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The Relationship Between Mental Health and Opioid Use Disorders

Elena Hill, MD, MPH profile image
By Elena Hill, MD, MPH • Updated Nov 10, 2023 • 7 cited sources

People who misuse opioid drugs often struggle with poor mental health. Researchers say close to 60% of people with opioid misuse had a concurrent mental health diagnosis.[1] 

Doctors call these issues co-occurring or comorbid, meaning that both conditions strike the same person at the same time. 

Treatment programs aim to address both issues simultaneously, ensuring that drug use doesn’t worsen due to an unaddressed mental health issue or vice versa. Untangling which came first isn’t as important as ensuring both problems are treated with equal care and concern. 

Why Are Opioids So Commonly Misused?

Opioids bind to opioid receptors in the brain and body, reducing pain sensation while also causing sedation, constipation, and slowing breathing. They are also highly addictive since people can experience a short-lasting euphoria and a relief of negative mood or anxiety, reinforcing further use. 

Illicit drugs such as heroin and fentanyl are opioids. So are prescription pain medications such as these:

More than half of the opioid prescriptions in the United States are given to people with anxiety and depression.[2]

What Is an Opioid Use Disorder?

Opioid use disorder (OUD) is the clinical term used to describe what happens when people start using opioids problematically

OUD is linked with poor mental health because opioid use can cause and heighten depression and anxiety. These diagnoses can also hasten the onset of OUD. 

Among people with OUD, anxiety disorder is present in a third and major depressive disorder in almost a quarter.[3] 

People with OUD may work hard to keep their issue hidden, but some signs of OUD include the following:

  • Spending lots of time using or searching for the drug or recovering from use
  • Continuing to use despite social and physical negative consequences
  • Intense cravings for the drug
  • Unsuccessful efforts to reduce or stop using
  • Tolerance and withdrawal symptoms 
  • Poor performance at school or work
  • Isolating from family and friends
  • Doctor shopping
  • Exaggerating pain symptoms
  • Hiding arms in long sleeves to conceal injection marks 

Some of these symptoms could be caused by mental health issues, so it can be hard to determine what’s at the root of a person’s distress. Treating both the psychiatric disorder and OUD in someone who suffers from both issues is essential. If that doesn’t happen, it will be much more difficult to recover from either condition.

Can a Mental Health Issue Cause OUD?

Yes. Psychiatric disorders like depression, anxiety and post-traumatic stress disorder predispose people who use or misuse opioids to develop OUD.[4]

In the short term, opioids may dull or numb some of the symptoms of a mental health disorder. People may use opioids as a form of self-medication, especially if they are not getting treatment for their anxiety or depression.[5] However, in the long term, a person may escalate the frequency of use and an OUD may thus develop. [6]

Can an OUD Cause Mental Health Issues?

Yes. Use of opioids can trigger anxiety and depression through a variety of mechanisms. Opioid use and subsequent withdrawal can cause neurobiologic changes in the brain that can lead to anxiety, insomnia, and depression, In addition, social consequences of of use such as job loss, strains on relationships or financial hardships can all lead to decreased quality of life that can then lead to depression, anxiety or other mental health concerns. There is ample evidence that certain individuals with more complex mental health disorders such as bipolar or schizophrenia might have an initial first episode that is precipitated by use of drugs or alcohol. 

Treatments for OUD & Mental Health Issues 

The key to recovery is to treat OUD and the underlying mental health problem simultaneously. Treatment teams use a combination of medications plus counseling to do this.


OUD responds to medications such as buprenorphine, naltrexone, or methadone. If symptoms associated with the mental health disorder don’t resolve with medication treatment of the opioid use disorder, a trial of antidepressant medications may also be recommended by your doctor. 

Selective serotonin reuptake inhibitors, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and anti-psychotics are all common classes of medications used to treat depression, anxiety, PTSD, and more complex mental conditions such as bipolar disorder or schizophrenia.  

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Depression, anxiety, and PTSD are all treated differently from one another, each with its own options for evidence-based treatment. However, several therapeutic modalities deserve mention here because they work across multiple diagnoses:

  • Cognitive behavior therapy: This therapy focuses on identifying maladaptive thoughts and replacing them. It is effective for mood issues, anxiety, chronic pain, and PTSD. 
  • Exposure therapy: This is effective for PTSD and phobias. 
  • Dialectical behavior therapy: This therapy focuses on enhancing mindfulness and emotion regulation for suicidal and self-harming behavior and substance use. It may prove useful for people with certain personality disorders. 

Learn How Bicycle Health Can Help You Overcome OUD

Bicycle Health is an organization that treats opioid use disorder through telehealth, offering patients affordable and evidence-based care with a first-line treatment for opioid use disorder: Suboxone (buprenorphine/naloxone)

Our therapists and medical personnel are well-liked by patients, and readily available.
Want to know more about how starting on Suboxone could interact with preexisting mental health disorders? Schedule a meeting with our experts or call us today at (844) 943-2514.


By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More

  1. Prevalence of Mental Health Disorders Among Individuals Enrolled In An Emergency Response Program for Treatment of Opioid Use Disorder. Substance Abuse: Research and Treatment. December 2020. Accessed January 2023.
  2. Greater Opioid Use and Mental Health Disorders Are Linked in a New Study. The Washington Post. June 2017. Accessed January 2023.
  3. Prevalence of Mental Health Disorders Among Individuals Enrolled in an Emergency Response Program for Treatment of Opioid Use Disorder. Substance Abuse: Research and Treatment. December 2020. Accessed January 2023.
  4. Alcohol Dependence, Psychiatric Disorders Share Genetic Links. Washington University School of Medicine in St. Louis. November 2018. Accessed January 2023.
  5. 'This Numbs Pain:' The Connection Between Mental Health and Opioids. Port City Daily. March 2017. Accessed January 2023.
  6. The Neurobiology of Addiction. Annals of the New York Academy of Sciences. January 2019. Accessed January 2023.
  7. Overdose Death Rates. National Institute on Drug Abuse. January 2022. Accessed January 2023.

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