Dual Diagnosis

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 classifi ed as depressants and induce serious depression and

anxiety, particularly with chronic and persistent use. Th e Diagnostic and Statistical Manual of Mental Disorders, fi ft h 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. Oft en the way to distinguish between a substanceinduced

disorder and an independent major depressive or anxiety disorder is to discontinue the opioid medications. Given that

opioids are not effi cacious for long-term prescribing, discontinuation of the medication is the treatment of choice