Psychiatric Comorbidities with Opioid Dependence

Over 40% of opioid dependent individuals have co-occuring psychiatric disorders. The most common are depression, anxiety disorders, and bipolar disorder.

Psychiatric comorbidities may complicate buprenorphine treatment in terms of treatment priorities, stabilization concerns, and medication interactions. To make a sound treatment decision, you need to distinguish between independent and substance-induced disorders using the criteria below:

  • Independent Disorders (Primary): continue to occur even when an individual is not using drugs for a sustained period of time, or have an onset before the opioid use disorder.
  • Substance-induced Disorders (Secondary): all or most of the symptoms are the direct result of substance use.

Try these techniques to determine if the psychiatric problem is related or unrelated to the substance abuse:

  • Observe the patient during a period of abstinence from the substance use
  • Take a thorough history and, if possible, talk to family members or friends treat both problems simultaneously. If one disorder is not treated adequately or at all, both can become more severe.
  • When possible, use medications that treat both disorders (Brady, 2006)


Related Resources: 
PCSS-B Guidance: Management of Psychiatric Medications in Patients Receiving Buprenorphine/Naloxone
Description: 
This document describes how to manage medications for co-occuring psychiatric disorders in a patient receiving buprenorphine.
Source: 
Physician Clinical Support System (PCSS)
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TIP 42 Chapter 5. Strategies for Working with Clients with Co-occurring Disorders
Description: 
Provides physicians with information on how to work with a patient who has co-occurring disorders, including how to engage the patient in treatment and how to develop a successful therapeutic relationship.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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TIP 43: Chapter 12. Treatment of Co-Occurring Disorders
Description: 
This chapter of TIP 43 discusses the prevalence, etiology, screening, diagnosis, and treatment of psychiatric disorders that co-occur with opioid addiction.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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TIP 45 Chapter 5: Co-Occurring Medical and Psychiatric Conditions
Description: 
This set of guidelines aids physicians in providing detoxification and substance abuse treatment, specifically examining co-occurring medical and psychiatric conditions.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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