Week 1 of a 5-Week Series on Opioid and Mental Health Education for Medical Providers

Importance of Addressing Opioid Education and Mental Health Together

The importance of addressing opioid misuse and mental health together cannot be overstated. With opioid addiction being a significant public health crisis, it is essential to recognize the intertwined relationship between substance use disorders (SUD) and mental health conditions. Understanding this relationship is key to developing effective and sustainable treatment plans.

The Crisis of Opioid Addiction

Opioid addiction remains a severe issue in the United States. In 2021 alone, 2.5 million Americans suffered from substance use disorders related to prescription opioids.[3] Despite the prevalence of this issue, many healthcare professionals are not adequately trained to handle addiction and pain management. A 2019 paper highlighted that 38% of surveyed MDs, DOs, and nurse practitioners lacked prior addiction training, and 36% lacked pain management training.[1] Additionally, 74% of medical students surveyed expressed a desire for more education on SUD, feeling unprepared to treat patients with addiction.[2]

The Interplay Between Opioid Use Disorder and Mental Health

Research indicates a significant overlap between opioid use disorder (OUD) and mental health conditions. Among individuals with OUD, 40% had no mental illness, 36% had mild or moderate mental illness, and 24% had serious mental illness.[4] Addressing opioid addiction without considering mental health can lead to incomplete treatment and higher relapse rates. 

The Relationship Between Chronic Pain and Depression

Chronic pain and depression often coexist, creating a complex scenario for treatment. Although no definitive hypothesis explains the relationship between these comorbidities, evidence shows that chronic pain can trigger depressive symptoms, and depression can manifest as both physical and emotional pain.[5] Effective management of these conditions requires a holistic approach that includes mental health assessments and integrated care plans.

The Prevalence and Impact of Mental Health Disorders

Mental health disorders are widespread and significantly impact individuals' physical health. Approximately 20% of patients in primary care present with clinically significant depressive symptoms.[6] Furthermore, nearly 50% of all Americans will be diagnosed with a mental illness or disorder at some point in their lifetime.[7]

Impact on Chronic Diseases

Patients with chronic illnesses, such as diabetes, cardiovascular disease, and chronic pain, often have comorbid mental health conditions. According to the National Institute of Mental Health, individuals with chronic conditions are more likely to experience depression, which can complicate disease management and worsen outcomes. [8] For instance, individuals with depression are 60% more likely to develop type 2 diabetes, highlighting the bidirectional relationship between mental and physical health.[9]

Healthcare Utilization and Costs

Patients with comorbid mental health conditions and chronic physical illnesses use more healthcare services and incur higher medical costs. Total healthcare expenditures among individuals with severe mental illness (SMI) are approximately 3.3 times greater than those without mental illness.[10] There is strong scientific evidence supporting the integration of psychotherapy within primary health care systems to reduce overall medical expenses and improve treatment outcomes.[11]

Mental Health and Pain Management

Mental health conditions can exacerbate the perception of pain, leading to poorer treatment outcomes.[12] Individuals being treated for chronic pain who also have depressive symptoms are more likely to experience higher pain severity, poorer quality of life, and functional impairment . Optimizing antidepressant therapy can significantly reduce depression severity, pain severity, and disability in this population.[13] 

Treatment Adherence and Integration

Patients with untreated mental health conditions are less likely to adhere to pain management regimens. Compared with non-depressed patients, depressed patients are three times more likely to be noncompliant with medical treatment recommendations.[14] Integrating mental health care into pain management programs can enhance treatment adherence and overall outcomes .

A Personal Perspective

As someone who has lost two family members to the effects of prescription opioids, I have witnessed firsthand the devastating effects of untreated co-occurring disorders. This personal experience has driven my work in developing and implementing integrated education programs that combine information on physical and mental health. Our goal is to provide healthcare providers with comprehensive assessment and education tools to improve patient outcomes and support long-term wellness.

