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Mood disorders and benzodiazepine use increase risk for new persistent opioid use in postsurgical adultsMood Disorders and Anxiety Linked to Higher Risk of Opioid Use

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Key Takeaway
Note that mood disorders, anxiety, and preoperative benzodiazepine use are associated with higher risk for persistent opioid use.

This meta-analysis synthesizes evidence from retrospective cohort studies to identify patient-related risk factors associated with new persistent opioid use (NPOU) in opioid-naïev postsurgical adults. The analysis focuses on sociodemographic, clinical, and opioid exposure factors as predictors of NPOU.

The meta-analysis found that mood disorders were associated with a higher risk for NPOU (effect size 1.24; 95% CI, 1.17-1.32). Anxiety was also associated with increased risk (effect size 1.17; 95% CI, 1.11-1.23). Furthermore, Medicaid enrollment (effect size 1.77; 95% CI, 1.46-2.15) and preoperative benzodiazepine use (effect size 1.77; 95% CI, 1.53-2.05) were associated with a higher risk for NPOU.

A primary limitation of the findings is that all included studies were retrospective cohort studies, which limits the ability to establish causality. Clinical application should be interpreted as identifying associations rather than certainties of causation. These factors may serve as indicators for identifying patients at higher risk for developing persistent opioid use following surgery.

How this fits prior evidence

This meta-analysis addresses a gap in identifying specific clinical and sociodemographic predictors for new persistent opioid use (NPOU) in postsurgical populations. While previous coverage noted that self-referential processing patterns are linked to depression and anxiety, this study specifically links those conditions to increased risk of NPOU. Additionally, while other evidence explored interventions to reduce dental anxiety, this meta-analysis identifies pre-existing anxiety as a specific risk factor for opioid use.

Researchers looked at what factors might lead to new, persistent opioid use in adults who had never used opioids before their surgery. The study focused on patients in the United States and looked at how personal history and medical conditions impact long-term recovery.

The results showed a link between certain conditions and higher risks for ongoing opioid use. Specifically, patients with mood disorders or anxiety were more likely to develop persistent use. Other factors like being enrolled in Medicaid or using benzodiazepines before surgery also showed links to higher risk levels.

It is important to note that these findings are based on retrospective data, which means they show associations rather than direct causes. Because the evidence comes from past records, it cannot prove that one factor definitely causes another. Patients should talk with their doctors about how these specific risks might apply to their own surgical care.

What this means for you:
Mood disorders and anxiety are linked to a higher risk of persistent opioid use after surgery.

Common questions

Does having anxiety increase the risk of opioid use after surgery?

The study found that anxiety is associated with a higher risk for new persistent opioid use in adults who had not used opioids before their surgery. This link was identified through an analysis of patient data, but it does not mean anxiety directly causes the behavior.

What other factors are linked to long-term opioid use?

In addition to mood disorders and anxiety, the study found that Medicaid enrollment and the use of benzodiazepines before surgery were also associated with a higher risk for new persistent opioid use in the studied group.

Are these findings certain for every patient?

No, these results show associations rather than certainties. Because the data came from retrospective studies, they indicate links that may be important for doctors to consider when planning care for patients with anxiety or mood disorders.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
OBJECTIVE: One in nine Americans will undergo a surgical procedure during their lifetime and, for some, the treatment of postoperative pain represents their first prolonged exposure to an opioid. New persistent opioid use (NPOU) refers to continued opioid use beyond the typical surgical recovery period (3 months) in opioid-naïve patients and has been linked to increased morbidity, mortality, and opioid-related complications. This systematic review with meta-analysis synthesized the recent evidence on patient-related risk factors for NPOU among opioid-naïve postsurgical adults in the United States to derive a pooled effect size for evaluable factors using a random-effects model (PROSPERO: CRD420250651059). METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and checklist. The level of evidence and methodological quality were assessed using the Joanna Briggs Institute checklist. Estimates of associations and CIs were extracted. Risk factors were categorized as either sociodemographic, clinical, or opioid exposure factors using a narrative synthesis. A random effects meta-analysis of estimates of association was performed. RESULTS: A comprehensive literature search resulted in 27 articles; all were retrospective cohort studies and 89% were deemed of good quality. Among the various risk factors identified through narrative synthesis, mood disorders, anxiety, Medicaid enrollment, and preoperative benzodiazepine use were the most predictive of NPOU. The pooled odds ratios for these risk factors from meta-analysis were 1.24 (95% CI, 1.17-1.32), 1.17 (1.11-1.23), 1.77 (1.46-2.15), and 1.77 (1.53-2.05), respectively. CONCLUSION: Opioid-naïve persons insured by Medicaid or with preoperative anxiety, depression, or benzodiazepine use, are associated with a higher risk for NPOU.
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