The Prevalence of Mental Health and Pain Symptoms in General Population Samples Reporting Nonmedical Use of Prescription Opioids: A Systematic Review and Meta-Analysis

Abstract Nonmedical prescription opioid use (NMPOU) has become a substantial public health concern in North America. Existing epidemiological data suggest an association between NMPOU and mental health or pain symptoms in different populations, although these correlations are not systematically assessed. To address this gap, a systematic search, review, and meta-analysis were completed separately for both mental health problem symptoms and pain in general population samples reporting NMPOU. Overall, 9 unique epidemiological studies were identified and included in the review. The pooled prevalence of any mental health symptoms in general population samples reporting NMPOU was 32% (95% confidence interval [CI]: 24–40). Specifically, the pooled prevalence of depression was 17% (95% CI: 14–19) and the prevalence of anxiety in general population samples of NMPOU was 16% (95% CI: 1–30) The pooled prevalence of pain in the population of interest was found to be 48% (95% CI: 37–59). This systematic review found evidence for disproportionately high prevalence levels of mental health problems and pain among general population samples reporting NMPOU. While the data reviewed cannot interpret dynamics of potential causality, these findings have implications for interventions for NMPOU, as well as medical practice involving prescription opioids. Perspective This systematic review and meta-analysis found evidence for disproportionately elevated rates of select mental health and pain problems in epidemiological studies based on general population samples reporting NMPOU. While causality cannot be established, these comorbidities may influence NMPOU behavior and hence ought to be considered in preventive and treatment interventions.