If you’re considering taking opioids to manage chronic pain, it’s important to learn about opioid side effects and possible risks of use, abuse, and misuse.
What are common opioid side effects?
Even when used correctly, opioids have a long list of potential side effects. Opioid side effects may include:
- Nausea
- Vomiting
- Drowsiness or sedation
- Skin changes, including rash or temperature changes
- Dry mouth
- Miosis, or the formation of small, constricted pupils
- Opioid induced constipation
- Respiratory depression, although severe respiratory depression only occurs with high doses of opioids
- Sleep apnea, during which the trachea collapses during sleep so breathing stops
- Psychological effects, such as euphoria, happiness, delirium, confusion, dizziness, memory loss, or headache
- Heart rate changes
- Spasms, especially in the ureter or biliary tree, which can make it difficult to pass urine or can cause abdominal pain
- Myoclonus, which includes muscle rigidity and abnormal movement
- Low sex hormones, causing a stop to menstrual cycles in women or erectile dysfunction in men
- Hyperalgesia, which causes new or worsened pain and makes the body interpret non-pain signals as pain
Additionally, some painkillers can have delayed effects, so someone who took a pill can experience respiratory distress or a changing heart rate days later. Always talk to your doctor about ways to mitigate or manage these opioid side effects.
What are other risks of opioid use?
Beyond these common opioid side effects, these painkillers can also lead to dependence, tolerance, and addiction. These terms all have slightly different meanings.
Tolerance is a physiological state wherein the body stops responding to the same dose of medication because of chronic use. When a person develops tolerance, he or she must take increasingly higher doses to experience the desired effects.
Physical dependence is the body’s physiological adaptation to the presence of a substance in its systems. When the substance stops, the body reacts negatively. Usually anyone who’s developed a tolerance for painkillers has also developed a physical dependence on painkillers.
Addiction is the compulsive use of a drug for non-medical reasons. Someone with an addiction to painkillers has likely developed a tolerance and a physical dependence to them, as well. When he or she stops taking the painkillers, he or she will experience the withdrawal symptoms that characterize a physical dependence. If addiction is present, too, he or she will also be psychologically unable to cope without painkillers.
Tolerance, dependence, and addiction can all cause individuals to take more of their painkillers than they are supposed to. Additionally, addicted people might become anxious if unsure about their access to painkillers, develop financial difficulties, lose interest in other activities, or act secretive.
Why are opioids so dangerous?
120 people die of drug overdose in the United States every day. In 2012, among United States citizens between the ages 25 and 64 years old, drug overdoses caused more deaths than motor vehicle crashes. Pharmaceuticals caused 51.8% of drug-overdose deaths (which include prescription and over-the-counter drugs). Out of the deaths caused by pharmaceutical overdoses, 71.3% involved opioid painkillers.
In a study released in 2014, researchers found that 67.8% of hospital emergency department visits for opioids involved prescription drugs. Opioids have even surpassed cannabis (marijuana) in drugged driving fatal crashes.
Due to the steady rise in opioid painkiller addiction and overdose, both the government and the medical community are struggling to find ways to curb opioid addiction and abuse. The government has attempted to lessen the problem by reclassifying hydrocodone (commonly known as Vicodin), so that it’s subject to tighter regulations.
The medical community is also working to identify strategies to avoid painkiller abuse and its side effects. The American Academy of Neurology (AAN) also no longer recommends the use of opioid painkillers for chronic non-cancer pain, stating that:
“The risk of death, overdose, addiction or serious side effects with prescription opioids outweigh the benefits in chronic, non-cancer conditions such as headache, fibromyalgia and chronic low back pain.”
There are some cases when opioid painkillers are a good option, perhaps even the best option. However, as is clear in the AAN’s position statement, these medications carry a long list of serious potential opioid side effects and risks.
Who is most likely to abuse opioids?
Rates of abusing opiates are on the rise, and the reasons behind this increase have shifted the demographic of people who are falling victim to it. The surprising new data is changing the way medical experts are responding to the growing problem, keeping everyone working on its front lines on their toes. Several factors have been identified that suggest whether or not an individual is likely to abuse opioids or develop an addiction.
Historically, the people who were most likely to abuse opioids were:
- White
- Male
- Middle-aged
- Low income
- On Medicare or Medicaid
- Had a personal history of addiction to or abuse of other substances, such as alcohol
- Suffering from a past physical or mental trauma
Family history can also have an impact. If an individual’s predecessors were addicted to any substances, it can suggest a genetic predisposition to addiction. Additionally, a person is more likely to abuse painkillers if he or she grew up in a dysfunctional family in which substance abuse was considered normal.
