Research calls for new measures to treat mental illness and opioid use

Opioid use among psychiatric hospital patients needs to be addressed through an integrated approach to managing mental illness, pain and substance use, a study by researchers at the University of Waterloo has found.

The study found that 7.5 percent of 165,434 patients admitted to psychiatric hospitals in Ontario between 2006 and 2017 had used opioids in the year prior to admission, which compares to estimates that 2 percent of the general population used opioids in 2015. Among patients who said they experience daily pain, the percentage who reported opiate use jumped to 22 percent.

"The patterns of use we saw are problematic," said Christopher Perlman, a public health researcher. "Opiate use is strongly linked to pain, mental health conditions and use of other drugs. While we don't know how many patients were initially prescribed an opioid for pain, we do know that a large number of patients reporting pain in psychiatry also have an addiction concern."

The study highlights the challenging circumstances faced by those who use opioids. For instance, opiate use was almost twice as common among those whose employment or education was at risk (10.5 percent) compared to those not at risk (5.8 percent). Many patients who had used opiates did not have a partner or spouse, and individuals living in rural and northern communities were more likely to use opiates, as were young people, and males rather than females.

"If we are serious about supporting people with mental and physical health concerns, we need an integrated approach to service delivery, which includes assessing and addressing the risk of addiction," said Perlman, who is a professor in the School of Public Health and Health Systems at the University of Waterloo. "Right now, the way our health system is structured and funded, it's not easy to integrate physical, mental and substance use services."

"This study was able to shed some light on the needs of persons who use opioids, but this is really the tip of the iceberg. Because we lack integrated health information systems across various health providers, we really don't know the extent of the physical and health needs of individuals who use opioids across the population. That means they are either getting help elsewhere, which would be good—or more likely, that they are not getting care they need."

The paper, "Factors Associated With Opiate Use Among Psychiatric Inpatients: A Population-Based Study of Hospital Admissions in Ontario, Canada" was co-authored by Oluwakemi Aderibigbe (Waterloo), Anthony Renda (independent), and Christopher Perlman (Waterloo), and published in Health Services Insights.