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Clinicians commonly encounter patients receiving selective serotonin reuptake inhibitors (SSRIs) for depression plus concurrent opioids for pain control. Prodrug opioids (e.g., hydrocodone, codeine, tramadol) become effective after being converted to active forms by cytochrome P450 (CYP) 2D6 hepatic enzymes; non–prodrug opioids (e.g., morphine, fentanyl, oxycodone) are effective without such transformation. Many SSRIs inhibit CYP2D6, thus reducing the effectiveness of prodrug opioids. To examine this issue further, investigators examined data on 4306 surgical patients with depression.
Natural-language techniques were used to extract data from electronic health records, including clinical notes and structured assessments. Patient groups were:…