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Understanding the Side Effects of Long-Term Opioid Misuse

May 4, 2022

Table of Contents

Opioids medications and drugs work by attaching to opioid receptors spread throughout your body and causing chemical changes both short and long termTake too much for too long, and your brain and body may not function properly without them. 

Definitions of long-term use vary, but most experts agree that changes can occur in as little as a few weeks of use.[1] Some changes such as constipation, could resolve when you stop using. Others, such as neuronal cell death, memory loss, and dependency, could last a lifetime.

Understand the Risks of Long Term Opioid Use  

Opioids act directly by binding to  cells inside your brain, nervous system, digestive system, and almost every other organ system in your body. 

These are a few of the known risks associated with long-term opioid use.

Withdrawal

Take opioids regularly, and your body becomes accustomed to them. Try to stop, and you may develop withdrawal symptoms. These symptoms are often flu-like symptoms and, while they are not life-threatening, they can be extremely difficult to bear. The longer you take opioids, the higher your risk of developing an OUD and a withdrawal syndrome with discontinuation 

Overdose

Long-term use of opioids results in tolerance. Patients often need to take higher doses of the same drug to feel the same effects. As the use of the drug escalates, so does the risk for overdose. Deadly overdoses are remarkably common. Between 1999 and 2014, more than 165,000 people in the United States died from an overdose related to a painkiller.[3] 

Tolerance

As your tolerance for opioids increases, you may need more of the medication than previously in order to get the same effects. For example, a patient who has been on pain killers for many months or years may not get the same relief they used to, prompting them to try more potent but potentially more dangerous drugs. prescriptions to buying drugs illicitly. This includes illicit drugs like heroin or fentanyl. Fentanyl is up to 100 times more potent than morphine.[4] 

Infectious disease

Injecting drugs carries the risk of developing an infection either from bacteria in the skin, or in the water used to melt heroin, or even from the bacteria in the mouth if a person “licks” the needle prior to injecting. If these bacteria get into the bloodstream, they can travel to the heart where they can cause a very serious infection called endocarditis, which can be deadly. 

In addition, transmissible diseases such as hepatitis B and C and HIV can be transmitted via needles.[5] 

Digestive disease

Opioid receptors appear throughout your body, and many sit in your gut. Active opioids can slow down your stomach and bowels, leading to constipation, obstruction and even bowel perforation which can be deadly. closely associated with constipation.[6]

Are Prescription Opioids Safer Than Street Opiates?

Many people with opioid use disorders developed them after taking painkillers to assist with an injury or another cause of chronic pain. The more we use these medications, the more we learn that even prescription opioids have serious risks with long term use, even if prescribed and taken as instructed. 

It's true that opioids like Vicodin are somewhat safer than street drugs like heroin due to the following: 

  • Prescription drugs are created in controlled environments. Chemists make prescription medications, and they test them for efficacy. Users don’t really know what is in the drugs they buy on the street.
  • Prescription medications are sold by licensed pharmacists. The medications you get from your drugstore have been tested, and the bottles are sealed and carefully monitored. No such testing occurs with street drugs.
  • Prescription drugs are made for oral use. In most cases, prescription painkillers are sold in pill form. Drugs that are sold as liquids can more easily be injected with a needle. 

However “prescription” painkillers can give users a false sense of security. They just seem safer than a drug you might buy on the street, and you might even feel comfortable taking them in front of your family and friends. Prescription opioids, just like street opioids, can be addictive, can cause constipation, bowel obstruction, and overdose. In fact, The overdose rate for prescription drugs is actually higher than the rate for illicit opiates.[7] 

In addition, it's very easy for people who start using prescription painkillers to transition to heroin. And once you make the switch, all of those dangers become real. In one study, 95% of people with injection-related hepatitis used prescription painkillers before starting heroin.[8]

Keep Yourself Safe From Opioid Side Effects

If you have a long-term opioid use disorder, get treatment as soon as you can. Your program might include therapies to help you with transient problems during acute withdrawal

If you've just started using an opioid, you can follow these steps to keep your brain and body safe:

  • Follow instructions. Take your doses exactly as prescribed by your doctor. Don't take your doses too close together, or take more pills than directed. 
  • Stop use as soon as you can. Talk with your doctor about non-drug options to control pain, such as acupuncture, cold therapy, physical therapy, or massage. Take opioids only for as long as necessary to control your pain and discontinue once pain improves as soon as possible. 
  • Get help if you can't stop using. If you've tried to stop taking prescription medications and find it's too difficult, reach out for help. Medications like Suboxone can help you as you discontinue long term opioid use.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Prevalence and Risk Factors Associated with Long-Term Opioid Use After Injury Among Previously Opioid-Free Workers. JAMA. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2738029. July 2019. Accessed April 2022. 
  2. Alcohol, Tobacco, and Other Drugs. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/find-help/atod. April 2022. Accessed April 2022. 
  3. CDC Guidelines for Prescribing Opioids for Chronic Pain — United States, 2016. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. March 2016. Accessed April 2022. 
  4. What Are Opioids? U.S. Department of Health and Human Services. https://www.hhs.gov/opioids/prevention/index.html. August 2020. Accessed April 2022. 
  5. Heroin. National Library of Medicine. https://medlineplus.gov/heroin.html. March 2021. Accessed April 2022. 
  6. A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner's Guide. The Primary Care Companion for CNS Disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466038/. June 2012. Accessed April 2022.
  7. Overdose Death Rates. National Institute on Drug Abuse. https://nida.nih.gov/drug-topics/trends-statistics/overdose-death-rates. January 2022. Accessed April 2022. 
  8. Prescription Opioids and Heroin Research Report. National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/prescription-opioids-heroin/rx-opioids-heroin-have-similar-effects-different-risk-factors. January 2018. Accessed April 2022.

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