Mood and Anxiety Disorders May Trigger Opioid Abuse
Many people suffering from depression or other mental health issues may turn to alcohol to ease their pain before seeking professional help. New research confirms that these patients are at an increased risk to use opioid drugs as well.
A new study published in the Journal of Psychological Medicine suggests that those suffering from mood and anxiety disorders may be more susceptible to opioid abuse.
Help is available for depression, talk to your physician.
Opioids are strong painkiller medications that are commonly prescribed for acute pain after surgery or trauma, and often for chronic pain in patients with terminal illnesses such as metastatic cancer.
Common opioids include codeine, morphine, hydrocodone (Vicodin), oxycodone (Percocet, Oxycontin), and meperidine (Demerol).
Silvia Martins, M.D., Ph.D., lead author of the study and associate scientist at the Bloomberg School’s Department of Mental Health explains, “Non-medical opioid-use disorder due to non-medical prescription opioid use was associated with any mood disorder, any anxiety disorder, as well as with several incident mood disorders and anxiety disorders.”
Dr. Martins continued, “There is also evidence that the association works the other way too. Increased risk of incident opioid disorder due to non-medical use occurred among study participants with baseline mood disorders, major depressive disorder, dysthymia and panic disorder, reinforcing our finding that participants with mood disorders might use opioids non-medically to alleviate their mood symptoms.”
“Early identification and treatment of mood and anxiety disorders might reduce the risk for self-medication with prescription opioids and the risk of future development of an opioid-use disorder.”
The study used data collected through a 2001-2005 longitudinal interview survey called the National Epidemiologic Study on Alcohol and Related Conditions (NESARC) in order to assess a history of psychiatric disorders in adult participants.
Dr. Martin’s coworker and coauthor on the study, Carla Storr, Sc.D., notes, “With the current increased use of non-medical prescription drugs, especially among adolescents, the association with future psychopathology is of great concern.
Using opioids, or even withdrawal from opioids, might precipitate anxiety disorders, suggesting that there is a subgroup of people who are vulnerable to future development of anxiety disorders.”
A study published this week by the National Institute of Health notes that the opioid painkiller Vicodin was used by 8.1% of twelfth grade high school students and by 5.9% of tenth graders participating in an annual Monitoring the Future survey through NIH.
Though down from past years, these reports did not show a decline in use of the opioid Oxycontin.
If concerned about prescription drug use with your child or loved one, contact a health professional to determine the best course of action.
Painkillers
It is estimated that approximately 1 million people in the United States suffer from heroin addiction, and another 1.4 million abuse prescription painkillers such as vicodin, oxycontin, and fentanyl. Opiates, derived from morphine, have been used as painkillers for centuries.
In the presence of chronic pain, users can become quickly addicted to them, as consistent use causes the body to stop making it’s own natural painkillers, called endorphins. When an addict tries to stop using , the resulting withdrawal sickness causes vomiting, insomnia, digestive problems, anxiety, depression, and body aches; and often causes the addict to use again, to alleviate the withdrawal sickness. Overdose can cause respiratory depression and death.
No response yet from Sheriff Davis as deadline approaches
Henderson County commissioners have given Sheriff Rick Davis until noon Friday to return to work or request a formal leave of absence after he announced he was taking sick time to get treatment for manic bipolar disorder.
Neither Davis nor his attorney has commented about the commissioners’ deadline.
“I don’t have anything I can tell you at this time,” attorney Joseph McGuire said Wednesday.
In a letter issued to Davis and his attorney last week, commissioners said that if the sheriff didn’t take one of these actions, they would view it as a refusal to perform the duties of his office and be forced to “act accordingly.” Refusal to perform the duties of the position is one of the conditions under which a superior court judge may remove a sheriff from office in North Carolina.
While the commissioners have not stated that they will file a petition to remove Davis from office if he fails to meet the deadline, such a petition might be a first in North Carolina because Davis is not accused of criminal acts.
Davis took sick time Nov. 23 after issuing a statement saying he was undergoing treatment for a diagnosis of manic bipolar disorder. At the time, Davis said his behavior had become “erratic” and he had made some “bizarre decisions.”
Bipolar disorder is defined as a chronic illness with recurring episodes of mania and depression that can last from a day to months, according to the National Alliance on Mental Illness website.
The mental illness causes unusual and dramatic shifts in mood, energy and the ability to think clearly. More than 10 million Americans have bipolar disorder and it is often hard to diagnose because of its irregular patterns.
Dr. Ilona Csapo, a board certified psychiatrist with Blue Ridge Community Health Services, said bipolar is the same as manic depression and that the disease has been around probably since the beginning of time.
“There is lots of thinking recently that the diagnosis is evolving,” she said. “The definition of the disease is expanding to include 2 to 5 percent of the population.”
