The Association of Nonmedical Prescription-Opioid Use and Psychological Distress Among Adults with and without Disability

Background and Purpose: According to the Centers for Disease Control and Prevention (2016), there has been a 400% increase in overdose deaths from prescription-opioid medication between 1999 and 2015. There is consensus among practitioners, researchers, policymakers, and the public at-large that the U.S. is in the midst of an opioid epidemic.

There is a critical need to understand how nonmedical prescription-opioid use (NMPOU) impacts mental health outcomes for vulnerable populations, especially those with a disability. Greater insight into this issue can potentially inform systems-level policies that lead to pathways for more effective assessment, treatment and recovery.

This study examines the relationship of NMPOU and psychological distress, stratified by disability status, for a nationally-representative sample of U.S. adults aged 18 and older. It is hypothesized that NMPOU will significantly increase psychological distress, and this effect will be greater than use of other substances. Additionally, the association of NMPOU and psychological distress will be different for those with a disability, compared to those who do not.

 

Methods: This study used data from the 2015 National Survey on Drug Use and Health. The sample in this analysis included 39,346 adults 18 and older. Weighted multivariate regression analysis was conducted to examine the effect of past year NMPOU on psychological distress, measured by the Kessler Psychological Distress Scale (K6). The independent variable, NMPOU, was captured by persons who ‘used prescription-opioid pain reliever not directed by doctor within the past 12 months.’ Other substance use variables included binge drinking in the past month and the use of the following substances within the past year: marijuana, heroin, cocaine, methamphetamine, tranquilizers, stimulants, and sedatives. Mental health variables included WHODAS score, major depressive episodes (past-year and lifetime), and suicidality (ideation and attempt). Additional sociodemographic variables included age, gender, race, marital status, income, education, and household composition. Subgroup analyses were conducted with respondents with a disability, compared to persons without.

 

Results: Analysis from the full sample indicated that NMPOU was associated with increased psychological distress (β=.03, p<.001), and this association was greater than all other substance use variables (Adjusted R²=0.47). Subgroup analyses found that the association for NMPOU and psychological distress was not statistically observed for persons with a disability (Adjusted R²=0.52). For persons without a disability, NMPOU was associated with increased psychological distress (β=.02, p<.001), and this association was greater than for all other substance use variables, except for methamphetamine use (Adjusted R²=0.46).

 

Conclusions and Implications: These results suggest that there is a link between NMPOU and greater psychological distress. Additionally, this link was observed specifically for persons without a disability, versus those who have a disability. Implications for practice include the need to further educate social workers about the relationship between NMPOU and psychological distress. These findings suggest that federal and state-level policies, in response to the opioid epidemic, should consider the existence of co-occurring substance use and mental health issues. Future research should examine the pathways to addiction with NMPOU, and effective interventions to help achieve recovery in addressing this social problem for vulnerable populations.