The psychiatric symptoms, particularly depression and anxiety, associated with chronic use of opioid medications as a result of overprescribing are common and debilitating. Opioid medications are classified as depressants and induce serious depression and anxiety, particularly with chronic and persistent use. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) provides diagnoses for these opioid-induced conditions. Substance-induced disorders, particularly for depression and anxiety, include intoxication and withdrawal, substance/medication-induced depressive disorder, and substance/medication-induced anxiety disorder. Importantly, DSM-5 criteria indicate that diagnoses for major depressive disorder and anxiety disorder cannot be made if there is a substance, such as opioid medications, responsible for the condition. Often the way to distinguish between a substance-induced disorder and an independent major depressive or anxiety disorder is to discontinue the opioid medications. Given that opioids are not efficacious for long-term prescribing, discontinuation of the medication is the treatment of choice.
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