The Dangers of Long Term Opiate Use

Written By Bobby Oerzen BS MA - February 7th, 2017
The Dangers of Long Term Opiate Use

It is the fail-safe drug of choice for those in hospital suffering from unbearable pain. Some of the most commonly prescription opioid drugs are household names; morphine, codeine, Vicodin and oxycodone. Where do these “miracle drugs” come from? And what makes them so addictive?

Opiates are natural substances that originally come from the seeds of the opium poppy flower (John Hopkins Medicine, 2018). However, poppy seeds aren’t the first source that gave humans a “taste” for opium.

To understand the long term effects of opiates and the dangers of opiate use, consider this:

All human beings have a “dependency” on natural opiates from birth. Scientists analyzing breast milk discovered that it contains a form of natural opioids (Angier, 1994). In the form of breast milk, this opiate forms part of the perfect food for babies, and thus, especially in their natural state, opiates can a necessary part of development. Angier (1994) reports that the natural opioids along with milk neuropeptides may influence the neonate’s brain and, therefore, behavior.

There has also been preliminary research and interest into so-called “food addiction.” Highly processed foods were found to be associated with an addictive pattern of eating, as they share the same pharmacokinetic properties as drugs of abuse. In fact, bingeing on sugar has been shown to increase mu-opioid receptor binding (Schulte, Avena & Gearhardt, 2015).

The big question now is:

What happens when someone takes opiate drugs by prescription for long-term, chronic medical conditions or pain management?

In their highly concentrated and synthetic forms, opioids do work to effectively reduce anxiety and pain for most people. However, their effects on the body and their addictive nature are such that doctors often won’t continue prescribing them to their patients unless they see no other alternatives for pain management.

Here’s a list of the top dangers of intoxication from opioid use (Fareed et al., 2011);

  • respiratory depression
  • nausea and vomiting
  • cognitive impairment
  • memory impairment
  • convulsions
  • confusion
  • death

Long term side effects of opioid use, however, become even more significant. Baldini, Von Korff & Lin (2012) make the following points:

  • Patients using long-term opioids for severe chronic pain run the risk of opioid overdose in an attempt to control their pain.
  • Constipation, vomiting, abdominal cramping and bloating can occur.
  • Sleep-disordered breathing and respiratory depression can occur.
  • Opioids may be associated with a 77% increase in risk of cardiovascular events (heart attack or heart failure)
  • Dizziness and sedation is important amongst the elderly, causing them to be prone to falls and fractures.
  • Opioids have been shown to affect the release of every hormone from the anterior pituitary gland, and may ultimately decrease certain hormones such as testosterone
  • Weakening of the immune system may occur

Ultimately, an opioid addiction and misuse disorder occurs.

Even worse, if someone with an opiate addiction tries to stop taking the drug or decrease their dosage, the withdrawal symptoms are so bad that most would rather not stop taking it. Opiate withdrawal symptoms include (Fareed et al., 2011):

  • Excessive sweating
  • Anxiety
  • Insomnia
  • Muscle pain
  • Diarrhea
  • Nausea and vomiting
  • Elevated pulse and blood pressure

There are drugs available to manage opioid addiction and withdrawal, but these must be used with caution.

Once a person becomes addicted to opiate drugs and foods with opiate triggers, they may feel unable to face the suffering of withdrawal on their own. Two drugs commonly available to assist a person through this difficult process are suboxone and methadone.

Methadone is efficacious when used in a clinical setting to “wean” someone off an opioid addiction. However, suboxone was developed as a safer alternative due to its lesser potency and ceiling effect – making overdose unlikely when compared to methadone (Whelan & Remski, 2012).

Doctors began prescribing suboxone, a combination of the synthetic opioid buprenorphine and the opioid-blocker naloxone. Whilst safer than methadone, it is not without its own risks. A rise in emergency department visits secondary to buprenorphine usage was documented from 2005 to 2010 (Substance Abuse and Mental Health Services Administration, 2013). This is likely due to the fact that diversion of suboxone has been documented, where tablets are crushed for intravenous misuse. Withdrawal symptoms and intoxication from suboxone (or buprenorphine) would constitute the same symptoms as previously mentioned.

However, it should be noted that it is unlikely to be abused by an opioid-naïve population; Schuman-Oliver et al. (2010) found that misuse of buprenorphine is primarily carried out by individuals already dependent on opioids, and that their primary desire is to self-treat opioid dependence and withdrawal.

Where do all these opiates and opiate-recovery drugs lead us?

Ultimately, down a slippery slope of addiction, withdrawal and overdose.

Opioids seem to give everything that suffering patients want most; less pain, a sense of calmness and a numbing of the mind and body. In large doses, people may even feel euphoric on opiates. Still, opiates are not the only answer to problems like pain management.

There are multiple alternatives available for pain management, including alternative drug options without the danger of addiction. There are also measures available beyond medicinal treatment. For example, exercise releases endorphins; important natural opiates. No one has as many endorphins in their systems as top performing athletes, so it’s easy to see how they can endure much higher levels of pain than the average person (Gordon & Bloxham, 2016).

Pain tolerance is highly individual, but treating pain does not solely rely on the use of opioids. It is a multidisciplinary approach, with multiple modalities to treat pain, best managed in a pain clinic under careful supervision.

 

References

Angier, N. (1994). Mother’s Milk Found to Be Potent Cocktail of Hormones. Retrieved March 31, 2019 from https://www.nytimes.com/1994/05/24/science/mother-s-milk-found-to-be-potent-cocktail-of-hormones.html

Baldini, A., Von Korff, M., & Lin, E. H. (2012). A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide. The primary care companion for CNS disorders14(3), PCC.11m01326. doi:10.4088/PCC.11m01326

Fareed, A., Stout, S., Casarella, J., Vayalapalli, S., Cox, J., & Drexler, K. (2011). Illicit opioid intoxication: diagnosis and treatment. Substance Abuse5, 17-25

Gordon, R., & Bloxham, S. (2016). A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel, Switzerland)4(2), 22. doi:10.3390/healthcare4020022

John Hopkins Medicine. (2018). Glossary of Terms. Retrieved February 26, 2019 from https://www.hopkinsmedicine.org/news/articles/glossary-of-terms

Schulte, E. M., Avena, N. M., & Gearhardt, A. N. (2015). Which foods may be addictive? The roles of processing, fat content, and glycemic load. PloS one10(2), e0117959. doi:10.1371/journal.pone.0117959

Schuman-Olivier, Z., Albanese, M., Nelson, S.E., Roland, L., Puopolo, F., Klinker, L., & Shaffer, H.J. (2010). Self-treatment: Illicit buprenorphine use by opioid-dependent treatment seekers. J Subst Abuse Treat, 39(1):41–50.

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013). The DAWN Report: Emergency Department Visits Involving Buprenorphine. Rockville, MD.

Whelan, P. J., & Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of neurosciences in rural practice3(1), 45-50.

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Dr. Ashley Murray

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Dr Ashley Murray obtained her MBBCh Cum Laude in 2016. She currently practices in the public domain in South Africa. She has an interest in medical writing and has a keen interest in evidence-based medicine.

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Bobby Oerzen BS MA