Prevalence of Axis-1 psychiatric (with focus on depression and anxiety) disorder and symptomatology among non-medical prescription opioid users in substance use treatment: Systematic review and meta-analyses
Abstract
Non-medical prescription opioid use (NMPOU) constitutes a substantial clinical and public health concern in North America. Although there is evidence of elevated rates of mental health problems among people with NMPOU, the extent of these correlations specifically in treatment samples has not been systematically assessed. A systematic review and meta-analysis were conducted for Axis-1 psychiatric diagnoses and symptoms with a principal focus on depression and anxiety disorders in substance use treatment samples reporting NMPOU at admission to treatment (both criteria within past 30days). 11 unique studies (all from either the United States or Canada) met inclusion criteria and were included in the meta-analysis. The pooled prevalence of 'any' mental health problems (both diagnosis and symptoms) among substance abuse treatment patients reporting NMPOU was 43% (95% CI: 32%-54%; I(2) for inter-study heterogeneity: 99.5%). The pooled prevalence of depression diagnosis among substance abuse treatment patients reporting NMPOU was 27% (95% CI: 9%-45%; I(2): 99.2%); the pooled prevalence of anxiety diagnosis in the sample was 29% (95% CI: 14%-44%; I(2): 98.7%). The prevalence rates of psychiatric problems (both diagnosis and symptoms), depression diagnosis and anxiety diagnosis are disproportionately high in substance use treatment samples reporting NMPOU relative to general population rates. Adequate and effective clinical strategies are needed to address co-occurring NMPOU and mental health in substance use treatment systems, especially given rising treatment demand for NMPOU. Efforts are needed to better understand the temporal and causal relationships among NMPOU, mental health problems, and treatment seeking in order to improve interventions.
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Patients with high levels of anxiety and depression receiving opioid treatment for chronic pain are at increased risk of developing opioid misuse.
“Previous studies have consistently found that patients with high levels of anxiety and depression receiving opioid treatment for chronic pain are at increased risk of developing opioid misuse [80,81,82,83,84,85,86,87,88,89,90].”
The relationship between anxiety and depression and substance abuse in general and opioid misuse in particular is well-documented.
“The relationship between anxiety and depression and substance abuse in general [81] and opioid misuse in particular is a well-documented finding [82,83]”
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- Authors
- Goldner, E. M., Lusted, A., Roerecke, M., Rehm, J., & Fischer, B.
- Affiliations
- Simon Fraser University (CA)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Fischer, Benedikt
- Venue
- Addictive Behaviors
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 39
- Issue
- 3
- Pages
- 520-531
- ISSN
- 0306-4603 (ISSN-L)
- OpenAlex
- W1995094141
- Cited by
- 102
- References
- 113
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 5 · 2023: 7 · 2022: 9 · 2021: 15 · 2020: 10 · 2019: 16 · 2018: 9 · 2017: 9 · 2016: 6 · 2015: 7 · 2014: 2
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (SAF94814, 108448_1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- prescription opioid misuse, opioid misuse, depression, anxiety disorders, psychiatric comorbidity, addiction treatment, prevalence, mental illness, co-occurring disorders
- MeSH terms
- Anxiety, Anxiety Disorders, Mental Disorders, Depression, Depressive Disorder, Humans, Opioid-Related Disorders, Prevalence, Diagnosis, Dual (Psychiatry)
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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