Anxiety disorders are the most common mental health conditions in the United States and opioids are among the most frequently prescribed medications. It’s no surprise, then, that many people who have anxiety disorders are also prescribed opiates. People with mood or anxiety disorders are four times more likely to be prescribed opioids and receive over half of all opioids prescribed in the United States.

While the analgesic effects of opiates can address mental as well as physical discomfort, opiates can also trigger anxiety as quickly as they can alleviate it. People with anxiety disorders who use opiates may experience a worsening of anxiety symptoms over time as levels of key brain chemicals drop and may even develop dependence and addiction.

Do Opiates Cause Anxiety?

People know that opiates can sometimes alleviate anxiety, but can opiates also cause it? Research shows that people who have anxiety disorders are more likely to misuse opioids. However, for ethical and procedural reasons, most studies can’t establish which came first, the anxiety disorder or the opiate use. Since it makes sense that people wanting to experience relief from anxiety might use opioids to feel better, it’s hard to prove that opiates cause anxiety.

However, general knowledge about the effects of opioids on the brain suggests that they can trigger or intensify anxiety symptoms. The parts of the brain most strongly affected in people with anxiety are the amygdala, the part of the brain associated with emotional arousal, and the hippocampus, which is central to the process of encoding and retrieving memories. Both of these brain regions are also affected by opioid use.

People who have anxiety disorders often grow up in stressful home environments or are born with temperaments that make them more sensitive to stress. Chronic stress trains the brain to recall frightening events more often and to amplify fearful responses, often leading to anxiety disorders. Over time, opiate use affects the brain’s ability to produce critical neurochemicals that it uses to alleviate stress and discomfort, even further heightening anxious responses.

Animal research further illuminates this process. A 2007 study by Chaoliang Gu, Peng Li and associates showed that administering morphine consistently impaired the extinction of the fear response in rats. In other words, opioids interfered with the brain’s ability to signal that a threat was no longer present and that there was no longer a reason to be afraid. This response suggests that opiate use may change the brain in ways that prolong periods of anxiety.

Opiate Withdrawal Anxiety

Drugs that lead to physical tolerance cause people to experience characteristic withdrawal symptoms when they stop using them. These withdrawal effects are usually the opposite of the drug’s active effects. Opiate withdrawal symptoms are notoriously unpleasant and can include hot flashes, muscle cramps, tremor, nausea and vomiting. Among psychological effects, opiate withdrawal anxiety is especially common.

The reason people experience anxiety during opiate withdrawal is the same reason people who use opiates experience increased anxiety overall. Long-term opioid use depletes the levels of crucial neurochemicals that the brain releases to signal the end of a threat and to quell the fear response. While the brain can ultimately heal and recover its ability to manage pain and fear, the immediate effect of abstaining from opiates after developing a physical tolerance to them is becoming more sensitive to pain and discomfort. The unpleasant physical symptoms of opiate withdrawal can further heighten anxiety.

The flu-like symptoms of acute opiate withdrawal usually only last for a week, while subtler symptoms continue until the brain has fully recovered. Symptoms of post-acute withdrawal syndrome (PAWS) may persist for several months after a person stops using opiates. People who experience anxiety after opiate withdrawal sometimes worry that this is a permanent change, but this is a relatively normal part of the long-term recovery process and doesn’t last forever. Many people do not experience PAWS at all, and most who do are entirely symptom-free within six months of abstaining from opiate use, if not sooner.

Of course, people with underlying anxiety disorders that are not substance-induced require specialized treatment for them. With the right interventions, people with anxiety disorders can recover. Therapy and medication can help reduce symptoms over time, and many people who persist in treatment experience a remission of anxiety.

Opiates as Treatment for Anxiety

Most doctors would never intentionally prescribe opiates for anxiety. Not only is this considered an off-label use of opiate medications by the Food and Drug Administration, but the opiate crisis has also caused many doctors to hesitate to prescribe opiates at all. However, those who do prescribe them for pain often end up inadvertently prescribing opiates to treat anxiety.

Physicians are more likely to prescribe opiates for acute pain following from traumatic injury or terminal illness. In some cases, people may have developed a chronic condition that is not only physically painful but is preventing them from working or performing everyday tasks. Under many of these circumstances, people experience increased anxiety, whether secondary to post-traumatic stress disorder or as a result of chronic stress.

The consequence of doctors prescribing opioids for pain for conditions that also cause anxiety, such as physical trauma, life-threatening illness or chronic life-altering pain, is that they are also prescribing opiates for anxiety. The reason that over half of all prescriptions for opiates are given to people with mood or anxiety disorders may have to do with the way that anxiety and depression amplify the perception of physical discomfort and pain.

Of course, regardless of whether it was what a doctor intended, many serious complications arise from prescribing opiates for anxiety, including addiction. Prescribing opiates at the same time as benzodiazepines for anxiety also significantly increases the risk of overdose and other drug-related complications including temporary amnesia or blackouts, accidental injury and impaired judgment.

Key Points: Opiates and Anxiety

Some important points to remember about the relationship between opiates and anxiety include:

  • Opiates are rarely prescribed for anxiety intentionally, but their ability to temporarily alleviate anxiety often drives people with anxiety disorders to use them to reduce anxiety symptoms
  • In hopes of finding relief from chronic anxiety, people with anxiety disorders may buy opioids on the black market or use them more often than prescribed.
  • Unfortunately, using opioids to alleviate anxiety comes with many negative consequences, including a higher risk of addiction, overdose, medical complications, social and legal problems, and worsened anxiety symptoms

Fortunately, there is hope for people with dual opioid use and anxiety disorders. Integrated treatment programs can help people control cravings and cope with post-acute withdrawal symptoms while also getting the treatment they need for their anxiety. The Recovery Village operates facilities across the United States that provide integrated treatment and has helped many people with co-occurring disorders.

If you are not sure whether your opiate use has progressed to addiction, you can read more about the signs and side effects of opiate abuse here. You can also read this overview of how anxiety disorders are diagnosed and treated. If you know you are addicted to opiates and also need help with anxiety, contact The Recovery Village today. A representative will talk to you about treatment options that can meet your needs and help you get started on the path to recovery.

    

Anxiety and Depression Association of America. “Facts & Statistics.” Accessed March 13, 2019.

Fuentes, Andrea. “Comprehension of Top 200 Prescribed Drugs in the US as a Resource for Pharmacy Teaching, Training and Practice.”  National Center for Biotechnology Information, June 2018. Accessed March 13, 2019.

Gu, Chaoliang. “Chronic Morphine Selectively Impairs Cued Fear Extinction in Rats: Implications for Anxiety Disorders Associated with Opiate Use.” Neuropsychopharmacology, 2008. Accessed March 13, 2019.

Science News. “Opioid abuse linked to mood and anxiety disorders.” Science Daily, December 13, 2011. Accessed March 13, 2019.

Zagorski, Nick. “Many Prescription Opioids Go to Adults With Depression, Anxiety.” Psychiatric News, August 17, 2017. Accessed March 13, 2019.

Opiates and Anxiety
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