Csapo, who is not involved in the treatment of Sheriff Davis, said bipolar disorder is a mood disorder that involves periods of depression and hypo-mania or mania.
“In my experience, doing this for about 12 years, it is the most misdiagnosed condition,” she said.
“It is often thrown around for a lot of reasons such as bad behavior or for legal reasons. There are a lot of conditions that can look as bipolar that really aren’t.”
She added that the average onset age is 19.
“There are elevated periods, depression, sadness, crying, loss of pleasure, guilt, suicidal thoughts, euphoric moods and irritable moods,” she said.
“Certain symptoms of mania include a decreased need for sleep, talking too much and everything is in overdrive. Manic people can be psychotic. Treatment consists of mood stabilizers, second-generation anti-psychotics, treating anxiety and therapy in addition to medications.”
While some people respond very well to treatment, others don’t adhere to their medication and use drugs and alcohol, which can make matters worse, Csapo said.
“Bipolar disorder is a constellation of symptoms associated with a mood state and is not the same as being moody or having a bad day,” she said.
L. Alvin Malesky, Jr., associate professor in the Department of Psychology at Western Carolina University, said the concept of mania has been around for years, but bipolar disorder is documented in the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1952.
“There is bipolar one and bipolar two,” he said. “I think, from what I have read (about Davis’ situation), we are dealing with bipolar one, which does include manic episodes.”
Malesky said the disorder can have symptoms of an inflated self-esteem, decreased need for sleep and racing thoughts.
“The most common treatment for the disorder is neuro-chemical,” he said, adding that with treatment, most people can lead normal lives.
“Typically the disorder starts in the early 20s,” he said. “Half to one-and-a-half percent of the population are diagnosed with the disorder.”
As people become familiar with their illness, they recognize their own unique patterns of behavior, according to the NAMI website.
If individuals recognize these signs and seek effective and timely care, they can often prevent relapses. But because bipolar disorder has no cure, treatment must be continuous.
Mood Disorders Up Risk of Opioid Abuse
Researchers have discovered that people suffering from mood and anxiety disorders are more likely to use and abuse non-prescription opioids.
The illnesses associated with abuse of opioids include bipolar disorder, panic disorder and major depression.
Mood disorders in general heighten the risk for substance abuse. In this study, investigators made a distinction between prescription opioids commonly used for treatment of chronic and acute pain and opioid use that occurs absent a prescription.
Opioids used for medical purposes include oxycontin, hydrocodone (e.g., Vicodin), morphine, fentanyl, codeine, and related medications.
Non-medical use of prescription opioids was defined in the study as use of a prescription opioid without a prescription or in greater amounts more often or longer than prescribed or for a reason other than a doctor’s instruction to use them.
According to the Substance Abuse and Mental Health Services Administration, the current use of opioids in this fashion has increased dramatically with prescription opioids being the second most frequently used illegal drug in the U.S. after marijuana.
Prescription opioids are highly addictive and prolonged use can produce neurological changes and physiological dependence.
For the study, researchers examined the association between individuals with mood and anxiety disorders with non-medical prescription opioid use and opioid disorder.
“Lifetime non-medical prescription opioid use was associated with the incidence of any mood disorder, major depressive disorder, bipolar disorder and all anxiety disorders.
Non-medical opioid-use disorder due to non-medical prescription opioid use was associated with any mood disorder, any anxiety disorder, as well as with several incident mood disorders and anxiety disorders,” said Silvia Martins, M.D., Ph.D., lead author of the study.
Investigators believe their findings support the belief that use of non-prescription opioids may be a method by which individuals self-medicate to reduce mood disorders, major depressive disorder, dysthymia and panic disorder.
As such, early identification and treatment of mood and anxiety disorders might reduce the risk for self-medication with prescription opioids and the risk of future development of an opioid-use disorder, say the researchers.
Researchers reviewed data from the National Epidemiologic Study on Alcohol and Related Conditions (NESARC) to assess participants for a history of psychiatric disorders.
Investigators used sophisticated statistical analysis to determine whether lifetime non-medical prescription opioid uses, and opioid disorders due to this use, occur among individuals who suffer from mood and anxiety disorders. And, if the mood disorders could result from non-medical prescription opioid use.
“With the current increased use of non-medical prescription drugs, especially among adolescents, the association with future psychopathology is of great concern. Using opioids, or even withdrawal from opioids, might precipitate anxiety disorders, suggesting that there is a subgroup of people who are vulnerable to future development of anxiety disorders,” said Carla Storr, Sc.D., author of the study.
Individuals using prescription opioids need to be closely monitored not only for the possibility of engaging in non-medical use, but also for the development of comorbid psychiatric disorders.
“Additional studies are needed to examine the relationship between non-medical prescription opioid use and prescription opioid-use disorder with mood and anxiety disorders since they could co-occur due to shared genetic or environmental risk factors,” Martins adds.
