How providers can manage abortion anxiety based on opioid use


Recent research suggests assessing recent opioid use could aid in managing anxiety related to abortion, shedding light on pain management strategies for providers and patients alike.

How providers can manage abortion anxiety based on opioid use | Image Credit: © ivanko80 - © ivanko80 -

How providers can manage abortion anxiety based on opioid use | Image Credit: © ivanko80 - © ivanko80 -

Abortion anxiety may be managed by assessing recent opioid use, according to a recent study published in Cureus.


  1. Recent opioid use may heighten anxiety surrounding abortion-related pain, indicating a need for tailored counseling for individuals with substance use histories.
  2. The study found that anxiety scores for pain during and after abortion were notably higher among recent opioid users compared to non-users.
  3. While anxiety levels were similar among marijuana users and non-users, cannabidiol users reported slightly increased anxiety about pain during the procedure.
  4. The majority of participants were aged 35 years or younger, with 46.5% reporting marijuana use and 5.1% reporting recent opioid use.
  5. Findings underscore the importance of considering recent substance use when counseling patients about pain expectations during abortion procedures, highlighting a potential area for improved patient satisfaction.

An elective termination of pregnancy occurs in approximately 1 in 4 US women, and 88% of abortions take place during the first trimester. Additionally, high rates of substance abuse have been reported in the United States, with marijuana use reported in 21.3% of women aged 18 to 25 years and 8.1% of women aged 26 years and older.

Opioid pain prescription misuse had a reported rate of 4.6% in 2015 to 2019 Colorado data. Research has indicated fear of pain and catastrophizing during pregnancy termination may raise pain intensity ratings, and that pain perception is higher among patients with substance use such as cannabidiol (CBD), marijuana, or opioids.

To evaluate the impact of recent substance use on anxiety toward abortion-related pain, investigators conducted a prospective, cross-sectional survey study. Participants included patients presenting for elective termination pregnancy procedures at a participating academic family planning clinic

Worry about expected pain during and after an abortion procedure was compared between patients with and without recent opioid use. Data about marijuana, CBD, and opioid use within the last 3 months and on the day of the procedure was determined among patients aged 18 to 45 years through an anonymous survey.

Anxiety about pain was measured by patients on a scale of 0 to 10, with 0 meaning not worried and 10 meaning extremely worried. Additional data collected during the survey included demographic characteristics and prior abortion and obstetrical history.

There were 217 participants included in the final analysis, 85% of whom were aged 35 years or younger and 50.2% were White. A previous delivery was reported in 55%, no prior abortion in 60.7%, and planned abortion procedure in 57%.

Of patients planning an abortion procedure, 31% planned to use intravenous sedation for pain management, while 28.5% were undecided. Marijuana use in the past 3 months was reported by 46.5% of patients, CBD use by 24%, and opioid use by 5.1%.

The overall study cohort had a median anxiety score of 6 for pain both during and after the procedure. Similar anxiety scores were reported between marijuana and non-marijuana users, but anxiety scores for pain during the operation were slightly increased among CBD users vs non-CBD users, at 7 vs 6, respectively.

Higher anxiety was reported for both pain during and after abortion among recent opioid users vs non-opioid users. Anxiety scores for pain during abortion were 7 vs 6, respectively, while scores for pain after abortion were 8 vs 6, respectively. Anxiety was reduced among patients with at least 1 previous abortion, with a median score of 5.

These results indicated recent substance use may be relevant for abortion providers toward counseling patients about pain expectations. Investigators recommended further research to evaluate the impact of counseling on patient satisfaction.


Masten M, Sheeder J, Lazorwitz A. Substance use and anxiety about pain among patients seeking abortion services. Cureus. 2024;16(3):e57034. doi: 10.7759/cureus.57034

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