From the Guidelines
When prescribing opioids to patients with panic disorder, it is crucial to prioritize alternative non-opioid pain management approaches and implement risk mitigation strategies to minimize the risk of worsening anxiety symptoms, substance use disorders, and respiratory depression. The use of opioids in patients with panic disorder requires careful consideration of the potential risks and benefits. According to the CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022 1, opioids should not be considered first-line or routine therapy for subacute or chronic pain. Instead, non-opioid therapies, such as cognitive behavioral therapy, should be prioritized whenever possible. Some key considerations when prescribing opioids to patients with panic disorder include:
- The risk of worsening anxiety symptoms, as opioids can paradoxically increase anxiety and potentially trigger panic attacks during both use and withdrawal 1
- The increased risk of substance use disorders, as patients with panic disorder may have an increased vulnerability to opioid misuse or dependence 1
- The risk of respiratory depression, overdose, and death when combining opioids with benzodiazepines, which are often prescribed for panic disorder 1
- The importance of using the lowest effective dose for the shortest duration, frequent monitoring, urine drug screening, prescription drug monitoring program checks, and clear treatment agreements to minimize the risk of opioid misuse or dependence 1
- The need for a collaborative approach involving mental health professionals to ensure proper management of both the panic disorder and pain condition 1 By prioritizing alternative non-opioid pain management approaches and implementing risk mitigation strategies, clinicians can minimize the risks associated with opioid use in patients with panic disorder and provide effective management of both conditions.
From the Research
Legal Considerations
- There are no specific legal considerations mentioned in the provided studies regarding the prescription of opioids to patients with panic disorder. However, it is essential to note that opioids are not typically recommended as a first-line treatment for panic disorder 2, 3, 4, 5, 6.
Ethical Considerations
- The use of benzodiazepines, which are sometimes prescribed for panic disorder, raises ethical concerns due to their potential for dependence and withdrawal symptoms 2, 3, 4.
- The decision to prescribe any medication, including opioids, should be guided by the patient's preference and should balance benefits and harms from treatment in a long-term perspective 2.
- It is crucial to consider the potential risks and benefits of medications, including opioids, and to discuss these with the patient to ensure informed decision-making 5.
Social Considerations
- Panic disorder is a common and disabling condition that can have significant social implications, including impaired social functioning and decreased quality of life 2, 3, 4, 5, 6.
- The treatment of panic disorder, including the use of medications, should take into account the patient's social context and should aim to improve social functioning and overall well-being 2, 3, 4, 5, 6.
- The potential for stigma and social stigma associated with mental health conditions, including panic disorder, should be considered when prescribing medications, including opioids 2, 3, 4, 5, 6.