From the FDA Drug Label
Nervous System: abnormal dreams, abnormal gait, agitation, amnesia, anxiety, ataxia, confusion, convulsions, coma, delirium, depression, dry mouth, euphoria, hallucinations, lethargy, nervousness, abnormal thinking, tremor, vasodilation, vertigo, headache
The following adverse reactions associated with the use of morphine were identified in clinical studies or post-marketing reports.
Serious adverse reactions associated with morphine use included:
The most frequent of these included: constipation, nausea, and somnolence. Other commonly observed adverse reactions included: lightheadedness, dizziness, sedation, vomiting, and sweating.
Yes, opioids can cause psychotic symptoms.
- Hallucinations are listed as a possible adverse reaction in the morphine drug label 1.
- Other nervous system adverse reactions that could be related to psychotic symptoms include abnormal thinking, confusion, delirium, and euphoria.
- The fentanyl drug label 2 also mentions euphoria and dysphoria as common effects, but does not explicitly list psychotic symptoms.
From the Research
Yes, opioids can cause psychotic symptoms in some individuals, particularly during withdrawal, as evidenced by a systematic review published in 2021 3. Medications such as morphine, oxycodone, hydrocodone, fentanyl, and methadone have been associated with psychotic manifestations, particularly at higher doses or with prolonged use. These symptoms may include hallucinations (visual, auditory, or tactile), delusions, paranoia, and disorganized thinking. The risk increases with higher doses, rapid dose escalation, longer duration of use, and in patients with pre-existing mental health conditions. Opioid-induced psychosis typically develops through direct effects on dopamine and serotonin neurotransmitter systems in the brain. The mu-opioid receptors, when activated by these medications, can indirectly increase dopamine release in certain brain regions, potentially triggering psychotic symptoms. Some studies suggest that opioids may have an antipsychotic effect, particularly in the context of withdrawal, where reintroduction of the opioid can lead to remission of psychotic symptoms 3, 4. However, the literature is scarce, and further investigation is needed to fully understand the relationship between opioid withdrawal and psychotic symptoms. Management typically involves dose reduction or discontinuation of the opioid when possible, along with supportive care. If opioid therapy must continue, switching to a different opioid or adding an antipsychotic medication might help control symptoms. Patients and healthcare providers should monitor for early warning signs of psychosis during opioid treatment, especially when starting therapy or changing doses. Key points to consider include:
- Opioids can cause psychotic symptoms, particularly during withdrawal
- The risk increases with higher doses, rapid dose escalation, and longer duration of use
- Opioid-induced psychosis may be related to the drug's effects on dopamine and serotonin neurotransmitter systems
- Management involves dose reduction, discontinuation, or switching to a different opioid, and adding an antipsychotic medication if necessary
- Monitoring for early warning signs of psychosis is crucial during opioid treatment.