Long-term opioid use is strongly associated with mood disorders, post-traumatic stress disorder, personality disorders and both attempted suicide and suicide. More than half of people who use illicit opioids fit the criteria for a psychiatric diagnosis. Another emerging issue of concern is the high rate of psychiatric comorbidity among individuals who develop dependence on pharmaceutical opioids, often in the context of chronic pain. Sensitive questioning by the GP about psychological distress and suicidal behaviours may enable better management of these often-overlooked issues.
Opioids are commonly used drugs both legally and illicitly, with illicit use accounting for just over half of all opioid use.1 Opioids have the highest dependence liability of all illicit drugs, with an estimated one in four users of heroin developing dependence. Other members of the opioid class include morphine, codeine, methadone, oxycodone and fentanyl. In recent years, the use and abuse of pharmaceutical opioids has become a major public health concern, particularly in North America but increasingly too in Europe and Australia.1