Pubdate: Mon, 10 Jul 2017
Source: Tennessean, The (Nashville, TN)
Copyright: 2017 The Tennessean


Adults with mental health disorders are consuming more than half of
all painkillers prescribed in the United States, according to a new

While adults suffering from depression, anxiety and mood disorders
represent just 16 percent of the nation's population, they received 51
percent of all opioid prescriptions.

Researchers at the University of Michigan and Dartmouth-Hitchcock
Medical Center said that rethinking pain management among this group
is "critical" to combat a growing national opioid addiction epidemic
- -- one that has hit Tennessee particularly hard.

Tennessee leads the nation in the number of opioid prescriptions per
person and has a five-year overdose death toll that has climbed to
6,036 people.

"When we got the results, we were completely shocked at the large
discrepancy in prescribing," said Dr. Brian Sites, an anesthesiologist
at the Dartmouth-Hitchcock Medical Center and a co-author of the study
published in the Journal of the American Board of Family Medicine.

"The sheer magnitude suggests the possibility of over-prescribing,"
Sites said. "There's just no way all these prescriptions are needed."

But the leader of Tennessee's Department of Mental Health and
Substance Abuse Services cautioned against drawing sweeping
conclusions or tailoring public policies around the conclusions of one

"If the study bears out with further research, our department will be
the first to say we want to develop ways in which we can serve that
population," said Marie Williams, the department's

"If it doesn't, we don't want to further stigmatize a group that is
already stigmatized."

Opioids were the number one substance abused in 2016 by individuals
with mental illness who were receiving services from the Department of
Mental Health and Substance Abuse Services, with alcohol a close second.

Williams noted the study did not focus on individuals known to be
abusing opioids. The study defined opioid users as anyone who had two
or more prescriptions per year. It also did not include people living
in institutions such as mental health facilities or jails.

Addiction treatment experts say they have long seen a correlation
between mental health disorders and substance abuse, but the study is
a first to put a number on those cases.

"The large number using opioids -- that's more than would have been
anticipated," said Dr. Karen Rhea, chief medical officer for
Centerstone, which treats more than 65,000 people in Tennessee at its
behavioral health centers.

Rhea said chronic physical pain among people with depression and
anxiety is a real problem, not a phantom one, she said.

An internal analysis of Centerstone patient data found that chronic
pain was a risk factor for attempted or completed suicide, Rhea said.

The cause and effect may differ among individuals, she said. People
with back pain or those who suffered debilitating injuries may be at
risk for depression, while individuals who suffer anxiety can
experience so-called somatic disorders, which are symptoms of physical
pain exacerbated by intense anxiety about that pain.

Sites, the study researcher, said while more research is needed, one
key to solving it is clear.

"This isn't a drug cartel problem," he said. "This is a physician
prescribing problem. We know where it starts."

But Shumaker said physicians need more tools to help patients with
chronic pain and those at risk for addiction.

Although mandatory training is now required for medical professionals
who prescribe opioids, Shumaker said the group would be working in the
coming year to provide education to both doctors and their patients to
help them manage "complex medical conditions while managing pain with
alternative treatment models."

Meanwhile, there are efforts underway in Tennessee aimed specifically
at people with "dual diagnoses" -- those with mental health illness
and addiction.

Centerstone in February launched an anxiety recovery program aimed at
educating patients with chronic anxiety about how it interacts with
physical pain, Rhea said.

And the Department of Mental Health and Substance Abuse Services has
launched an initiative with the Tennessee Hospital Association to
create a protocol for emergency rooms that identify people with
anxiety or depression and treat them for those conditions, rather than
prescribing opioids.
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