Opioid-Induced Psychosis: Symptoms, Causes, and What To Do

Medically reviewed by Paul Ballas, D.O.

Written by Emily Van Devender

Posted on November 2, 2026

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Key Takeaways

Opioid-induced psychosis is an uncommon but potentially serious mental health complication that can happen during opioid use or withdrawal, and while it may be underreported due to stigma, recognizing the signs early can make a real difference.
Symptoms of opioid-induced psychosis can include hallucinations, delusions, and changes in thinking or behavior, and they may show up gradually or all at once. Certain factors can raise the risk of experiencing a psychotic episode, including high opioid doses, use of multiple substances, preexisting mental health conditions, and suddenly stopping opioid agonist therapy.
If you or someone you know shows signs of opioid-induced psychosis, it is important to seek medical attention right away so a healthcare provider can evaluate the symptoms, explore possible causes, and talk through options for care, and if someone is in immediate danger, calling 911 is the right step.

View all takeaways

When you think about the risks of opioid use, you probably think about dependence and overdose. A lesser-known risk is opioid-induced psychosis, an uncommon but potentially dangerous mental health complication that can occur during opioid use or withdrawal.

Psychosis more commonly occurs with other types of substance use, but opioid-induced psychosis may be underreported. Although stigma can make it difficult to tell someone about symptoms like hallucinations, help is available.

This guide can help you recognize the signs early in yourself or someone you care about.

🗳️ Have you experienced opioid-induced psychosis?

Yes

What Is Opioid-Induced Psychosis?

Psychosis, or a psychotic episode, involves a loss of touch with reality. Although most people recover from psychosis caused by drug use or withdrawal, it can be very scary for the person experiencing it and those around them.

Substance-induced psychosis occurs when a psychotic episode is triggered by using or stopping a drug. It’s most commonly associated with substances like hallucinogens (including LSD and PCP), methamphetamine, and cannabis. Psychotic episodes involving these substances can begin during active drug use or withdrawal.

Although research is limited, reports suggest that opioid-induced psychosis may be more likely to occur when someone abruptly stops using opioids than while actively using them. Psychosis during active opioid use is also possible but rare.

What Are the Symptoms of Opioid-Induced Psychosis?

Opioid-induced psychosis may be hard to distinguish from psychotic disorders that aren’t associated with substance use because they share many of the same symptoms. These symptoms can develop suddenly or gradually and typically fall into three categories.

Hallucinations

Hallucinations involve sensing something that isn’t really there, such as feeling that someone is touching you, seeing objects or people that aren’t there, or hearing voices. You might smell odors that nobody else can smell.

Hallucinations associated with opioid use are more often sounds or images than physical sensations. These are called auditory and visual hallucinations.

Delusions

Delusions, another key feature of psychosis, involve false beliefs that don’t reflect reality. For example, you might believe you’re being stalked or targeted in some way or think that foods are contaminated when they’re actually safe.

Changes in Thinking and Behavior

Impaired thinking can result from a psychotic episode linked to opioid use or discontinuation. This means your thoughts and behaviors may be different from usual. You might have trouble thinking clearly, remembering information, or expressing your emotions.

What Do Psychosis Symptoms Look Like From the Outside?

It may not be easy to recognize when you’re experiencing opioid-induced psychosis because delusions may seem reasonable to you at the time, and hallucinations can seem very real. People who know you might recognize the psychotic symptoms before you do. Here are some examples of what symptoms can look like to someone other than yourself:

Unusual hostility or aggressiveness
Confusing or nonsensical speech
Fear or suspicion without a clear reason
A lack of emotional expression when emotions are expected
A lack of motivation
Withdrawal from social interactions

Some of these behaviors might be difficult to distinguish from typical opioid side effects. For example, a lack of motivation could be mistaken for drowsiness caused by opioid use. Memory and concentration problems can also occur as side effects of opioids.

If you think someone may be experiencing opioid-induced psychosis, look for signs that their thoughts or beliefs don’t match reality. Compare their behavior with how they usually act, and note any clear changes.

