The association of opioid use duration and new depression episode among patients with and without insomnia

Joanne Salas, MPH; Mary Beth Miller, PhD; Jeffrey F. Scherrer, PhD; Rachel Moore, MS; Christina S. McCrae, PhD; Mark D. Sullivan, MD, PhD; Kathleen K. Bucholz, PhD; Laurel A. Copeland, PhD; Brian K. Ahmedani, PhD; F. David Schneider, MD; Patrick J. Lustman, PhD

doi:10.5055/jom.2020.0587

Authors

Joanne Salas, MPH
Mary Beth Miller, PhD
Jeffrey F. Scherrer, PhD
Rachel Moore, MS
Christina S. McCrae, PhD
Mark D. Sullivan, MD, PhD
Kathleen K. Bucholz, PhD
Laurel A. Copeland, PhD
Brian K. Ahmedani, PhD
F. David Schneider, MD
Patrick J. Lustman, PhD

DOI:

https://doi.org/10.5055/jom.2020.0587

Keywords:

insomnia, pain, opioid, depression, retrospective cohort

Abstract

Objective: Insomnia commonly co-occurs with depression, chronic pain, and opioid use. Both insomnia and chronic opioid analgesic use (OAU) are independent risk factors for a new depression episode (NDE). This study determined if the association between longer OAU duration and NDE was stronger in those with versus without insomnia.

Design: Retrospective cohort.

Setting: Veterans Health Administration electronic medical records (2000-2012).

Participants: New opioid users in follow-up (2002-2012), free of depression for two years prior to follow-up, and aged 18-80 (n = 70,997).

Methods: NDE was ≥ 2 ICD-9 codes in a 12-month period. Insomnia before OAU initiation was ≥1 ICD-9 code. Cox proportional hazard models stratified on insomnia assessed the relationship between initiating a 1-30, 31-90, or > 90 day period of OAU and NDE while controlling for confounders using inverse probability of treatment-weighted propensity scores (PS).

Results: Compared to 1-30 day OAU, 31-90 day was associated with NDE in those without (HR = 1.20; 95 percent CI: 1.12-1.28) but not with insomnia (HR = 1.06; 95 percent CI: 0.86-1.32). Results showed a stronger effect of chronic (>90) OAU in those with insomnia (HR = 1.59; 95 percent CI: 1.27-1.98) compared to those without (HR = 1.31; 95 percent CI: 1.21-1.42). However, all stratum-specific effects were not significantly different (p = 0.136).

Conclusions: Although stratum-specific risks were statistically similar, there was evidence for a trend that chronic OAU is a stronger risk factor for NDE in those with versus without insomnia. Providers are encouraged to monitor sleep impairment among patients on opioid therapy, as sleep may be associated with greater risk for NDE in patients with chronic OAU.

Author Biographies

Joanne Salas, MPH

Senior Biostatistician, Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Harry S. Truman Memorial Veterans’ Administration Medical Center, Columbia, Missouri

Mary Beth Miller, PhD

Assistant Professor, Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri

Jeffrey F. Scherrer, PhD

Associate Professor, Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Harry S. Truman Memorial Veterans’ Administration Medical Center, Columbia, Missouri

Rachel Moore, MS

Research Assistant/Doctoral Student, Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri

Christina S. McCrae, PhD

Professor, Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri

Mark D. Sullivan, MD, PhD

Professor, Department of Psychiatry and Behavioral Health, University of Washington School of Medicine, Seattle, Washington

Kathleen K. Bucholz, PhD

Professor, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri

Laurel A. Copeland, PhD

Associate Professor, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts

Brian K. Ahmedani, PhD

Clinical Associate Professor, Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan; School of Social Work, Michigan State University, East Lansing, Michigan

F. David Schneider, MD

Professor and Chair, Department of Family and Community Medicine, University of Texas Southwestern, Dallas, Texas

Patrick J. Lustman, PhD

Professor, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; The Bell Street Clinic, VA St. Louis Health Care System—John Cochran Division, St. Louis, Missouri

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