Dose-Related Effects for the Precipitation of Psychopathology by Opioid or Tranquilizer/Sedative Nonmedical Prescription Use Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Objectives: Recent work offers evidence that nonmedical use of prescription medications (NUPM) may precipitate the development and recurrence of psychopathology. This work further explores this relationship by examining the dose-related effects of past year opioid and pooled tranquilizer/sedative NUPM on incidence and recurrence of psychopathology. Methods: Data are from waves 1 and 2 of the National Epidemiological Survey on Alcohol and Related Conditions, a national, household-based survey of US adults. Participants who completed both waves (N = 34,653) were included in analyses. Design-based multivariate logistic regression tested the effects of past-year NUPM frequency on the incidence and recurrence of psychopathology, separately for opioids and tranquilizers/sedatives. Results: Recurrence of alcohol use disorder and incidence and recurrence of non-NUPM substance use disorder were less likely in non-past-year users, with any increasing risk of NUPM. For mood and anxiety disorders, elevated risk occurred in 8 of 12 cases for weekly/daily users, though in 3 cases, non-past-year users were also at higher risk than monthly or less frequent users. Incidence of bipolar disorder related to opioid NUPM and incidence of anxiety disorders related to tranquilizer/sedative NUPM evidenced a stepwise risk progression based on the NUPM frequency. Conclusions: Any opioid or tranquilizer/sedative NUPM may increase risk for alcohol use disorder and non-NUPM substance use disorder, with weekly/daily opioid or tranquilizer/sedative nonmedical users appearing to be most vulnerable to the incidence and recurrence of depressive, bipolar, and anxiety disorders. This work highlights the importance of screening for the NUPM by clinicians, and it highlights the need for further research to better understand the psychopathology-NUPM interaction.