Can Opioids Cause Anemia?

Researchers say long-term misuse of opioids can lead to anemia.[1] 

Some people have obvious, severe symptoms of anemia that doctors can spot during routine medical exams. Others have mild symptoms that could go unnoticed for years, or their symptoms may be explained as a consequence of drug use. 

Many factors link opioids and anemia, including immune system depression, contamination and malnutrition. Chronic use of any opioid can cause changes in your blood.[2] 

Anemia is treatable, but therapies likely won’t work unless you stop misusing opioids too.[3] An anemia diagnosis could prompt you to stop misusing opioids for good. 

What Is Anemia?

Cells rely on a constant supply of oxygen delivered by red blood cells. People with anemia don’t have enough red blood cells, and their lack of oxygen can make them tired and weak.[4]

If left untreated, anemia can lead to serious problems. Some people develop an irregular heartbeat or shortness of breath due to oxygen loss. 

But people with opioid use disorders (OUD) may feel tired often due to their drug use. They may not realize they have anemia until they undergo a blood test during a routine medical exam. 

Mild anemia can be easily treated. Chronic anemia persists, and it may never go away, but it’s important to address it so it can be effectively managed.

Why Can Opioids Cause Anemia?

Many studies have linked opioids and anemia, and researchers have uncovered several potential causes. You could have one, two or all of them if you’re struggling with opioid use disorder. 

These are factors researchers say directly connect opioids and anemia: 

Immune System Depression 

Researchers say morphine works directly on the immune system, slowing cells down and making them less effective.[5] When your immune system isn’t functioning at full capacity, infections can take hold. 

Anemia further weakens the immune system, putting people in a deep spiral of lowered immunity. If neither the anemia nor the opioid use disorder is addressed, immune function will be even further depressed, and significant damage can occur.

Contamination 

Anemia is closely associated with exposure to lead and other heavy metals.[6] Long-term exposure to these contaminants keeps the body from producing key enzymes in the bone marrow, spleen, tonsils and lymph nodes. They can’t produce the elements needed for new blood cells.

Dealers often add contaminants to their drugs. Elements help molecules stick together, or they bulk up drugs sold by weight. It’s difficult to detect contaminated drugs, but opium sold by street dealers is rarely 100% pure. When you purchase drugs on the street, you never know what you are actually getting in a batch.

Researchers said anemia was detected in close to 40% of people with an OUD who used opium.[7] Contaminants were the likely cause. 

Malnutrition 

People with OUD often struggle with malnutrition.[8] They may forget to eat while they’re high, or they may eat foods with a low nutritional profile. Without a proper diet, people may not have the raw materials they need to create new blood cells. 

Infection

People with OUD may use dangerous methods, such as injecting drugs with dirty needles, to keep using drugs. Those issues can cause HIV and tuberculosis infections.[6] 

Health problems like this can also lead to anemia, as the body may not have the resources to develop or nurture red blood cells. Again, anemia depresses immune function, thwarting the body’s ability to fight infection.

Which Opioids Are Closely Related to Anemia?

Researchers say chronic OUD has a significant impact on blood health.[6] Most studies on the topic have been performed with substances like heroin or morphine. 

But the causes that link anemia and opioids aren’t specific to one type of medication or illicit drug. Any substance you buy from a dealer could begin a process that leads to anemia. 

What to Do Next

Treatments for anemia typically involve diet changes, iron supplements, and medication management.[4] If you’re struggling with OUD and anemia, your doctor might use these therapies to help improve your physical health. 

But you must also stop misusing drugs. Medication for Addiction Treatment (MAT) programs involve using a prescription like Suboxone combined with traditional therapy to help you build a different type of life. If you’re misusing opioids, ask if MAT is right for you.