Opioid use and schizophrenia

Abstract

Purpose of review To summarize the current literature regarding comorbid schizophrenia and opioid use disorder (OUD). Recent findings Epidemiological evidence is unclear on whether patients with schizophrenia have a higher rate of OUD. Patients with OUD have been shown to have a higher risk of developing schizophrenia. However, it is clear that patients with both schizophrenia and OUD are less likely to receive standard of care including medication-assisted treatment (MAT) for opiate use disorder and have worse outcomes compared with patients with schizophrenia who do not abuse opioids. OUD significantly increases the risk of converting patients from prodromal schizophrenia states to schizophrenia or schizoaffective disorder. Shared pathophysiology involving the kappa opioid receptor may help explain the relationships between schizophrenia and OUD. Second-generation antipsychotics, long-acting injectables, and MAT for OUD should be utilized in a dual-diagnosis and treatment approach for patients with schizophrenia and OUD. Summary Exploration into the relationship between schizophrenia and opiate abuse is still in its infancy and requires a significant amount of future attention to clarify the epidemiology of this comorbidity, neurobiological relationship, shared genetic underpinnings, and possible treatments for both the psychotic symptoms and substance abuse.

Hospitalization Associated With Comorbid Psychiatric and Substance Use Disorders Among Adults With COVID-19 Treated in US Emergency Departments From April 2020 to August 2021

“…These 2 conditions share a common mechanism involving the kappa opioid receptor pathway, which is reversable by opioid antagonists. [45][46][47] The opioid receptor pathway is also required to control respiratory syncytial virus replication, thereby controlling its disease severity. 51 Such observations only suggest but do not indicate a specific mechanism of action here and merit further investigation.…”

“…Separately, PD, SUD, and COVID-19 have been found among people with environmental risks or low socioeconomic status, including persons experiencing homelessness and those with poor medical care . One common pathogenesis pathway proposed is the development of an inflammatory response among those with PD, SUD, or COVID-19 . Substance use can influence the pulmonary, cardiac, metabolic, and immune systems; each such system is also targeted by the SARS-CoV-2 virus .…”

“…20,40,41 One common pathogenesis pathway proposed is the development of an inflammatory re-sponse among those with PD, SUD, or COVID-19. [43][44][45][46][47] Substance use can influence the pulmonary, cardiac, metabolic, and immune systems; each such system is also targeted by the SARS-CoV-2 virus. 41 Opioid use can dampen the immune response, 48 initiate or worsen acute respiratory distress syn- drome, or depress respiratory drive.…”

The Developmental Origins of Opioid Use Disorder and Its Comorbidities

“…Another study found a very high co-incidence of PTSD and opioid abuse among women that was explained by a history of childhood trauma (Najavits et al, 1997). The risk for schizophrenia and psychosis is also increased by ELA (van Os et al, 2010;Bentall et al, 2014), which are highly comorbid with substance use disorder (Schmidt L. M. et al, 2011;Li et al, 2020). Palatable food cravings and disordered eating are strongly associated with ELA (Halmi, 2009;Dallman, 2014;Osadchiy et al, 2019), and these cravings are commonly observed in individuals with OUD (Morabia et al, 1989;Pelchat, 2002;Mysels and Sullivan, 2010;Canan et al, 2017;McDonald and Laurent, 2019;Nolan, 2019).…”

Opioid use disorder and the brain: a clinical perspective

“…high genetic risk, schizotypal personality disorder, subpsychotic symptoms, etc.) [93]. Studies have indicated that this risk is comparable or higher than for cannabis, stimulants and alcohol [94,95].…”