What Causes Opioid-Induced Psychosis, and Who Is at Risk?

Opioid use is rarely associated with psychosis. Some research suggests that opioids may even have antipsychotic effects. However, certain circumstances and patterns of opioid use may raise your risk of experiencing a psychotic episode.

High Doses of Opioids

Studies of people using opioids for cancer pain or in end-of-life care suggest that high doses may be linked to a higher risk of opioid-induced hallucinations. This may also be true when opioid doses are rapidly increased.

Buildup of Neurotoxic Metabolites

Certain opioids produce substances called metabolites when your body breaks them down. Some of these metabolites can build up and affect the brain and nervous system. These are called neurotoxic metabolites.

Neurotoxic metabolites are associated with opioids such as codeine and morphine. They can contribute to opioid-induced neurotoxicity, which may cause symptoms such as hallucinations, confusion, or seizures.

Use of Certain Types of Opioids

Some opioids appear to be more likely than others to cause hallucinations. Morphine is the opioid most commonly associated with hallucinations, possibly because of its neurotoxic metabolites. However, the data may be skewed because morphine has a longer history of use and has been studied more thoroughly than other opioids.

In one study, hallucinations occurred in up to 6 percent of people receiving IV fentanyl for pain after surgery. Hallucinations and other psychotic symptoms have also been reported in people taking hydromorphone, hydrocodone, and tramadol.

Use of Multiple Substances

Using multiple substances, also called polysubstance use, can increase your risk of a psychotic episode. This can include combinations of drugs with or without opioids.

Preexisting Mental Health Conditions

Some people who experience psychosis while taking opioids may already have an underlying mental health disorder that can cause psychosis. They may not know they have the condition or that they have a family history of it.

In these cases, the psychosis may not be caused by opioid use or withdrawal. Research also suggests that people with certain mental health conditions, such as schizophrenia, may be more likely to use heroin or other opioids.

Sudden Discontinuation of Opioid Agonist Therapy

Some reports of opioid-related psychosis involve people who abruptly stop opioid agonist treatment with medications like buprenorphine (Brixadi, Sublocade) or methadone (Diskets, Methadose). Psychosis isn’t a common withdrawal symptom of these medications, but it has been reported when treatment is stopped suddenly.

Psychosis has also been reported during withdrawal from fentanyl, heroin, and other opioids. However, large-scale studies are lacking, so it’s unclear how often this occurs.

What Should You Do if You Notice Signs of Opioid-Induced Psychosis?

If you notice signs of opioid-induced psychosis in yourself or someone else, it’s important to get immediate medical attention. A doctor can evaluate the symptoms and determine whether they’re caused by opioid use or withdrawal or another condition, such as schizophrenia or Parkinson’s disease. This is important because these conditions may require different treatments.

Address Opioid Use With Your Doctor

When psychosis is suspected to be caused by active opioid use, your doctor may recommend stopping the opioid that may have triggered the symptoms. However, stopping opioids suddenly can cause withdrawal symptoms, so it’s important to get medical guidance. If you have opioid use disorder (OUD), discuss OUD treatment options with your doctor.

Resume Opioid Agonist Therapy if Recommended

If your doctor determines that psychosis is linked to withdrawal from opioid agonists like methadone or buprenorphine, they may recommend resuming treatment right away. They might also suggest switching to another medication as part of treatment with medications for opioid use disorder (MOUD).

Use Antipsychotic Medications if Prescribed

If psychosis symptoms continue after opioid use or withdrawal is addressed, your doctor might prescribe antipsychotic medications. Antipsychotics help reduce psychosis symptoms by affecting certain brain chemicals. They may also be helpful if your doctor determines that an underlying disorder is causing your symptoms.

Know When To Seek Emergency Care

In some cases, emergency care may be necessary for psychosis symptoms. Call 911 if someone is experiencing psychosis and threatens to hurt themself or others, becomes violent, or poses an immediate danger. Seek emergency care if someone is severely distressed, agitated, or experiencing severe hallucinations.

References

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