![]() ![]() Otherwise stated, the direction of causality and potential moderators in the relationship are not well understood. While stigma, stress and social exclusion commonly experienced alongside opioid use may produce poor psychological outcomes, opioids may also be used as a form of self-medication for coping with emotional pain or mental disorder symptoms. It is also unclear whether there is an identifiable causal relationship between mental disorder and opioid overdose. Thus, there is difficulty in distinguishing between the presence of a mental disorder and behaviors attributable to the use of drugs, leading to imprecision in the evidence base on mental disorder and opioid use. In addition, the historical expansion of diagnostic scope for mental disorders may contribute to over-pathologizing drug use, criminality, and social deviance. For example, individuals with mental disorders are often prescribed opioids or other psychotropic medications that may interact or cumulate with non-prescription or illicit opioids to increase overdose risk. First, disentangling the symptoms of substance use disorders, other non-substance use psychiatric disorders, and medication side effects can be challenging, which complicates the identification of the relationship between mental disorder and opioid overdose. This review summarizes the evidence on mental disorder and the risk of opioid overdose to advance understanding of this relationship.Īlthough past research indicates that individuals with mental disorders are at increased risk for overdose, there are multiple considerations that have precluded definitive conclusions from being made in this area. Some evidence exists to suggest that opioid overdose is commonly experienced by individuals with co-occurring mental disorder but literature that examines these two phenomena together is sparse. Opioid toxicity deaths, commonly referred to as opioid overdose has become a global crisis that has intensified during the COVID-19 pandemic. Nearly all reviewed studies found a connection between mental disorder and overdose, and the evidence suggests that having mental disorder is associated with experiencing fatal and non-fatal opioid overdose, but causal direction remains unclear. Moderate evidence also was found for the association between any disorder and overdose. The largest body of evidence exists for internalizing disorders generally and mood disorders specifically, followed by anxiety disorders, although there is also moderate evidence to support the relationship between thought disorders (e.g., schizophrenia, bipolar disorder) and opioid overdose. 37 of the 38 studies included in this review show a connection between at least one aspect of mental disorder and opioid overdose. Overall, 6512 records were screened and 38 were selected for inclusion. Data were synthesized using the lumping technique. ![]() Studies published between January 1, 2000, and January 4, 2021, from North America, Europe, the United Kingdom, Australia, and New Zealand were systematically identified and screened through searching electronic databases, citations, and by contacting experts. We used the PECOS framework to frame the review question. The protocol was published in Open Science Framework. This systematic review summarizes and presents the current state of research quantifying the relationship between mental disorder and overdose for people who use opioids. ![]()
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