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Opioids & Anxiety: What You Need to Know

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Aug 21, 2023 • 11 cited sources

Though opioids are not used to treat anxiety, some people report feeling lower anxiety symptoms after taking opioids. The euphoric feeling that comes with the use of the drugs can feel like a relief compared to the discomfort of anxiety. However, this is caused by the triggering of the pleasure pathway in the brain, which when repeated, can lead to opioid use disorder (OUD) and other related problems. 

Additionally, long-term opioid use can actually create or worsen anxiety symptoms.[1] Chronic opioid use may cause changes in brain chemistry that make anxiety more likely, and they can increase the risk of depression, another condition that often co-occurs with anxiety.

Opioids & Anxiety

Medications are often one of the first lines of defense against chronic anxiety symptoms. Certain classifications of drugs can help to slow the autonomic responses caused by anxiety and help to create a sense of calm. 

Opioids are almost never prescribed to treat anxiety in a clinical setting. Though they were once the primary treatment method for chronic pain, their highly addictive nature has made them a second- or third-tier treatment option in recent years.[2] This has decreased even further the likelihood of their use for anxiety management in a treatment setting. 

However, people who are living with an ongoing anxiety issue may not be able to access the treatment they need to address the problem safely and effectively. Because opioids can be found on the street in the form of pills and drugs like heroin, they may turn to these options to help them manage the symptoms of anxiety on their own. 

This only leads to more problems, however. If you or someone you love is using opioids in an attempt to manage anxiety symptoms, don’t wait to get help.

How & Why Does Opioid Use Cause Anxiety? 

Opioid use can cause anxiety through several mechanisms. One of the main mechanisms is brain chemistry alteration. This occurs when opioids act on the brain’s reward system, causing a surge of dopamine, a neurotransmitter that produces feelings of pleasure and reward.[3]

However, over time, the brain can become less responsive to opioids, requiring higher doses to achieve the same effect. This can lead to changes in brain chemistry that can increase the likelihood of anxiety and other mood disorders.

Additionally, opioids can cause physical symptoms that mimic anxiety, such as shortness of breath, sweating, and palpitations. These symptoms can be alarming and may trigger or exacerbate anxiety.

Opioid use can also increase the risk of developing depression, a disorder that often co-occurs with anxiety and with substance use disorder (SUD). Depression and anxiety share many common symptoms, including feelings of hopelessness, fatigue, and irritability.

It is important to note that not everyone who uses opioids will develop anxiety, and the relationship between opioid use and anxiety is complex and multifactorial. Other factors that can contribute to the development of anxiety include genetics, environmental stressors, and a prior history of trauma or mental health disorders.[4]

What Is the Link Between Anxiety & Opioid Use Disorder? 

There is a strong link between anxiety and opioid use disorder. An opioid use disorder is a chronic condition characterized by the compulsive use of opioids despite negative consequences. 

People with OUD often experience physical dependence on opioids, meaning that people can feel extremely unwell without the drug in their system. The condition is also characterized by paranoia and other symptoms that are also seen among people living with an anxiety disorder. 

Anxiety is a common co-occurring condition in people with opioid use disorder. One study found that more than 60% of people living with an opioid use disorder reported also having an anxiety disorder at some point in their lifetime.[5]

Anxiety can also play a role in the development of opioid use disorder. Some people may use opioid painkillers or street drugs as a way to self-medicate symptoms of anxiety, such as fear or panic. Though opioids may provide temporary relief from anxiety symptoms, they can also lead to OUD and other negative consequences over time.

Additionally, people with anxiety may be more likely to experience social isolation and other stressors that increase the risk of misuse of opioids, which can quickly turn into an OUD if the behavior is repeated continually. 

What Are the Signs & Symptoms of Opioid-Induced Anxiety?

Opioid-induced anxiety, or anxiety directly caused by the use and misuse of opioids over time, can trigger a range of mental health and physiological symptoms.

These symptoms may include the following:

  • Obsessive thoughts or behaviors
  • Compulsive behaviors
  • Feelings of restlessness or nervousness
  • Increased heart rate and blood pressure
  • Sweating or chills
  • Rapid breathing or shortness of breath
  • Tremors or shaking
  • Agitation or irritability
  • Panic attacks
  • Difficulty sleeping
  • Gastrointestinal distress, such as nausea or diarrhea

A free floating anxiety may characterize anxiety caused by use of opioids, or it may be acute in nature, creating feelings of intense panic and/or obsessive-compulsive thoughts and behaviors.[6]

These symptoms may be more likely to occur when opioid use is long term or among those who take high doses of opioid drugs. Additionally, individuals who are using opioids without a prescription, using them in ways other than prescribed, or using street opioids like heroin may be at higher risk of developing symptoms of opioid-induced anxiety. 

