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Recovery Providers see a link between addiction, mental health diagnosis Say findings of recent study are not surprising

Portsmouth Herald - 7/2/2017

PORTSMOUTH - Last week's study regarding the correlation between opioid use and mental health did not surprise many of those on the frontlines of the crisis.

The study, released last week by Dartmouth-Hitchcock and the University of Michigan, indicates that more than half of all the nation's opioid prescription are written for adult patients who also have a diagnosis of some type of mental health issue, even though that population represents only 16 percent of people in the country.

The study, in the July issue of the journal of the American Board of Family Medicine, indicates that most patients being prescribed opioids have a diagnosis of depression and/or anxiety. The study warns that this population is at a higher risk factor for overdose and other adverse opioid-related outcomes. It concluded that the 16 percent of Americans who have mental health disorders receive more than half of all opioids prescribed in the United States, and that improving pain management among this population is critical to reduce national dependency on opioids.

Dr. Julie Frew, head of the perinatal addiction program at Dartmouth-Hitchcock Medical Center, was not involved in the study.

She is very interested in the findings and said she is not at all surprised by the link.

"What's interesting to me as a clinician is that we are very aware that the women we care for with a substance abuse disorder most always have a mental health diagnosis," said Frew. "I think the two really tend to travel together."

Amanda Pinkham, coordinator for the Rochester Community Recovery Center, said she agrees with the study's findings 100 percent.

"That is our primary focus at the center," said Pinkham. "I think that when your life is not going really well and you don't have the resources to deal with it, you can turn to opioids. It takes away the pain, literally and figuratively. It provides relief."

Pinkham said she doesn't know if people with mental health issues are selling their pain better to doctors. She agrees that they are certainly getting prescriptions written, and that when they can no longer afford them, they are turning to the streets for their drug.

"I wonder if they experience pain differently on a psychological level," said Pinkham. "We have many members here with pain issues, and mental diagnoses. Are they using more to treat both their pain and their feelings related to mental health? I don't know the answer to that. I do know there is a very real correlation between the two."

One link, said Frew, that she had observed is that there is almost always a significant trauma history in her patients.

"There is usually a history of physical, sexual or emotional trauma," said Frew. "It can be from their childhood or through things that happened to them as adults. There was abuse that was dangerous to them. That exposes them to PTSD and general anxiety disorders and depression. That puts them at a higher risk for pain issues."

Frew said that stress affects the way the brain interprets pain signals.

"We have to treat the whole person," said Frew. "We can't just treat the SUD, the pain, or even the underlying cause.

We need to do a better job."

The uncertainly over the health care bill pending in Congress is another concern, said Frew. She said goods efforts are underway with new prescribing guidelines, the prescription monitoring program and the accessibility to treatment.

"Over the past couple of years, we have seen better resources being put in place," said Frew. "If the resources are taken away; I don't know what will happen.

SUD is a chronic disease. A person is not instantly better once they leave treatment to detoxify. We need to understand that."

In fact, Pinkham speculated that once a person gets out of recovery, they are at the highest risk.

"They do not have that physical addiction when they are released," said Pinkham. "So, if they try to use, even a small amount can be enough to kill them. And, that's not even talking about not knowing what they are getting these days in the drug."