Medical Research: What is the background for this study? What are the main findings?
Dr. Gupta: Opioid (narcotic) analgesics (OA) are FDA-approved primarily for the symptomatic relief of pain in acute and chronic conditions. The prescription rates of Opioid analgesics in the US have increased significantly since 1989, and their possible inappropriate use has been declared a public health concern. We have recently reported (GuptaMA et al. J Dermatol Treat, 2014) that the use of Opioid analgesics in primarily skin disorders (with no reported non-dermatologic comorbidities) has increased from 1995-2010. Skin disorders are associated with psychiatric pathology in up to 30% of cases. Psychiatric disorders have been associated with an increased use of Opioid analgesics and other potentially addictive drugs. We examined psychiatric disorders, comorbidities and psychotropic drugs in patient visits with skin disorders and Opioid analgesics use (‘Skin Disorders+OA’).
We examined nationally representative cross-sectional data collected between 1995-2010 by the NAMCS and NHAMCS. Up to 3 ICD9-CM diagnoses are coded for each patient visit; the following codes were used to create the ‘Skin Disorders’ variable: ICD9-CM codes 680-709 ‘Diseases of the Skin and Subcutaneous Tissue’ and ICD9-CM codes 172, 173, 216 and 232 for cutaneous malignancies. Ambulatory Care Drug Database System drug codes were used for creation of variables for Opioid analgesics and other psychotropics.
Medical Research: What should clinicians and patients take away from your report?
Dr. Gupta: There were 6659 (3.8% ± 0.2% skin disorders) patient visits with Opioid analgesics use and 171 (3.5% ± 0.5%) were associated with a psychiatric disorder (ICD9-CM codes 290-319). Logistic regression analysis using ‘Skin Disorders+OA’ versus ‘Skin Disorders-OA’ (skin disorders without OA use) as dependent variable revealed that comorbid Psychiatric Disorders (OR=1.68, 95%CI1.17-2.41), independent of sex (OR=1.05, 95%CI 0.95-1.17), age (≥40 versus <40 years)(OR=1.33,95%CI1.17-1.52), race (‘non-white’ versus ‘white’)(OR=1.49,95%CI1.25-1.77), and other significantly associated comorbidities including Hematologic (OR=2.72,95%CI 1.33-5.54), Cardiovascular (OR=1.34,95%CI1.04-1.73), Digestive (OR=1.88,95%CI1.31-2.71), Musculoskeletal (OR=3.62, 95%CI 2.98-4.41), Injuries (OR=2.40,95%CI 1.88-3.06) and Ill-defined Symptoms (OR=1.50, 95%CI 1.18-1.91), were significantly associated with Opioid analgesics use in skin disorders as were psychotropic drugs such as benzodiazepines (OR=5.20,95%CI 3.94-6.85), antipsychotics (OR=4.40,95%CI 2.66-7.28) and antidepressants (OR=3.45,95%CI 2.70-4.42).
Skin disorders patient visits associated with the use of an Opioid analgesics, were more likely to have a comorbid psychiatric disorder, even after controlling for demographic factors and other non-dermatologic comorbidities. Comorbid psychiatric disorders can increase the overall morbidity associated with dermatologic conditions. Psychotropic drugs such as benzodiazepines, that can result in serious interactions (eg., respiratory depression) with Opioid analgesics, or antipsychotics whose side-effects (eg., metabolic syndrome) may complicate the course of certain dermatologic disorders, were also significantly more frequently used in skin disorders patients using Opioid analgesics.
Higher Frequency of Psychiatric Comorbidity and Psychotropic Drug Use in Patient Visits with Skin Disorders and Opioid Analgesics Use: Results from a Nationally Representative US Sample
Madhulika A. Gupta, Aditya K. Gupta, Branka Vujcic
MedicalResearch.com Interview with: Madhulika A. Gupta MD (2015). Opioid Analgesics Prescribed In Patients With Skin Disorders and Psychiatric Diagnoses