A prospective cohort study of prescription opioid use and change in generalized anxiety in non-cancer pain

Objective Anxiety symptoms are common among people with chronic, non-cancer pain, and a growing literature suggests prescription opioid use may be contributing to these symptoms. However, acute opioid effects can be euphoric and potentially anxiolytic. We determined if daily opioid use and higher doses were risk factors for anxiety. Methods Baseline surveys were administered to patients with non-cancer pain beginning a new period of prescription opioid use who were then invited to complete 6-month and 12-month follow-ups with questions on pain, mood, and prescription opioid use. At each wave, prescription opioid use was self-reported via structured survey and generalized anxiety disorder (GAD) symptoms were assessed using the GAD-7. Within-person multivariable models controlled for demographic and clinical confounders. Results The cohort was 52.8 ± 11.9 years of age, 69.7 % were female and 70.4 % were White race. When a participant had an opioid during follow-up, compared to when a participant was no longer using a prescription opioid, they had 40 % the odds of developing probable GAD (OR = 0.40; 95 % CI: 0.21–0.74). Participants who reported using an opioid daily, compared to those who did not, had approximately half the odds for probable GAD (OR = 0.51; 95 % CI: 0.29–0.89). Higher MME was not associated with GAD. Discussion Over a 12-month follow-up period, the odds of experiencing GAD symptoms and probable GAD were lower when participants were using a prescription opioid and when using daily versus non-daily. Short-term anxiety relief is expected with prescription opioid use but may eventually contribute to adverse opioid outcomes, such as opioid use disorder.