Is Opioid Use the Cause or Consequence of Mood Problems and Anxiety?

Opioids are prescribed to relieve pain but are often abused. People who take opioids for nonmedical uses are at increased risk for substance dependency and significant neurologic damage. Researchers have discovered a clear link between opioid misuse and anxiety and mood problems, but the relationship is still unclear. To better understand how opioids affect mood and anxiety problems, Silvia S. Martins of the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health in Maryland conducted a follow up to one of her previous studies.

Martins sought to determine if opioid use caused mood and anxiety problems (precipitation theory), if mood problems led to opioid abuse (self-medication theory), or if these issues shared relational influences. For instance, heavy drug use could trigger bipolar, manic, depressive, or anxious episodes in individuals already predisposed to these mental health challenges. People with a family history of mental illness who misuse opioids may be more vulnerable to experiencing symptoms, especially if they are under psychological stress. Therefore, Martins examined each of these directional relationships in a sample of over 34,000 adults who were part of a larger, national study. She assessed the relationships between moods and substance based on interviews conducted with the participants in 2001(Time 1) and again 3 years later (Time 2).

The analysis revealed that all of the participants who had used opioids nonmedically at Time 1 were at increased risk for anxiety, depression, mood issues, and bipolar at Time 2. The study also uncovered a clear link between mood issues and opioid abuse. Specifically, a lifetime history of generalized anxiety or depression and mood problems at Time 1 led to opioid use at Time 2 in all of the participants. Martins also discovered that opioid use at Time 1 increased the risk of anxiety problems at Time 2. In addition, she found that individuals with mood problems, such as panic, depression, and dysthymia at Time 1 were more likely to use opioids at Time 2 than those without. “Thus, early identification and treatment of mood and anxiety disorders might reduce the risk for self-medication with prescription opioids and the risk of future development of an opioid disorder.” Finally, Martins also found that there was a shared relationship between mood/anxiety issues and opioid use in some of the participants. Overall, these results expand the existing body of research on substance use and mood problems and can help clinicians identify coexisting problems or risk factors in clients facing these issues.

Martins, S. S., Fenton, M. C., Keyes, K. M., Blanco, C., Zhu, H., Storr, C. L. (2012). Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: Longitudinal evidence from the national epidemiologic study on alcohol and related conditions. Psychological Medicine, 42.6, 1261-1272.

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  • Elizabeth


    May 18th, 2012 at 2:56 PM

    I suppose it could be either. However I very strongly feel that for most users it is a result of the depression. I think that mostly people begin to take opioids to lessen the pain that they are feeling, and we know as a resulting consequence that many of them then get hooked uncontrollably on the drugs.

  • Cat


    May 18th, 2012 at 4:27 PM

    The more prescribers dole out these meds like candy, then the more we are going to see greater numbers of users with problems like this. I think that we have viewed these drugs too lightly, we have thought that they were necessary but essentially harmless for much of the population. With the rising numbers of those who abuse these drugs I think that there is very clear and real evidence that we were wrong. There are far too many people with an addiction to these substances and that is rising steadily. There are aeven storied of young kids stealing these pills! It’s insane. They are on the streets, they are “acceptable” and it is becoming a problem that if we don’t get a handle on soon we are going to have a huge issue on our hands very soon.

  • Stuart G

    Stuart G

    May 19th, 2012 at 7:33 AM

    Well, I can see how if someone is all consumed with getting that next fix, then they could be prone to anxiety. Maybe even mood disorders if this is something that they have allowed to start controlling their lives. I used to think that you couldn’t become addicted to something that was prescribed to you by a doctor. I thought only in terms of the street drugs giving you issues. I guess we have learned the hard way that this is just not the truth. I think that I have read that more and more people every day are becoming addicted to painkillers and that this alone is one of the biggest problems facing the medical community today. How can doctors continue to treat patients who are in constant pain without the use of these drugs, yet so many of the are becoming addicted that it is causing even greater problems than they may have initially started out with. It is a very tough situation to navigate for sure.

  • Jordan


    May 19th, 2012 at 12:30 PM

    This is not self medicating. This is a willingness of doctors to provide them with medicines that they don’t need, mainly so that the patients will just leave them alone.

  • Catherine


    May 19th, 2012 at 12:36 PM

    I have to concur with Cat except that her statement “it is becoming a problem” is more accurately stated as it IS already a problem! Of course anxiety and mood problems arise with opiates due to the disruption it causes to the delicate balance of the brain! Doctors, not only the psyciatric profession, are not only wedded to the pharma industry, patients seeing doctors do not want to leave their offices without 1 or more prescriptions. Conducting therapy with an individual whose mind is ‘slicked’ under the influence of opiates or psychotropics is like climbing an iced mountain–very frustrating. As counselors we need to start looking more closely at the advice of individuals like Peter Breggin and helping wean our clients off of these substances.

  • keli deon

    keli deon

    May 20th, 2012 at 5:52 AM

    it would be so nice if before even prescribing some of this kind of medicine if the doctors could have some little bit of insight that would let them know if they are working with someone for whom essentially taking this kind of substance could turn into an addiction. i know that a lot of this would depend on the patient being very forthright with the doctor and talking about their past as well as the past history of drugs and close family members. but i guess this kind of thing does not always come up in routine exams and doctors are not privy to a magic eight ball answer for everything :(

  • zaneiac


    May 21st, 2012 at 4:32 PM

    I would have to think long and hard before adding drugs like this ot my daily life. More and more people have come to rely on the thought that there is a medicinal cure for every life situation, but that’s not the case. I am tired of relying on chemicals to alter my mood, and I wish that the health care community as a whole could embrace that reticence too.

  • happygirl


    December 12th, 2016 at 6:23 PM

    I am a young college student who has never abused drugs, but has had existing anxiety and depression for most of my life. I was prescribed an opioid after a surgery. (Oxycodone? I believe that was the one) It gave me some of the worst anxiety I have ever experienced, so I immediately told the nurses to switch to a non-opioid medicine. The pain from the surgery was wayyy worse without the opioid, but my anxiety lessened so it was worth it! My father was also prescribed the same medicine and had the exact same effect. Just thought I would let you know that we are not drug abusers and have never been addicted to drugs. we have, however experienced extreme anxiety directly after starting a regimen of oxycodone.

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