The Research Question

1. The Research Question • Does longer duration of prescription opioid use lead to new onset depression when controlling for maximum daily dose, pain and other confounders? • Does maximum daily dose of prescription opioid use lead to new onset depression when controlling for duration of use, pain and other confounders?

2. What the Researchers Did • Retrospective cohort design using patient data from: • Veterans Administration (VA), n= 70,997 • Baylor Scott & White (BSW), n=13,777 • Henry Ford Health System (HFHS), n=22,981 • Variables created from ICD-9-CM codes, pharmacy records, vital signs, lab results etc. • Confounding controlled by Inverse Probability of Treatment Weighting using Propensity Scores • Separate Cox models computed to estimate association between opioid duration, morphine equivalent dose and new diagnosis of depression

3. What the Researchers Found • Risk of new onset depression increased with opioid duration in each patient sample. As shown in Table 1, >90 day use was associated with 35% to 105% increased risk of new onset depression compared to 1-30 use. • Dose was not associated with new onset depression

4. What This Means for Clinical Practice 1. Baseline depression screening insufficient, consider depression screening at each opioid refill 2. Add depression to risk – benefit discussion 3. Short term euphoria but long term depression 4. Opioid taper if new onset depression in chronic pain 5. Consider opioid, not just pain, as source of depression