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The Use of Prescription Opioid Medication by Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 10-Year Follow-Up Study

J Clin Psychiatry 2014;75(4):357-361
10.4088/JCP.13m08557

Objective: The first purpose was to determine the rate of use of prescription opioid medication reported by patients with borderline personality disorder and to compare that to the rate reported by Axis II comparison subjects during a 10-year period of prospective follow-up. The second purpose was to determine the most clinically relevant predictors of prescription opioid use among borderline patients.

Method: The medical conditions and Axis I disorders of 264 borderline patients and 63 Axis II comparison subjects were assessed at 6-year follow-up and 5 contiguous follow-up waves that were 2 years apart. These assessments were conducted between July 1998 and December 2010. Family history of psychiatric disorder was assessed at baseline by interviewers blind to the diagnostic status of the subjects. All 3 areas were assessed using semistructured interviews with proven psychometric properties: the Medical History and Services Utilization Interview (MHSUI), the Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I), and the Revised Family History Questionnaire.

Results: Borderline patients were significantly more likely to report the use of prescription opioid medication over time than Axis II comparison subjects (OR = 1.79; 95% CI, 1.01–3.17). The best predictors of opioid use among borderline patients were the time-varying presence of back pain (OR = 1.95; 95% CI, 1.41–2.70), fibromyalgia (OR = 3.29; 95% CI, 1.70–6.36), and osteoarthritis (OR = 3.32; 95% CI, 2.08–5.29) as well as a baseline history of drug abuse (OR = 1.89; 95% CI, 1.27–2.81).

Conclusions: The sustained use of prescription opioids is common among and discriminating for patients with borderline personality disorder. The results also suggest that these borderline patients may be particularly sensitive to physical pain—mirroring their well-known heightened sensitivity to emotional pain.

J Clin Psychiatry

Submitted: April 27, 2013; accepted September 19, 2013.

Online ahead of print: January 7, 2014 (doi:10.4088/JCP.13m08557).

Corresponding author: Frances R. Frankenburg, MD, McLean Hospital, 115 Mill St, Belmont, MA 02478 (Frances.Frankenburg@med.va.gov).