Gender and the Association between Long-Term Prescription Opioid Use and New Onset Depression

5 years ago

Gender and the Association between Long-Term Prescription Opioid Use and New Onset Depression

Women have a higher prevalence of chronic non-cancer pain conditions and report more severe pain, yet, it is not known if the association between long term opioid analgesic use (OAU) and risk of a new depression episode (NDE) differs by gender. We analyzed patient data from the Veterans Health Administration (VHA; 2000 to 2012; n=70,997) and a large private-sector health care organization (2003 to 2012; n=22,981) to determine whether long-term OAU and risk of NDE differed by gender. Patients were free of depression and OAU for two years prior to baseline. OAU duration was defined as 1-30, 31-90 and >90 days, and NDE was defined by ICD-9 codes. Gender-stratified Cox proportional hazard models estimated hazard ratios. Propensity scores and subsequent inverse probability of treatment weighting controlled for confounding. In the VHA, >90 compared to 1-30 day OAU was more strongly associated with NDE among females than males (female: HR=1.79; 95%CI:1.45-2.22 vs. male HR=1.25; 95%CI:1.16-1.34, p=0.002). In private sector patients, there was no gender difference in the association between >90 day OAU and NDE (female HR=1.97; 95%CI:1.64-2.37 vs. male HR=1.99; 95%CI:1.44-2.74). Risk of NDE following long-term OAU is similar in men and women in private-sector patients but may differ for VHA patients. Future prospective studies are needed to identify mechanisms for the association between longer OAU and NDE.

Perspective

Existing research is mixed regarding gender differences in outcomes following long-term prescription opioid use. This study found both genders have increased risk of a new depression episode following >90 day opioid use. Women and men may benefit from closer monitoring of mood associated with chronic opioid use.

Publisher URL: www.sciencedirect.com/science

DOI: S1526590017307307