A new study suggests that people with anxiety and depression are consuming a disproportionate share of prescription painkillers, a finding that could add a new wrinkle to the epidemic of opioid use in the United States.

Researchers at Dartmouth College and the University of Michigan found that nearly 19 percent of the estimated 38.6 million people with those two most common mental health disorders received at least two prescriptions for opioids during a year. And more than half the prescriptions for the powerful, highly addictive painkillers went to individuals in that group, the researchers asserted.

Those patients may have some form of physical pain, said Brian Sites, a professor of anesthesiology and orthopedics at Dartmouth’s Geisel School of Medicine, who led the study team. But their mental condition may cause them to feel that pain more acutely or be less able to cope with it, leading to increased requests for something to dull it.

Pain that “you may report as a two out of 10, someone with mental health disorders—depression, anxiety—may report as a 10 out of 10,” Sites said in an interview. In addition, opioids may improve the symptoms of depression for a short while, he said, with patients who experience that then asking for continued refills.

As a result, doctors trying to be empathetic to their patients’ complaints may tend to overprescribe opioid painkillers, he said. About half of all opioids are prescribed by primary-care physicians, who also manage most routine anxiety and depression.

The study was published online Monday in the Journal of the American Board of Family Medicine.

Opioid abuse has caused the worst drug crisis in U.S. history. In 2015,91 people died each day of overdoses of prescription painkillers, heroin, fentanyl and other opioids.

Typically, authorities have said, addiction to prescription opioids begins with some physical ailment—a back or knee injury, for example—for which a narcotic painkiller is given. Some people are highly susceptible to the euphoria that such medications generally provide and quickly can become dependent on them, experts say.

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That narrative rarely considers the possible impact of mental health factors, so Sites’s team examined the prevalence of the drugs’ use among people with anxiety and depression. Using a government survey for 2011 and 2013 in which patients describe their health conditions and medication use, the researchers estimated that 7.2 million of the 38.6 million people with anxiety and depression took opioids. They concluded that adults with mental disorders were much more likely than people without them to use prescription opioids—18.7 percent vs. 5 percent.

The results are not based on a randomized, controlled study and therefore don’t yield any information on whether having a mental disorder might cause someone to use opioids.

The researchers concluded that 51.4 percent of 115 million opioid prescriptions written annually were given to people with anxiety and depression. Their figure for the total number of prescriptions issued is about half the number commonly cited by other authorities, including the Centers for Disease Control and Prevention.

Still, the study may provide doctors with some insight about possible overprescribing for people with anxiety and depression, Sites said. He emphasized that physicians are in a difficult position on the issue. “We’re in an independent crisis of mental health as well, the under-treatment of it,” he said. “These two things collide.”

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