorter than the median treatment delay 6.
The comparatively low treatment rates among individuals with substance use disorders may be due to low perceived need of treatment Mojtabai et al. The reasons for the particularly low treatment rates for prescription opioid use disorder are unknown, but may be related to prescription drugs being perceived as less dangerous than illegal drugs or to people's concern that discussing concerns about potential prescription drug misuse with their doctor may endanger future prescriptions.
The shorter delay to treatment may also be related to their easier access to the health care system as compared with individuals with other substance use disorders. Regardless of the reason, the strong association between medical and non-medical prescription drug use Fenton et al. In addition, increasing rates of death from overdose of prescription opioids in the US Bohnert et al. Fortunately, a recent multi-site randomized trial of buprenorphine treatment for prescription opioid use disorder Weiss et al. We also found that several comorbid psychiatric disorders, including MDD, bipolar disorder or specific phobia, increased the probability of treatment-seeking and decreased delays to first-treatment contact for prescription opioid use disorders.
MDD and bipolar disorder are each associated with high rates of psychosocial disability, suicidal ideation and attempts Judd et al.
The reasons that comorbid specific phobia also increases prescription opioid use disorders treatment seeking are not known, but this finding is consistent with recent from the World Mental Health Survey suggesting that specific phobia is an important predictor of later-onset internalizing disorders and may be an early-onset marker for further psychopathology Kessler et al.
It is possible that the impairment associated with specific phobia increases the likelihood of treatment seeking for prescription opioid use disorders. Cluster B personality disorders narcissistic, borderline, histrionic, and antisocial were also associated to shorter delays to treatment. The more emotional American Psychiatric Association, and action-oriented pattern behavior Fossati et al. Cluster B personality disorders have also been associated with greater severity of substance use Gibbie et al. A notable finding of this study was that earlier age of onset of prescription opioid use disorder was associated with a shorter delay to treatment, in contrast with findings in other disorders Kessler et al.
It is possible that this finding is due to greater contact with the health system among individuals with prescription opioid Bf seeking wm lm am disorders. It may also be related to lower degrees of perceived stigma associated with prescription opioid use compared to illicit drug use disorders Subramaniam et al. Because pain is more common at older ages, young individuals using prescription opioids may also be acutely aware of the unusual pattern of behavior represented by the need to take opioid analgesic medication from a young age.
They may also be more concerned than older-onset individuals about the potential for hyperalgesia that may be associated with long-term use of opioids Angst and Clark, ; Chu et al. Our findings have clinical and public health implications.
From the clinical point of view, our findings highlight the need when prescribing opioids to balance the needs to alleviate pain with the increased risk of substance dependence. Systematic clinical assessments at baseline of known risk factors for prescription opioid use disorder Huang et al. From the public health point of view, there is a need to train clinicians in appropriate use of opioids to avoid underuse, overuse or the possibility of medication diversion.
Educating patients and the general public about the short- and long-term risk and benefits of prescription opioids and the need to avoid their use by individuals to whom these medications were not prescribed may also help to decrease the rate adverse events associated with prescription opioids and save lives. The low rate of treatment-seeking documented by this study also indicates the need to facilitate treatment access for those patients. Due to complex management required for many of these patients, a better integration of primary care, mental health and substance abuse treatment seems essential for the appropriate care.
Educating clinicians and patients about the medical rather moral nature of prescription opioid use disorder and the availability and efficacy of its treatment may contribute to increase treatment-seeking.