People with anxiety and depression have a high rate of prescription opioid use, a new study finds.

Almost 19 percent of the estimated 38.6 million people diagnosed with anxiety and depression received at least two prescriptions for opioids in one year, the study found. More than half of opioid prescriptions went to people with these mental health disorders, according to The Washington Post.

People with anxiety and depression may feel pain more acutely, or may be less able to cope with the pain, leading to increased requests for opioids, said lead researcher Brian Sites of Dartmouth’s Geisel School of Medicine.

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 told the newspaper. He added that opioids may improve the symptoms of depression for a short while. This may lead patients to ask for additional refills.

The study will appear in the Journal of the American Board of Family Medicine.