Comparative Analysis of Anxiety, Depression, and Stress in Opioid-Dependent Patients Treated with Methadone, Buprenorphine, or Opium Tincture: A Cross-Sectional Study

Introduction: Opioid use disorder (OUD) is a global public health crisis, with high comorbidity rates of anxiety and depression. This study evaluates mental health outcomes in patients receiving methadone, buprenorphine, or opium tincture, while addressing confounding factors such as polysubstance use and dosage variability. Methods: A cross-sectional study was conducted with 200 adults diagnosed with OUD (DSM-5 criteria) at an addiction clinic in Isfahan, Iran. The Depression, Anxiety, and Stress Scale (DASS-21) was administered to assess symptom severity. Statistical analyses included ANOVA, post-hoc Tukey tests, and descriptive reporting of confounders. Results: Buprenorphine users exhibited significantly lower anxiety (10.2 ± 2.1), depression (9.4 ± 3.0), and stress (11.3 ± 3.4) scores compared to methadone (anxiety: 15.1 ± 3.0; depression: 14.3 ± 4.2; stress: 16.4 ± 4.1) and opium tincture (anxiety: 20.5 ± 5.2; depression: 19.1 ± 4.3; stress: 21.2 ± 5.0) groups (ANOVA: p < 0.001 for all domains). Post-hoc analyses confirmed inter-group differences (p < 0.05). Discussion: Buprenorphine’s pharmacological profile may confer mental health advantages, while opium tincture’s unregulated use correlates with poorer outcomes. Limitations include unmeasured confounders like socioeconomic stressors. Conclusion: Buprenorphine should be prioritized in OUD patients with psychiatric comorbidities, supported by integrated mental health interventions.