What Is the Link between Opioids and Mental Health?

There is compelling evidence that there is a strong link between opioid painkiller use and mental health problems.  According to a report published in the Journal of the American Board of Family Medicine, only about 16 percent of the U.S. population suffers from a mental health issue, but almost half of all opioid users are among this group.

Although this isn’t irrefutable proof that mentally ill patients are more likely to seek out opioids, it does suggest that there may be an important mental health component that medical professionals should examine before writing an opioid prescription.

The nature of this relationship between opioids and mental health is still unclear. It is likely that the underlying pain condition that prompts the search for painkillers does deteriorate the mental health of the sufferer. However, there is also some evidence that long-term opioid use also has a negative impact on mental wellbeing.

What Are Opioids?

Opioids have been in the news for many years, but many people still may not clearly understand what they are. They are a class of synthetic drugs used to dull pain. Based on the naturally occurring opiate compounds found in poppy plants, opioids may be as or more potent than related compounds like heroin.

Among the more commonly available forms of opioids are

  • Morphine
  • Vicodin
  • Percocet
  • Oxycontin
  • Hydrocodone
  • Fentanyl

Opioids will bind with receptors in the brain causing a surge in dopamine, a neurochemical that produces feelings of pleasure.  That sense of euphoria diminishes over time, however, which can lead to increased usage beyond a safe dosage.

It is easy to abuse opioids, so to minimize the risk of addiction, you should only use them as directed by your doctor. Also, do not use them if the condition they are meant to treat has disappeared.

Mental Illness May Originate before Opioid Use

It is quite common for people suffering from an undiagnosed or poorly managed mental health conditions to turn to drugs as a way to self-medicate. Combined with some of the following traits common to depression patients, it is easy to see why they often resort to opioids:

  • Almost two-thirds of depression patients report more aches and pains
  • Chronic fatigue
  • Insomnia or oversleeping
  • Diminished appetite
  • Reduced interest in previously enjoyed activities

Furthermore, there is a strong relationship between mental illness and chronic pain. It is a firmly established fact that ongoing pain raises the likelihood of developing mental health problems like anxiety and depression. This is because these conditions use similar neurochemical pathways in the brain. Many chronic pain conditions have an elevated associated risk for anxiety or depression; for example, people with fibromyalgia have a five-fold higher risk of anxiety disorders than the general population.

Additionally, many people respond to chronic pain by isolating themselves from friends and family. This ongoing social isolation has a deleterious effect on mental health as well. Other coping strategies like tobacco or alcohol use can also degrade health and emotional wellbeing.

It should therefore not be surprising that many chronic pain patients respond positively to antidepressants. Not only do many see an improvement in their mental health, but many also experience a marked improvement in their pain symptoms as well.

How Opioids Affect Mental Health

Opioids alter brain chemistry in dramatic ways. When they bind to opioid receptors in the brain, that induces the production and release of pleasure-producing neurotransmitters like dopamine. However, over time, your brain becomes accustomed to these new levels of neurochemicals and is rewired. Ultimately, this creates a dependence upon the opioid that can have devastating consequences on mental health.

Although the opioid itself may wreak havoc on the brain chemistry, it is most dangerous when the user becomes addicted to them. Opioids are a Schedule II controlled substance which means that there is a high risk of abuse and dependency. In fact, the risk of addiction is the same for those using it medicinally as for those who use opioids recreationally.

Once opioid addiction takes hold, the user will require larger doses or more potent alternatives like heroin or fentanyl. At this point, opioid addicts may display the following mental health symptoms:

  • Anxiety
  • Violence
  • Mood swings
  • Isolative behaviors
  • Depression
  • Despair

Although the greatest risk is, of course, overdosing on opioids, but a secondary risk is the feeling of being hopelessly dependent on this substance. Without medical intervention, the user may succumb to despair and attempt suicide.

Treating Opioid Use Disorder and Mental Illness

It can be difficult to treat opioid use and mental health disorders but getting treatment for both conditions at the same time is normally the most effective. In the 2016 National Survey on Drug Use and Health, it was reported that 42.8 percent of people who abused opioids had a mental illness. In this period almost 2 million Americans suffered from an opioid use disorder or OUD, but only about 24 percent of them received treatment for their mental health problem.

The real challenge for people with an OUD and mental illness is obtaining the medical care that they require. In many cases, the mental illness will go undiagnosed and interfere with the patient’s ability to make effective health care decisions. This is also often complicated by the stigma that accompanies both conditions. To make getting help even more difficult is the growing lack of mental health care providers throughout the U.S. but especially in rural areas.

One of the most successful programs for treating OUD and mental illness is the Collaborative Care program that delivers both behavioral health treatment as well as psychiatric services. Instead of relying on a patient navigating a team of specialists after seeing a primary care physician, the Collaborative Care program assigns a case manager who coordinates treatment.

This program has proven more effective because it tailors the care to the specific needs of the patient, making it more economical and productive. The case manager is in constant communication with the patient so they can adjust the treatment plan if it is not progressing well. Case managers employ a non-confrontational approach that allows the patient to make the ultimate decision so that they will remain invested.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA, and you should not post any of your private health information.