Is treating depression the answer to solving the opioid crisis?

Mental illness plays a major role in our current national opioid crisis. Of more than 115 million prescriptions for opioid medications in the United States, more than 51% were for persons with a mental illness. Further, depression is known to double the likelihood that a person will use opioids. And conversely, use of opioids doubles the likelihood that a person will develop depression in as short as 30 days, which also can escalate further to a suicide attempt. Anecdotal evidence from the field suggests that as many as half of those with serious mental illness in our urban areas use or are dependent upon opioids.

Thus, we posed the following important question at a Hill Briefing on May 23: Is treating depression the answer to solving the opioid crisis? These deliberations were held as part of Mental Health Awareness Month, hosted by Rep. Grace Napolitano (D-CA) and Rep. John Katko (R-NY), co-chairs of the House Mental Health Caucus.

Katko welcomed participants and related the tragic story of his niece who died by suicide. This family loss has motivated him to make mental health a top priority of his current efforts.

Napolitano noted that Congress needs help in developing legislation on improving mental health and addressing opioids. She invited ideas from the audience for “this most important of activities that the Congress undertakes.”

We also were very pleased to be joined by Rep. Paul Tonko (D-NY) who told the audience “to be bold. The opioid crisis demands bold strokes.” Tonko has made mental health and substance use a major focus of his work in the Congress. He is seeking better access to care and a more flexible Medicaid program.

To gauge the human toll of depression and opioids, Mia St. John, the famed boxer, recounted her own personal struggle. Her son suffered from depression, used opioids, overdosed, and died. Subsequently, in her grief, she developed depression, became addicted to opioids, and now is on the road to personal recovery.                     

The panel of experts assembled to provide guidance on key steps to be taken added important information about needed developments in the field.  Kenneth Thompson, MD, University of Pittsburgh Medical Center, spoke of the diseases of despair, including opioid dependence. He asserted that that vast majority of mental health providers who treat people with mental illness never know whether a client also uses or is dependent upon opioids. He further noted that the reverse also is true for substance use providers. The obvious need is much more effective care integration between mental health and substance use providers, together with primary care physicians to address related chronic health and support problems. 

Sara Sarkey, MD, Takeda Pharmaceuticals, described a project being conducted on the Advocate Pathway App, a digital tool designed to improve patient-provider engagement for people with major depressive disorder. Clearly, this tool can extend provider capacity and linkage with clients, particularly in rural areas where care is very sparse.

Jennifer Andrashko, Minnesota State University at Mankato, offered several stories of persons in rural Minnesota who suffer from mental illness and opioid dependency. Clearly, good care is very difficult to find in the rural parts of the state. She also underlined the important role that primary care actually plays in delivering these services in rural areas.

At the conclusion of the briefing, I summarized some recommended next steps that the Congress can take. First, whenever the Congress develops legislation on prevention, treatment, or rehabilitation for persons who use or are dependent upon opioids: the fundamental role of mental healthcare should always be addressed. Second, the role of depression care should be recognized as a critical tool to prevent opioid use and dependence. Third, the role of opioids in causing depression and subsequent suicide should always be addressed.

Sponsors of the briefing were the National Association of County Behavioral Health and Developmental Disability Directors; the National Association of Counties; Takeda Pharmaceuticals; and the National Association for Rural Mental Health.

Upon leaving the briefing, a senior House staffer noted, “I have been working on the problem of opioids for almost five years. Prior to today, I never appreciated the intimate linkage between mental illness and opioid use. We must address this linkage in our future legislation.”

We extend our very warm and sincere thanks to Rep. Napolitano and Rep. Katko for hosting this important event.