Mental Health
Jump to: Youth Mental Health | Adult Mental Health | Experiences with Mental Health Care | Suicide Risk
Mental health and opioid use are deeply intertwined, creating layered challenges for individuals and the healthcare system. In 2022, approximately 21.5 million U.S. adults experienced both a mental health condition and a substance use disorder in the past year—a clear indication of the widespread nature of dual diagnoses.¹ Adults with mental health conditions are notably more likely to receive opioid prescriptions and use opioid therapies for longer periods of time.² Prescription opioid use is significantly higher among those with mental illness, with individuals who have a mental health disorder accounting for over half of all opioid prescriptions: 18.7% of adults with a mental health disorder receive prescription opioids compared to 5.0% of those without such disorders.³ Moreover, among opioid-involved hospital encounters, patients with co-occurring mental health and substance use disorders face worse outcomes, including higher rates of repeat visits, transfers to other facilities, discharges against medical advice, and a greater risk of death within a year following discharge, particularly from overdose (10% versus 3–4%).⁴ These data underscore the critical need for early identification, integrated treatment approaches, and coordinated collaborations across mental health and substance use services to break the cycle of worsening outcomes.
Youth Mental Health
Mental health challenges during adolescence—such as depression, anxiety, trauma exposure, and behavioral disorders—are closely linked to increased risk of opioid misuse and related harms. Youth experiencing poor mental health may be more likely to engage in substance use as a form of self-medication, particularly in the absence of adequate support systems. Research shows that early onset of mental health symptoms is a strong predictor of later prescription opioid misuse, illicit opioid use, and the development of opioid use disorder (OUD). Moreover, the co-occurrence of mental health disorders can intensify the severity and duration of opioid-related problems in young people, making recovery more complex. Stigma, lack of access to youth-centered behavioral health care, and low identification of mental health needs further compound these risks. Addressing mental health early through prevention, intervention, and trauma-informed care is essential to reducing long-term opioid misuse and promoting resilience among youth.
Adult Mental Health
Mental health challenges among adults are a key driver of opioid use and poor opioid-related outcomes. Adults living with mental illnesses—such as depression, anxiety, bipolar disorder, or PTSD—are significantly more likely to misuse opioids, develop opioid use disorder (OUD), and experience overdose. In fact, over half of all opioid prescriptions in the U.S. are written for adults with a diagnosed mental health condition. Adults with co-occurring mental health and substance use disorders often experience more severe symptoms, lower treatment engagement, and higher relapse rates. According to SAMHSA’s 2022 National Survey on Drug Use and Health, approximately 9.2 million adults in the U.S. had both a mental illness and a substance use disorder in the past year, and among those with serious mental illness, rates of opioid misuse are disproportionately high. Stigma, limited access to behavioral health care, and fragmented systems of treatment often prevent adults from receiving the integrated support they need. Improving opioid outcomes requires robust screening, coordinated care between mental health and substance use providers, and expanded access to evidence-based treatment that addresses the full spectrum of behavioral health needs.
Experiences with Mental Health Care
When mental health needs go unrecognized or untreated, people may turn to opioids as a form of self-medication, increasing both short- and long-term risks. Timely, affordable, and culturally appropriate mental health care can interrupt this pathway by addressing underlying psychological distress and promoting healthier coping strategies. However, many individuals—especially in rural and underserved communities—face significant barriers to accessing mental health services, including stigma, provider shortages, long wait times, and high costs. In this landscape, primary care providers (PCPs) serve as crucial entry points to mental health support. Because they are often the first and most frequent point of contact within the healthcare system, PCPs are uniquely positioned to identify mental health needs early, provide basic interventions, and connect patients to specialized care when needed. Collaborative care models that integrate behavioral health into primary care settings have been shown to improve both mental health and substance use outcomes. Enhancing access to mental health services—particularly through strong linkages with primary care—is essential for reducing opioid misuse, supporting recovery, and improving community-level health outcomes.
Note: Sometimes organizations - especially state agencies - will use different geographic breakdowns based on how they deliver services or how they distribute funding. In Colorado, the Department of Public Health and Environment (CDPHE) divides counties across 21 Health Statistics Regions (HSRs) based on statistic and demographic criteria. Certain data they collect, such as the data presented below, are only available based on HSR and reflect a broader area than just that which the council represents.
Suicide Risk
Suicide rates in the United States have risen significantly in recent decades. Individuals with opioid use disorder (OUD) are at higher risk for suicidal ideation, suicide attempts, and suicide death, especially when co-occurring mental health conditions such as depression, anxiety, or trauma-related disorders are present. Opioid misuse can intensify feelings of hopelessness, social isolation, and emotional distress—factors closely linked to suicide risk—while also impairing judgment and increasing impulsivity. Intentional and unintentional opioid overdoses can be difficult to distinguish, underscoring the blurred line between substance use and suicide. The presence of chronic pain, which is often treated with opioids and frequently coexists with mental health issues, adds another layer of risk. Suicide prevention efforts in the context of the opioid crisis require integrated strategies that encompass mental health screening, substance use treatment, pain management, and social support to reduce poor mental health and promote recovery.
