Depression - A major but neglected consequence contributing to the health toll from prescription opioids?

Prescription opioid analgesic (POA) use is common especially in North America, and associated with extensive morbidity and mortality. While medical and non-medical POA use have been documented to be associated with mental health problems, and specifically depression, newly emerging epidemiological evidence suggests that incident depression post-initiation of POA use may be common. Neurobiological - specifically regarding impacts of POAs on brain functioning - and/or psycho-social processes may be relevant pathways; these must be better understood, also to guide clinical practice for interventions. Incident depression outcomes may be an added component to the extensive health toll from widespread POA use.