What Are the Traditional Ways to Treat Anxiety? 

Anxiety is usually treated with a combination of traditional therapeutic interventions that will vary according to the person’s past experience with treatments and the severity of their symptoms.[7] 

In most cases, traditional therapies for anxiety treatment include the following:

  • Psychotherapy: Therapy, such as cognitive behavioral therapy (CBT), is a commonly used treatment for anxiety disorders. CBT can help create new ways of thinking and behaving that improve the response to anxiety triggers or begin to eliminate them entirely. 
  • Medication: Antidepressants and anti-anxiety medications, such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, are generally the medications of choice in the clinical setting for the treatment of symptoms of anxiety.[8]
  • Relaxation techniques: Techniques such as deep breathing, progressive muscle relaxation, and meditation can help individuals reduce feelings of anxiety, both overall so that stressful situations feel less stressful and when in crisis and experiencing panic. 
  • Lifestyle changes: Engaging in regular exercise, eating healthier, and getting enough sleep can all help to manage symptoms of anxiety when incorporated into an overall anxiety treatment plan. 
  • Support groups: Joining a support group, such as a peer-led anxiety support group or a group therapy session, can help people to feel less isolated and connect with others who may be able to offer advice, friendship, and support.

There is no one-size-fits-all treatment for anxiety disorders, just like there is no single perfect course of care for everyone living with a substance use disorder. 

Additionally, if there is an opioid use disorder co-occurring with the anxiety disorder, treatment for both issues must happen at the same time. If only one condition is treated, relapse for both disorders is likely. 

What Are Alternative Options to Manage Anxiety?

In addition to traditional treatments, there are several non-traditional options that may be helpful in treating anxiety. Though it is rarely recommended to engage in these treatments on their own, especially if there is a diagnosed anxiety disorder present, these options can augment traditional therapies and improve outcomes while decreasing anxiety symptoms along the way. 

Alternative options for treatment of anxiety may include the following:

  • Exercise: Regular exercise has been shown to reduce symptoms of anxiety by increasing endorphins and reducing stress hormones.
  • Mindfulness meditation: This practice can help individuals learn to observe their thoughts and feelings without judgment, which in turn reduces anxiety and stress.
  • Acupuncture: Acupuncture may help to reduce anxiety symptoms by stimulating energy points on the body that are thought to affect mood and other ailments that may contribute to anxiety. 
  • Dietary changes: Cutting out or cutting down on sugar and caffeine is often recommended for anxiety management, and any use of alcohol is advised against as well. Additionally, an overall healthier diet that prioritizes fresh whole, nutrient-rich foods can be helpful in finding more balanced physical and mental health.

Treatment for Anxiety & Opioid Use Disorder

If opioid misuse is a contributing factor in an anxiety disorder, anxiety will not be able to be treated effectively until the opioid use disorder is under control as well. 

If you are struggling with both anxiety and opioid use disorder, contact Bicycle Health today

We can help you access treatment options that can be life-changing and help you to stop misusing opioids and start managing anxiety effectively.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Mood and Anxiety Symptoms in Persons Taking Prescription Opioids: A Systematic Review with Meta-Analyses of Longitudinal Studies. American Academy of Pain Medicine. August 2022. Accessed March 2023.
  2. Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. National Institutes of Health. September 2014. Accessed March 2023.
  3. The Neurobiology of Opioid Dependence: Implications for Treatment. Addiction Science and Clinical Practice July 2002. Accessed March 2023.
  4. Genetic Variants Associated With Anxiety and Stress-Related Disorders.
  5. A Genome-Wide Association Study and Mouse-Model Study. JAMA Psychiatry. May 2019. Accessed March 2023.
  6. Comorbidity of Opioid- and Anxiety-Related Symptoms and Disorders. Current Opinion in Psychology. December 2019. Accessed March 2023.
  7. Comorbidity of Opioid- and Anxiety-Related Symptoms and Disorders. Current Opinion in Psychology. January 2019. Accessed March 2023.
  8. Treatment of Anxiety Disorders. Dialogues in Clinical Neuroscience. June 2017. Accessed March 2023.
  9. Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in Psychiatry December 2020. Accessed March 2023.
  10. Clinical Applications of Herbal Medicines for Anxiety and Insomnia; Targeting Patients With Bipolar Disorder. Australian & New Zealand Journal of Psychiatry. June 2014. Accessed March 2023.
  11. Yoga for Anxiety: 9 Poses to Try. Psych Central. October 2021. Accessed March 2023.

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