Oxycodone and Anxiety: Understanding Rebound Effects, Withdrawal, and Dual Diagnosis

Oxycodone and anxiety can be connected in more than one way. Some individuals take oxycodone for pain management and experience new-onset anxiety symptoms. Other individuals already live with generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), depression, or another mental health condition and find that oxycodone exacerbates unstable mood.

Oxycodone’s initial calming and sedative effects can be attributed to its ability to interact with the body’s opioid receptors, resulting in euphoria and/or pain relief. However, as oxycodone begins to wear off, anxiety after oxycodone can develop. In addition to anxiety developing as a result of oxycodone wearing off, anxiety can develop as an individual increases their doses, uses oxycodone more frequently, or misuses prescription opioids.

Oxycodone and How It Interacts With The Brain

Oxycodone interacts with the body’s opioid receptors in the brain, spinal cord, and throughout the body. According to the National Institute on Drug Abuse (NIDA), opioids can block pain signals and release large amounts of dopamine into the brain, which can reinforce continued use and create a desire to repeat the experience. [1]

As a result of its interaction with the central nervous system, oxycodone can produce side effects such as drowsiness, confusion, nausea, constipation, euphoria, and slowed breathing. It can also lead to tolerance, physical dependence, opioid use disorder, overdose, and withdrawal symptoms.

Can Oxycodone Cause Anxiety?

Yes. Oxycodone can cause or exacerbate anxiety in some individuals. Although anxiety is not always considered a common side effect associated with opioids, anxiety can develop during use, as oxycodone wears off, or during withdrawal.

Oxycodone may contribute to anxiety through:

• Changes in dopamine levels and other brain chemicals
• Sedation followed by rebound restlessness
• Fear of running out of medication
• Worry about pain returning
• Physical dependence
• Withdrawal symptoms between doses
• Sleep disruption
• Mixing oxycodone with alcohol, benzodiazepines, or other substances
• Exacerbating depression or another mental health disorder

The official label of oxycodone warns of risks associated with addiction, abuse, misuse, life-threatening respiratory depression, and withdrawal reactions when opioids are stopped too quickly in physically dependent patients. [2]

Anxiety may also be related to the reason oxycodone was prescribed. Severe pain can increase stress, fear, insomnia, and panic attacks. It can be difficult to determine whether anxiety is caused by oxycodone, pain, withdrawal, or an underlying mental health condition.

Why Does Anxiety Happen After Oxycodone Wears Off?

Some people feel anxiety after oxycodone because the initial calming and euphoric effects fade. When the body adapts to repeated oxycodone use, it may react when the medication level starts to drop. As levels drop following use, the nervous system may become unsettled.

This may cause symptoms such as:

• Restlessness
• Irritability
• Cravings
• Sweating
• Insomnia
• Muscle aches
• Increased heart rate
• Nausea
• Stomach discomfort
• Panic-like sensations
• Fear or unease

This cycle can become self-reinforcing. A person feels anxious when oxycodone wears off and takes more to feel better, then they feel anxious again as the next dose fades. Over time, tolerance can develop, whereby the same dose will no longer provide the same degree of relief. This may encourage higher doses or more frequent dosing.

Is Anxiety a Symptom of Oxycodone Withdrawal?

Yes. Oxycodone withdrawal anxiety is very common. Opioid withdrawal can involve both physical symptoms and psychological symptoms.

Possible symptoms include:

• Anxiety
• Restlessness
• Insomnia
• Sweating
• Chills
• Muscle aches
• Runny nose
• Watery eyes
• Nausea
• Vomiting
• Diarrhea
• Abdominal cramps
• Increased heart rate
• High blood pressure
• Cravings
• Depression or mood swings

The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) opioid withdrawal guidance lists anxiety, irritability, sleep problems, sweating, nausea, vomiting, diarrhea, muscle aches, and increased pulse or blood pressure among signs that can occur during opioid withdrawal. [3]

Withdrawal can begin when someone stops oxycodone suddenly, reduces the dose too quickly, misses doses, or attempts to quit without support. Although opioid withdrawal is often not as medically dangerous as alcohol or benzodiazepine withdrawal, it can still feel severe and can increase the risk of relapse and overdose.

How Are Anxiety Disorders and Opioid Misuse Connected?

Anxiety disorders and opioid misuse can be closely related. Some people use oxycodone to self-medicate anxiety symptoms, panic attacks, trauma symptoms, or emotional pain. Others develop anxiety due to how oxycodone interferes with their sleep, relationships, work, finances, or health.

The connection can function in two directions:

• Anxiety may increase the urge to use oxycodone for relief.
• Oxycodone may exacerbate anxiety as tolerance or withdrawal develops.
• Depression or anxiety may make cravings harder to manage.
• Opioid use may interfere with psychotherapy, medications, or coping skills.
• Fear of withdrawal may keep someone using even though they want to stop.

According to SAMHSA, co-occurring disorders refer to the presence of both a mental disorder and a substance use disorder, and integrated care addresses both substance use disorders and mental disorders together. [4]

This matters because treating only the opioid use disorder or only the anxiety disorder may leave part of the problem untreated. Dual diagnosis treatment can help both.

Oxycodone, Anxiety Medications, and Overdose Risk

Anxiety is sometimes treated with benzodiazepines; however, taking benzodiazepines with oxycodone can be dangerous. Both can slow the central nervous system. When combined, they increase the risk of sedation, confusion, respiratory depression, overdose, and death.

Respiratory depression means shallow breathing that leads to carbon dioxide build-up and lack of oxygen. This is a medical emergency.

Naloxone can reverse an opioid overdose. The Centers for Disease Control and Prevention (CDC) advises giving naloxone and calling 911 if someone may be overdosing on opioids. Warning signs of an opioid overdose include slow breathing, blue or gray lips, inability to wake up, choking sounds, or a limp body. [5]

Any individual taking oxycodone should ask their healthcare provider about accessing naloxone.

When Oxycodone Use May Be Becoming a Problem

Taking oxycodone exactly as prescribed for short-term severe pain is different from opioid misuse. Still, long-term use of prescription opioids represents a potential problem, especially when use continues beyond what was initially expected or when it feels emotionally necessary.

Signs of potential misuse may include:

• Taking more than prescribed
• Running out early
• Feeling anxious when doses are missed
• Using oxycodone to calm down or escape emotions
• Taking oxycodone with alcohol or benzodiazepines
• Needing higher doses for the same effect
• Cravings
• Withdrawal symptoms
• Doctor shopping or borrowing medication
• Continuing use despite harm
• Fear of stopping due to withdrawal

If anxiety, pain, and oxycodone use feel tangled together, professional support can help clarify what is happening and which level of care is safest.

Treatment Options for Oxycodone Use and Anxiety

There are multiple ways to treat oxycodone misuse and anxiety, but care is often most effective when both concerns are addressed together through dual diagnosis treatment.

NIDA has stated that there are effective medicine and behavioral therapy options available for individuals suffering from opioid addiction. Additionally, NIDA has confirmed that prescription medications for treating opioid use disorder (OUD) are safe, effective, and save lives.

Oxycodone Addiction and Anxiety Treatment in Haddam, Connecticut

If you are struggling to control oxycodone use, living with anxiety you can’t manage, or have another mental health or substance use disorder, we can help.

At Paramount Wellness, we offer a wide range of addiction, substance use disorder, and mental health treatment services in Haddam, Connecticut. Reach out today to begin your healing journey.