Matthew A. Davis, MPH, PhD, Lewei A. Lin, MD, Haiyin Liu, MA, and Brian D. Sites, MD, MS

Background: The extent to which adults with mental health disorders in the United States receive opioids has not been adequately reported.

Methods: We performed a cross-sectional study of a nationally representative sample of the noninstitutionalized U.S. adult population from the Medical Expenditure Panel Survey. We examined the relationship between mental health (mood and anxiety) disorders and prescription opioid use (defined as receiving at least 2 prescriptions in a calendar year).

Results: We estimate that among the 38.6 million Americans with mental health disorders, 18.7% (7.2 million of 38.6 million) use prescription opioids. Adults with mental health conditions receive 51.4% (60 million of 115 million prescriptions) of the total opioid prescriptions distributed in the United States each year. Compared with adults without mental health disorders, adults with mental health disorders were significantly more likely to use opioids (18.7% vs 5.0%; P < .001). In adjusted analyses, having a mental health disorder was associated with prescription opioid use overall (odds ratio, 2.08; 95% confidence interval, 1.83–2.35).

Conclusions: The 16% of Americans who have mental health disorders receive over half of all opioids prescribed in the United States. Improving pain management among this population is critical to reduce national dependency on opioids. ( J Am Board Fam Med 2017;30:000 – 000.)


This pretty well matches my experience as well.  Substance abuse is an interesting problem.  It’s hard to make a clear, conclusive diagnosis of any mental health disorder on those currently abusing drugs and/or alcohol; addiction can mimic any and all mental illnesses.  “Which came first, the chicken or the egg”?  Many of these folks self-treat their mental illness with obtainable drugs as well.  The only sure way of dealing with this conundrum is to get the patient off of their abused drugs, then re-evaluate after a year or so of abstinence and figure out what their mental health diagnosis’ are.  Medication-Assisted Treatment can be an essential part of that first step.  We frequently treat patients whose mental health improves and their need for medications and other forms of therapy diminish over time as they get deeper into recovery.  The 12-step recovery program steers folks toward greater mental health.  This is part of the miracle of addiction/recovery.  Numerous mental disorders can be diagnosed in any 12-step meeting.  All treated differently with medications.  All improve by being in the rooms of the 12-Step program and working the program under the direction of a sponsor.  When asked how the 12-Step Programs work, there’s only one obvious answer; “it’s a miracle!”

Dr. Raymond Oenbrink