Opioid addiction has been an issue at the forefront of public health concerns for decades. In fact, 128 Americans die from opioid overdose every day.¹ However, there is a rising concern with individuals facing opioid addiction and co-existing mental health disorders. The intersectional relationship between the two is complex and multifaceted, highlighting the importance of addressing both opioid addiction and mental health, meanwhile seeking strategies for effective, dual-diagnosis treatment.
Opioids are a class of drugs originating from opium poppy seeds, which can contain substances like morphine and codeine. This provides a sedating, pain-relieving, and euphoric effect.¹ Although they can come in both prescription painkillers and illegal forms, opioids are highly addictive and can pose a danger in large doses. For instance, heroin can result in physical dependence, tolerance, and long-term neuronal and hormonal imbalances.¹ Many Canadians can attribute the origins of this crisis to widespread legal opioid addiction, which is partly a result of inappropriate prescription practices and insufficient education regarding the dangers linked to opioids.² Opioid use disorder (OUD) can occur if an individual has strong cravings for the opioid, takes large amounts of it, experiences withdrawal symptoms, and uses them in hazardous situations.¹ Some medications can be prescribed to combat opioid addiction, including buprenorphine-naloxone and methadone, which can help reduce cravings and interfere with receptors that produce the euphoric effects when consuming opioids.¹
Figure 1: Buprenorphine as a Medication to Combat OUD³
People who have OUD often experience a co-existing mental health disorder, like depression or anxiety. In fact, within 19.3 million adults who faced a substance use disorder in 2018, 9.2 million also dealt with a co-occurring mental illness.⁴ In some situations, individuals develop mental health issues as a result of their OUD, whereas some acquire an OUD to cope with symptoms of their mental health disorders. For example, some people with depression may seek opioids for their euphoric effect to alleviate their depressive symptoms.¹ However, over time, this can only worsen depression. Opioids can alter one’s brain chemistry and thereby, induce sleep disturbances and social withdrawal, ultimately heightening the severity of depression symptoms.¹
One of the issues with treatment for both OUD and mental illness is the lack of accessibility and willingness of individuals to seek treatment. Mental illnesses often goes undiagnosed, which increases the risk of OUD and can interfere with an individual’s capability to make healthcare decisions.⁵ A stigma is also prevalent with both conditions, making it more challenging for patients to recover and seek treatments.⁵ In fact, medication for OUD and buprenorphine has specifically been correlated with decreasing suicidal ideation among patients with concurrent OUD and major depression.⁶ Despite its efficacy, many individuals with concurrent OUD and depression never receive treatment. 50-80% of those who do initiate treatment end up discontinuing it within weeks or months of initiation, putting them at a high risk of relapse and overdose.⁶
Collaborative Care is a well-known model of combining mental health and physical health care. It is a specific service delivery model where two key services are provided: care management support for patients receiving behavioral health treatment, and regular consultation with a psychiatrist for the primary care team.⁵ From this, Watkins et al., are conducting research on the efficacy of Collaborative Care to treat patients with OUD and co-existing depression or post-traumatic stress disorder (PTSD).⁶ Although still at the early stages of research and design, Watkins et al. have found that integrating family members and other support individuals can be effective in Collaborative Care treatment, as they are often the front-line individuals who can identify early signs of substance use and are generally deeply motivated to help their loved ones. The researchers demonstrate great potential in this collaborative model in helping patients recover from both OUD and mental illnesses.⁶
Figure 2: Collaborative Care Model for Treating OUD and Mental Health Illnesses⁵
Therefore, the intersection between opioid addiction and mental health underscores the critical need for a holistic and integrated approach to treatment and recovery. As we continue our efforts to combat the opioid epidemic, it is imperative for policymakers and several stakeholders to appreciate a multidimensional approach to support those in need.
References
Southern California Sunrise. The Connection Between Opiate Addiction & Mental Health. socalsunrise.com. Published July 21, 2020. Accessed October 26, 2023. https://socalsunrise.com/mental-health-opioid-addiction/
Government Response - 8512-421-134 - House of Commons of Canada. Ourcommons.ca. Published 2016. Accessed November 1, 2023. https://www.ourcommons.ca/DocumentViewer/en/42-1/HESA/report-6/response-8512-421-134
Kounang N. Opioid addiction drugs severely underutilized, study finds. CNN. Published June 18, 2018. Accessed October 26, 2023. https://www.cnn.com/2018/06/18/health/opioid-drug-medication-assisted-therapy-study/index.html
Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.; 2019.
National Institutes of Health. When Addiction and Mental Illness Collide. NIH HEAL Initiative. Published May 19, 2020. Accessed October 26, 2023. https://heal.nih.gov/news/stories/collaborative-care
Osilla KC, Meredith LS, Griffin BA, Martineau M, Hindmarch G, Watkins KE. Design of CLARO+ (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses, Plus): A randomized trial of collaborative care to decrease overdose and suicide risk among patients with co-occurring disorders. Contemporary Clinical Trials. 2023;132:107294. doi:https://doi.org/10.1016/j.cct.2023.107294