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
Open accessAbstract
BACKGROUND: Non-medical use of prescription opioids represents a national public health concern of growing importance. Mood and anxiety disorders are highly associated with non-medical prescription opioid use. The authors examined longitudinal associations between non-medical prescription opioid use and opioid disorder due to non-medical opioid use and mood/anxiety disorders in a national sample, examining evidence for precipitation, self-medication and general shared vulnerability as pathways between disorders. METHOD: Data were drawn from face-to-face surveys of 34 653 adult participants in waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models explored the temporal sequence and evidence for the hypothesized pathways. RESULTS: Baseline lifetime non-medical prescription opioid use was associated with incidence of any mood disorder, major depressive disorder (MDD), bipolar disorder, any anxiety disorder and generalized anxiety disorder (GAD in wave 2, adjusted for baseline demographics, other substance use, and co-morbid mood/anxiety disorders). Lifetime opioid disorder was not associated with any incident mood/anxiety disorders. All baseline lifetime mood disorders and GAD were associated with incident non-medical prescription opioid use at follow-up, adjusted for demographics, co-morbid mood/anxiety disorders, and other substance use. Baseline lifetime mood disorders, MDD, dysthymia and panic disorder were associated with incident opioid disorder due to non-medical prescription opioid use at follow-up, adjusted for the same covariates. CONCLUSIONS: These results suggest that precipitation, self-medication as well as shared vulnerability are all viable pathways between non-medical prescription opioid use and opioid disorder due to non-medical opioid use and mood/anxiety disorders.
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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].”
From Pain acceptance creates an emotional context that protects against the misuse of prescription opioids: A study in a sample of patients with chronic noncancer pain (2021) · cites this paper as [82]
The Results (self-medication pathway, Table 3; page unavailable) associate baseline mood disorders and generalized anxiety disorder with later nonmedical prescription opioid use. But this was a general-population study of diagnosed disorders, not a study of anxiety and depression levels among patients receiving opioids for chronic pain. The Discussion also says the authors lacked information about where users’ first significant opioid exposure occurred. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMDD was associated with substance use disorders, particularly drug disorders.
“Major depressive disorder was assoc iated w ith SUDs, particularly drug disorders, as found previously for cannabis, 40,62 nonmedical prescription opioids, 5,57,63 and drug use disorders.41”
From Epidemiology of Adult <i>DSM-5</i> Major Depressive Disorder and Its Specifiers in the United States (2018) · cites this paper as [62]
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
- Martins, S. S., Fenton, M. C., Keyes, K. M., Blanco, C., Zhu, H., & Storr, C. L.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Martins, S. S.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2011-10-17
- Volume
- 42
- Issue
- 6
- Pages
- 1261-1272
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC3513363
- OpenAlex
- W2123764225
- Cited by
- 283
- References
- 53
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 13 · 2023: 21 · 2022: 24 · 2021: 34 · 2020: 34 · 2019: 32 · 2018: 17 · 2017: 22 · 2016: 15 · 2015: 12 · 2014: 14 · 2013: 17 · 2012: 4
- FWCI
- 10.99
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Substance Abuse and Mental Health Services Administration
- National Institute on Drug Abuse (R21DA020667, R03DA023434, R01DA019606, K02DA023200)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- prescription opioid misuse, prescription opioid use disorder, mood disorders, anxiety disorders, generalized anxiety disorder, major depressive disorder, bipolar disorder, dysthymia, panic disorder, self-medication, precipitation, shared vulnerability, temporal sequence, substance use comorbidity
- MeSH terms
- Adolescent, Adult, Aged, Analgesics, Opioid, Anxiety Disorders, Disease Susceptibility, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Models, Theoretical, Opioid-Related Disorders, Self Medication, Time Factors, United States, Causality, Mood Disorders, Prescription Drugs, Young Adult
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