Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 1:272:112685.
doi: 10.1016/j.drugalcdep.2025.112685. Epub 2025 Apr 22.

Substance-induced mental disorders and discontinuation of medication for opioid use disorder

Alyssa Shell Tilhou  1 , Richard A Grucza  2 , Kevin Y Xu  3
Affiliations

Substance-induced mental disorders and discontinuation of medication for opioid use disorder

Alyssa Shell Tilhou et al. Drug Alcohol Depend. .

Abstract

Background: People with opioid use disorder (OUD) often exhibit psychiatric symptoms representing primary (PMD) and substance induced mental disorders (SIMD). PMD are associated with increased discontinuation of medications for OUD (MOUD). It is unknown if this relationship holds for SIMD.

Objective: To examine the association between SIMD and time to MOUD discontinuation.

Methods: In this retrospective cohort study using the Merative™ MarketScan® Commercial and Multi-State Medicaid insurance claims Databases (2015-2019), we identified individuals initiating MOUD (buprenorphine, methadone, and extended-release naltrexone) following a 180-day pre-period of continuous enrollment without MOUD. Episodes were classified based on > 1 SIMD diagnosis in this pre-period. We estimated days to MOUD discontinuation using stepwise multivariable Cox regression, adjusting for age, sex, insurance type (Medicaid or Commercial), Charlson Comorbidity Index, MOUD at initiation, co-occurring substance use disorders (SUD), and PMD.

Results: Of 31,134 MOUD initiation episodes, 3.5 % exhibited SIMD. Episodes with SIMD demonstrated a higher prevalence (p < .001 for all) of mood and psychotic disorders (42.8 vs 16.4 %; 4.0 % vs 0.7 % respectively) but lower prevalence of anxiety-related disorders (51.3 % vs 59.9 %) relative to episodes without SIMD. Unadjusted models illustrated a 44 % (95 %CI:1.34-1.55) increased hazard of MOUD discontinuation associated with SIMD. After adjusting for all covariates but PMD, SIMD retained a 13 % increased hazard of MOUD discontinuation (95 %CI:1.05-1.21). Adjusting for PMD eliminated this association.

Conclusion: SIMD is associated with reduced time to MOUD discontinuation, which may be accounted for by PMD. Further research on SIMD treatment among individuals with OUD is needed to improve OUD treatment outcomes.

Keywords: Medication for opioid use disorder; Opioid use disorder; Substance induced mental disorder; Treatment discontinuation; Treatment retention.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

    1. Wilson L, Szigeti A, Kearney A, Clarke M. Clinical characteristics of primary psychotic disorders with concurrent substance abuse and substance-induced psychotic disorders: A systematic review. Schizophrenia Research. 2018;197:78–86. - PubMed
    1. Hides L, Dawe S, McKetin R, et al. Primary and substance-induced psychotic disorders in methamphetamine users. Psychiatry research. 2015;226(1):91–96. - PubMed
    1. Kendler KS, Ohlsson H, Sundquist J, Sundquist K. Prediction of Onset of Substance-Induced Psychotic Disorder and Its Progression to Schizophrenia in a Swedish National Sample. AJP. 2019;176(9):711–719. doi: 10.1176/appi.ajp.2019.18101217 - DOI - PMC - PubMed
    1. Lai HMX, Cleary M, Sitharthan T, Hunt GE. Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: A systematic review and meta-analysis. Drug and alcohol dependence. 2015;154:1–13. - PubMed
    1. Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Social psychiatry and psychiatric epidemiology. 2015;50(11):1609–1640. - PMC - PubMed

LinkOut - more resources