Exploring risks & benefits of opioids
You may have already talked about the risks and benefits of opioids with your health care team.
Even so, you may want to revisit this topic since opioids are complex drugs that affect your brain and body in many ways. Also, the risks and benefits change the longer you are on opioids and as you age. Finally, your doctor may not have had time to talk in-depth about these risks and benefits.
In this module, we aim to give you a fresh perspective. The goal is to help you think about what risks you are comfortable taking. It may also help you understand your health care team's concerns about taking opioids long-term for chronic pain. We also want to convey a sense of hope and optimism that your pain may be manageable with fewer or no opioids.
Check Your Understanding
Here are a few questions for you to try answering. You won’t be graded on your answers. These are just for you to see what you already know about this topic.
Carlos, age 66, back pain
“I recently learned [about] the function in your brain that measures your carbon dioxide. Basically, the opioids when you take too much will shut that function down where your body doesn’t recognize the fact you have this buildup of carbon dioxide, so you effectively stop breathing. … I just never understood the actual mechanism of the brain that did that.”
Learn/Refresh
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Opioids are a class of drugs that are either derived from the opium poppy plant or created synthetically in laboratories to mimic the effects of natural opioids.
Our bodies make their own opioids that play an important role in regulating many of our organs and bodily functions, and helping us manage social stress and build strong relationships.
Prescription opioids bind to and activate opioid receptors located in the brain, spinal cord, and other organs involved in pain and pleasure. When this occurs, they block pain signals from reaching the brain and can make the brain release dopamine, creating feelings of safety and euphoria.
Prescription opioid medications include: Codeine, Tramadol. Hydrocodone (e.g., Vicodin®), Morphine, Oxycodone (e.g., OxyContin®, Percocet®), Fentanyl, Hydromorphone, Oxymorphone, Methadone, and Buprenorphine.
People sometimes get opioids without a prescription, like heroin or fentanyl. In this case, the dose is unknown and other non-opioid drugs may be added. This means that heroin and fentanyl may be especially dangerous and can cause death from overdose.
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Opioids are best for the severe, short-term pain people have right after injury or surgery. They reduce the feeling of pain and the emotional stress it causes.
However, even following surgery, you can develop a tolerance to opioids within a week or so. This means you need to take more and more to relieve your pain.
Even if you use opioids for only a short time, they may alter your mental state and affect your judgement after you stop taking them.
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Opioids have a negative effect on almost all your body’s systems and organs. Here are some examples.
Brain and mood: Taking prescription opioids can cause your body to reduce or even stop producing its own opioids which keep many of your body’s systems in balance, especially your mood. Your naturally produced opioids affect your internal reward systems and also affect social interaction and bonding. As a result, taking opioids may decrease your experiences of joy and also your sense of connection with other people.
Hormones: Opioids decrease your body’s production of testosterone and estrogen, lowering your sex drive.
Lungs: Opioids can make it harder for you to breathe. This can make lung conditions such as asthma and bronchitis worse. High doses of opioids can also make you stop breathing altogether.
Heart and circulation: Opioids increase your risk of heart and circulation problems, such as stiff arteries and an irregular heartbeat (atrial fibrillation). If you have cancer, they can also encourage the growth of new blood vessels on tumors.
Immune system: There is strong evidence that taking opioids for long periods of time can suppress your body’s immune system, putting you at higher risk for serious infections and affecting your body’s ability to fight illness.
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You can develop opioid tolerance and dependence even if you take opioids exactly as your doctor prescribes.
As you develop tolerance to opioids, you have less pain relief from the medication. As a result, you end up needing more opioids to manage your pain to the same degree.
Tolerance increases the risk of an accidental overdose, particularly if you are older. As you age, your metabolism, and kidney and liver functions change. As a result, your body starts to react differently to the same dose of opioids.
As you develop tolerance, you also become physically dependent on opioids. This means that if you stop opioids abruptly, you will get withdrawal symptoms, such as nausea, chills, stomach cramps, and muscle aches. Withdrawal can also cause psychological symptoms like anxiety, depression, trouble sleeping, and even thoughts of suicide.
Dependence may also create a sense of your life revolving around your opioid medications and thinking about your next dose. This may seem like a natural result of worrying about your pain, but it may instead be a result of the opioids.
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Many people have “between dose” withdrawal. This means they get withdrawal symptoms as their opioid dose wears off. You may hear this called “interdose withdrawal.”
Opioids may also increase the number of pain receptors in your body.
A symptom of withdrawal can be pain. This is not your pain coming back (breakthrough pain). Instead, it is pain caused by your body starting to go into withdrawal.
Many people who gradually reduce (taper) or stop taking opioids over a period of weeks or months don’t have increased pain — instead their pain stays the same or even gets better.
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An opioid overdose—taking more opioids than your body can handle—can cause you to lose consciousness and in some cases stop breathing and die.
An overdose may have causes other than misuse of your opioid prescription, such as accidentally forgetting that you already took your medication, mixing opioids with other medications or substances such as alcohol, and changes in metabolism or other organ function, such as your kidneys.
If you are taking opioids, it is strongly advised that you have Narcan/Naloxone in case of an accidental overdose.
Duane, age 62, degenerative disc disease
“Now that I'm off of it, the pain is bad at times, but oddly not as bad as it often was when I was taking the drug and it would wear off. I feel I was experiencing the same amount of pain every day. It would just be more concentrated in an 8-hour period instead of now it's spread over the whole day. It's like there's a sum here. … I would argue in some ways [that] the way I was taking it caused more pain later. It caused less pain when I took it but then more later.”
Mike, age 62, back pain
“So, I think we started with Vicodin, and after 8 to 9 months, you kind of got acclimatized to it. [My doctor] would say something like ‘Let’s move you a little closer to the poppy — we’ll switch this up and put you on Percocets for a while.’ That worked just fine until 8 to 9 more months down the road and then we’d switch back. Then they just didn’t seem to be as effective in that milligram, so they bumped it up. By the time I quit the damn things, I was [at] like 7.5 milligrams of whatever I was taking. That went on — I mean, I was on opiates for over a decade.”
Reflect
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Exercise #1 is a conversation starter with family or close friend: This exercise helps you get the perspective of a family member or close friend about how they think about the risks and benefits of opioids for you personally.
Click here to download the exercise worksheet
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Exercise #2 helps you think through the risks and benefits of using opioids long-term.
Click here to download the exercise worksheet
Consider these possible next steps:
Look through your exercises and see if you have:
Questions for your health care team about the risks and benefits of taking opioids long-term
Changes in how you are thinking about the risks and benefits
Consider revisiting the stage of change model
Move on to the next module
Resources
Summary of key risks of opioids
Long-term harms of opioids (includes links to scientific articles)
Selected scientific articles