Researchers at the National Institute on Alcohol Abuse and Alcoholism observed a possible genetic link between major depression (MDD) and anxiety and stress-related disorders (ASRD) with increased prescription opioid use. These results were published in JAMA Psychiatry.
Data from 3 published genome-wide association studies (N = 737,473) were combined for this analysis. The relationship between self-reported use of pain relievers (opioids, salicylic acid, anilides, nonsteroidal anti-inflammatory drugs) [NSAIDs]) in individuals with MDD (n = 45,591) and ASRD (n = 12,665) was associated with the genetics of the disorders using a 2-sample Mendelian randomization approach.
The risk of opioid use was increased in people with MDD (inverse variance-weighted odds ratio) [IVW OR]1.14; 95% CI, 1.06-1.22; P <0.001) and ARSW (IVW OR, 1.24; 95% CI, 1.07-1.44; P = 0.004) in a one-variable model.
This increased risk was replicated in a multi-variable model (MDD: IVW OR, 1.14; 95% CI, 1.04-1.25; P = 0.005; ARSD: IVW OR, 1.30; 95% CI, 1.08-1.56; P =. 006).
Control for back-related pain, increased risk for MDD (IVW OR, 1.12; 95% CI, 1.05-1.21; P = 0.001) and ARSW (IVW OR, 1.26; 95% CI, 1.09 -1.45; P =. 002) remained significant.
Using a bidirectional single-variable approach in individuals with MDD, based on 92 single nucleotide variants (SNVs), the risk for opioid (IVW OR, 1.18; 95% CI, 1.08-1.30; P <0.001 ), Salicylic acid, increased (IVW OR, 1.10; 95% CI, 1.03-1.17; P = 0.002), anilide (IVW OR, 1.20; 95% CI, 1.00-1.28 ; P <0.001) and NSAIDs (IVW OR, 1.15; 95)% CI, 1.09-1.22; Use P <0.001).
Using the same bi-directional approach, no increased risk of opioid use was found in people with ARSW and based on 17 SNVs (IVW OR, 1.04; 95% CI, 0.97-1.12; P = 0.29), Salicylic acid (IVW OR) found 1.05; 95% CI, 0.99-1.11; P = 0.11), anilides (IVW OR, 1.02; 95% CI, 0.97-1.06; P = 0.43) or NSAIDs (IVW OR, 1.01; 95% CI, 0, 96-1.06; P = 0.80).
These results may have been limited by the study population, which was predominantly European, and therefore may not be generalizable to people with other ancestry.
These data suggest that clinicians may make important clinical considerations when prescribing opioids to patients with MDD or ASRD, as these patients may be at greater risk for increased opioid use.
Rosoff DB, Smith, GD, Lohoff FW. Prescription Opioid Use and Risk for Depression and Anxiety, and Stress-Related Disorders – A Multivariable Mendelian Randomization Analysis. JAMA psychiatry. Published online 11 November 2020. doi: 10.1001 / jamapsychiatry.2020.3554
This article originally appeared on Psychiatry Advisor