(19) Impact of Mental Health Conditions and Psychiatric Prescriptions on MOUD at Discharge

Background & Introduction: Opioid Use Disorder (OUD) commonly co-occurs with mental health conditions such as depression and anxiety. This comorbitidy often results in poorer quality of care from clinicians and can negatively affects treatment outcomes, suggesting that these conditions need to be studied and treated together to better support this population. Both Medications for Opioid Use Disorder (MOUD) and psychiatric medications are highly stigmatized, often leading individuals to prefer non-medication treatments, which are less effective on their own. While past research has explored the impact of mental health on OUD treatment, the combinations between mental health and psychiatric medications have not yet been explored. This study investigates the associations between lifetime anxiety and depression, lifetime psychiatric medication prescriptions, and MOUD status at discharge in individuals with OUD at an inpatient treatment facility, comparing three groups: 1) both lifetime depression/anxiety (LDA) and psychiatric medication (LPM), 2) LDA without LPM, and 3) neither LDA nor LPM. We hypothesize that the group with both LDA and LPM will be most likely to receive MOUD at discharge, as acceptance mental health treatment should improve individuals' willingness for and success of OUD treatments.

Methods: A sample (N = 1,273) from the larger Electronic Health Records (EHR) data exclusive to OUD patients admitted to a public-sector substance use treatment provider in Maryland during 12/1/2020-11/30/2021 was extracted and analyzed. The independent variables of interest were LDA (Y/N) and LPM (Y/N). Patients who endorsed ever having experienced “serious depression, sadness, hopelessness, loss of interest (not attributable to alcohol/drug use)” or “serious anxiety/tension-uptight, unreasonably worried, inability to feel relaxed (not attributable to alcohol/drug use)” were coded “yes” for LDA, and patients who endorsed having been “prescribed medication for any psychological or emotional problem” were coded “yes” for LPM. The dependent variable of interest was whether the individual was discharged on MOUD, including methadone, long-acting injectable naltrexone or buprenorphine, or sublingual buprenorphine. Patients who were discharged with a supply or prescription to continue MOUD or who had received an injection prior to discharge were coded as “yes”. Logistic regressions in R were used to assess the impact of LDA and LPM on likelihood of having received MOUD at discharge. This study analyzed de-identified data and was determined to be exempt from IRB review.

Results: In the sample, the average age was 38, 74% were male, 58% were White, and 36% were Black. Nearly all individuals in the sample had LDA (93%), and 67% had LPM. Only 49% of those with OUD received MOUD before being discharged from inpatient treatment. An examination of the different combinations of LDA and LPM revealed that only 7% reported no LDA or LPM, while 26% reported LDA but no LPM, and 67% reported both LDA and LPM. Patients with LDA, regardless LPM, were more likely than those without LDA to have received MOUD at discharge (OR=1.75, 95% CI [1.11, 2.80]). Similarly, patients with LPM were more likely than those without LPM to have received MOUD at discharge (OR=1.29, 95% CI [1.01, 1.64]). Compared to patients with no LDA or LPM, patients with both LDA and LPM (OR=1.79, 95% CI [1.13, 2.89]) were more likely to have received MOUD at discharge. There was no significant difference in MOUD status at discharge when comparing patients with LDA but no LPM to patients with neither LDA nor LPM and patients with both LDA and LPM.

Conclusion & Discussion: Contrary to prior research, our results suggest that individuals with LDA are more likely to receive MOUD compared to those without LDA, regardless of LPM status. This may be because individuals with comorbid mental health conditions are more likely to experience negative consequences related to OUD, so they may be more aware of the need for more intensive OUD treatments or receive greater encouragement from medical staff at this inpatient facility to receive MOUD. As predicted, we found that individuals with LPM were more likely to receive MOUD compared to individuals without LPM, and that those who endorsed both LDA and LPM were more likely to receive MOUD than those with neither LDA or LPM. These findings aligned with our expectations as previous literature suggests that both LPM and MOUD are stigmatized, so individuals with comorbid conditions who received stigmatized mental health care may be more open towards receiving also stigmatized MOUD. Understanding that past mental health diagnoses may not hinder individual from receiving MOUD and that past prescriptions could be a predictor of MOUD acceptance may help clinicians better understand the population and cast less doubt on the success of patients that arrive with mental health conditions or prescriptions.

References:
Dickson-Gomez, J., Spector, A., Weeks, M., Galletly, C., McDonald, M., & Green Montaque, H. D. (2022, June 27). “you’re not supposed to be on it forever”: Medications to treat opioid use disorder (MOUD) related stigma among drug treatment providers and people who use opioids. Substance abuse : research and treatment,16. https://pmc.ncbi.nlm.nih.gov/articles/PMC9243471/

Henderson, C., Evans-Lacko, S., & Thornicroft, G. (2013a). Mental illness stigma, help seeking, and public health programs. American Journal of Public Health, 103(5), 777–780. https://doi.org/10.2105/ajph.2012.301056

SAMHSA. (n.d.). Key substance use and mental health indicators in the United States: results from the 2023 National Survey on Drug Use and health. https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-national.htm

Williams, R., Farquharson, L., Rhodes, E., Dang, M., Butler, J., Quirk, A., Baldwin, D. S., & Crawford, M. J. (2020). Impact of substance use disorder on quality of inpatient mental health services for people with anxiety and depression. Journal of Dual Diagnosis, 17(1), 80–93. https://doi.org/10.1080/15504263.2020.1825892