Conclusion

Addressing mental health in primary care and pain management settings is crucial for improving patient outcomes and reducing healthcare costs. By integrating mental health care into these areas, we can develop more comprehensive and effective treatment plans. Join us on this journey as we explore the critical components of opioid education, the role of mental health, and the benefits of a holistic approach to treatment. Together, we can make a difference.

References

[1] Kirane, H., Drits, E., Ahn, S., Kapoor, S., Morgenstern, J., Conigliaro, J., & Enden, J. (2019). Addressing the opioid crisis: An assessment of clinicians' training experience, practices, and attitudes within a large healthcare organization. Journal of opioid management, 15(3), 193–204.

[2] Gamez, S., Nijike, V., Bethune, D., Brown, P., Button, D., Gondy, K., Ho Jati, R., Karagiannis, C., Onyejiaka, C., Steyer, H., & Hawk, K. (2021, October). 220 An Exploratory Study of Medical Students’ Knowledge, Attitudes, and Perceptions of Treating Patients With Addiction. Annals of Emergency Medicine. https://www.annemergmed.com/article/S0196-0644(21)01073-8/fulltext#%20 

[3] U.S. Department of Health and Human Services. (2023, October 2). Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021. National Institutes of Health. https://nida.nih.gov/news-events/news-releases/2023/08/only-1-in-5-us-adults-with-opioid-use-disorder-received-medications-to-treat-it-in-2021 

[4] Novak, P., Feder, K. A., Ali, M. M., & Chen, J. (2019). Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: Evidence from a national survey. Journal of substance abuse treatment, 98, 47–52.

[5] Bonilla-Jaime, H., Sánchez-Salcedo, J. A., Estevez-Cabrera, M. M., Molina-Jiménez, T., Cortes-Altamirano, J. L., & Alfaro-Rodríguez, A. (2022). Depression and Pain: Use of Antidepressants. Current neuropharmacology, 20(2), 384–402.

[6] Tylee, A., & Gandhi, P. (2005). The importance of somatic symptoms in depression in primary care. Primary care companion to the Journal of clinical psychiatry, 7(4), 167–176.

[7] Centers for Disease Control and Prevention. (2021, April 22). Teen newsletter: November 2020 – mental health. Centers for Disease Control and Prevention. https://www.cdc.gov/museum/education/newsletter/2020/nov/index.html#:~:text=Mental%20illnesses%20are%20among%20the,illness%20in%20a%20given%20year. 

[8] U.S. Department of Health and Human Services. (n.d.). Understanding the link between chronic disease and Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health 

[9] Otten, D., Ernst, M., Werner, A. M., Tibubos, A. N., Reiner, I., Brähler, E., Wiltink, J., Michal, M., Nagler, M., Wild, P. S., Münzel, T., König, J., Lackner, K. J., Peiffer, N., & Beutel, M. E. (2023). Depressive symptoms predict the incidence of common chronic diseases in women and men in a representative community sample. Psychological medicine, 53(9), 4172–4180. 

[10] Lee, S., Rothbard, A., & Choi, S. (2016). Effects of comorbid health conditions on healthcare expenditures among people with severe mental illness. Journal of mental health (Abingdon, England), 25(4), 291–296. 

[11] American Psychological Association. (n.d.). Recognition of psychotherapy effectiveness. American Psychological Association. https://www.apa.org/about/policy/resolution-psychotherapy 

[12]   Kardash, L., Wall, C. L., Flack, M., & Searle, A. (2024). The role of pain self-efficacy and pain catastrophising in the relationship between chronic pain and depression: A moderated mediation model. PloS one, 19(5), e0303775.

[13] Teh, C. F., Zaslavsky, A. M., Reynolds, C. F., 3rd, & Cleary, P. D. (2010). Effect of depression treatment on chronic pain outcomes. Psychosomatic medicine, 72(1), 61–67.

[14] DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of internal medicine, 160(14), 2101–2107.