Methods: We utilized 2015-2016 NSDUH data to examine whether U.S. individuals aged 12 or older (n=53,120). Unmet mental health care need was identified as need for mental health services in the past 12 months without receipt of services. Prescription opioid misuse was defined as using prescription opioids differently from the manner prescribed. Using a logit model to estimate the association between unmet mental health care need and prescription opioid misuse, we controlled for demographic variables such as age, race/ethnicity, marital status, family income, experience of a major depressive episode, and indicators related to mental health service access (e.g. county metro status, insurance status, insurance type, and whether the individual had moved within the past 12 months). We conducted sub-group analyses of individuals with a major depressive episode in the past 12 months.
Results: About 16% of individuals reported prescription opioid misuse, and 5.8% reported having an unmet mental health care need. After controlling for demographic and access variables, individuals reporting an unmet mental health care need had over twice the odds of reporting opioid misuse compared to individuals without an unmet mental health need (OR=2.368, 95% CI: 2.137-2.622). Among individuals with a major depressive episode, individuals reporting an unmet mental health need had higher odds of opioid misuse (OR=2.030, 95% CI: 1.733-2.379). Risk factors for misuse include having Medicaid, moving frequently, and those who have never been married.
Conclusion: We found that individuals who report unmet mental health care needs had greater odds of opioid misuse, especially among individuals with a major depressive episode. Furthermore, subgroups with an increased risk for misuse include those insured by Medicaid, those who move frequently, and those who have never been married. Clinical guidelines recommend mental health services as a potential pain treatment, and our analyses suggest that such services may be one way to deter prescription opioid misuse. One limitation is that we were unable to explore the temporality between opioid misuse and unmet mental health care need. Future research should explore how prevention efforts can facilitate mental health service access, as well as other sources of emotional support beyond the healthcare system.