Weekly Mind Reader: The Numbers Tell A Different Story About Opioid Use Disorder

This week starts with a critical examination of the numbers behind opioid use disorder, follows that up with a deep dive into mild cognitive impairment, and concludes with a roundup of bipolar disorder research.

Study Reveals Most Prescription Opioid Use Disorder Cases in 2021 Didn’t Involve Misuse

Researchers have long sought to mitigate the risks tied to prescription opioids, particularly overdose deaths. Despite leveling off over the past decade, prescription opioids still accounted for 20.7 percent of opioid-related overdose deaths in 2021.

Historically, the medical community has blamed prescription opioid use disorder (POUD) for most cases of opioid misuse. As a result, public health efforts have targeted misuse in the first place.

However, POUD can also develop in individuals using prescription opioids as directed by a clinician, as illustrated in the 2021 National Survey on Drug Use and Health (NSDUH). This survey, for the first time, assessed POUD among all individuals using prescription opioids, regardless of misuse.

An analysis of this study, appearing in this week’s Journal of Clinical Psychiatry, revealed that 27 percent of U.S. adults used prescription opioids in the past year, with 12.1 percent misusing them. And 7 percent went on to develop POUD. Notably, POUD was 4.5 times more prevalent among those misusing opioids compared to those who didn’t.

The survey also found that 62 percent of adults with POUD didn’t report misuse. That implies that a sizable portion of this population might be overlooked in clinical settings.

The study pointed to higher POUD prevalence among older adults, Medicaid beneficiaries, and individuals with disabilities or certain health conditions. It also found that individuals with POUD, regardless of misuse, typically didn’t receive treatment.

The findings suggest that focusing solely on misuse overlooks many adults with POUD who still need treatment.

The paper’s authors also insist that it’s crucial to screen and treat POUD among all adults using prescription opioids. This includes the incorporation of a comprehensive plan that addresses pain, co-occurring substance use, and mental health challenges. This broader approach could improve prevention efforts, treatment, and recovery options.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

• The Primary Care Companion for CNS Disorders published original research this week that estimates the prevalence of mild cognitive impairment (MCI), assesses its clinical presentation and outcomes, and identifies factors for reversion to baseline.
• In a JCP commentary piece, Drs. Rush and Tramontin discuss how simple outcomes, often patient-reported, could facilitate evidence-based decision-making by clinicians, administrators, and payors and provide the foundation for a learning healthcare system.
• In a PCC letter to the editor, one reader offers a mnemonic device to help clinicians obtain a psychiatric history.
• The pandemic increased our collective focus on mental health, driving research into conditions such as bipolar disorder.
• Finally, a paper in PCC addresses the question: Ever wonder how the neuropsychiatric sequelae of traumatic brain injuries (TBIs) can be managed?