Once someone has become addicted, repeated past emergency department visits for overdose increase the risk of future respiratory failure and the need for a mechanical ventilator. Also, a study in Copenhagen found that the mortality rate of chronic pain patients with long-term opioid painkiller use was 1.72 times higher than that of people without chronic pain.
New populations at risk
However, these risk factors are changing over time. For example, seniors aged 50 to 69 are the fastest growing segment of the population now addicted to opiates, reports Medscape. From 2011 to 2012, the number of adults over 65 who reported abusing opiates jumped by 34%. Johns Hopkins University professor Dr. Joseph V. Pergolizzi says:
“What this tells us is that there’s some evolving demographics for opioid addiction and guess what, it’s not just that young college student who is the addict; it’s actually also working people and it’s more mature adults.”
Further, about 45% of those with addictions are high school graduates, and 30% completed at least some college. About 24 million people in the U.S.—about 9% of the population—reported using an illegal drug in 2012, according to Medscape. Besides older adults, young people aged 12 to 17 are also at risk for succumbing to addiction. The age range accounts for 26% of those addicted to opiates.
Risk of heroin and other drug use
Opioids derive their name from the opioid brain receptors they interact with. The class of drugs includes commonly prescribed pain pills like oxycodone and codeine, but also street drugs like heroin. Many opiate users end up on heroin, seeking cheaper and easier access. And many people experience the reverse. About 23% of heroin users develop opioid addictions, according to the American Society of Addiction Medicine (ASAM).
About 9% of the 21.5 million people in the U.S. with a substance use disorder are addicted to painkillers, reports ASAM.
Risks of longer-term prescriptions
Twenty-five perfect of people prescribed opiates move on to longer-term prescriptions, researchers say.
Scientists from Mayo Clinic discovered that one in four people who receive first-time opiate prescriptions go on to take the medications for a longer span of time. Risk factors included a history of smoking and past substance abuse. However, researchers said all patients should be evaluated with caution. Mayo Dr. Michael Hooten tells Science Daily:
“I encourage use of alternative methods to manage pain, including non-opioid analgesics or other non-medication approaches…That reduces or even eliminates the risk of these medications transitioning to another problem that was never intended.”
Women face especially high risks of developing an addiction, according to ASAM. They’re more likely to develop chronic pain, more likely to receive opiate prescriptions, tend to receive higher doses, and take the pills for longer periods of time than men. Their biology also predisposes them to develop an addiction more quickly.
And more than half of the women surveyed in a methadone clinic reported their first contact with opiates was from painkillers prescribed by a physician, according to research from Canada’s McMaster University. For 38% of men, the same was true.
The women surveyed in the clinic were more likely than men to have medical difficulties and mental health problems, along with child care responsibilities contributing to high stress levels. Men, meanwhile, were more likely to report a history of psychiatric illness in their family.
Ensuring safer pain management
Researchers say this information about who is at risk of addiction is critically important to tailor treatment programs so they’re more effective. Study author Monica Bawor tells ScienceDaily:
“A rising number of women are seeking treatment for opioid addiction…Yet, in many cases, treatment is still geared towards a patient profile that is decades out of date—predominantly young men injecting heroin, and with few family or employment responsibilities.”
The study highlighted other changing demographics as well. The average age of a person addicted to opioids has increased, now 38 compared to 25 in the 1990s, and people are much less likely to inject drugs today. To respond to these changing demographics, researchers are investigating ways of treating older adults who develop addictions.
Using opioids safely
Despite all this, it is possible to use prescription painkillers safely and effectively. Doctor-patient communication is key to strategies that prevent abuse and addiction. The patient must clearly communicate about his or her personal and family history, side effects, and other medications.
At the same time, the physician must clearly communicate the risks of prescription painkillers so the patient understands the importance of following instructions. Also, some preexisting conditions contraindicate the use of opioid painkillers. For example, because of the potential for respiratory distress or biliary tree spasms, those with sleep apnea or kidney problems should be extremely cautious when considering opioids.
You can see our opioid therapy statement here and in the video below.
Talk therapy
A simple form of talk therapy has been found effective for helping people kick addiction, researchers found.
Researchers from the University of Buffalo have discovered a simple, effective method of intervention has proved highly effective. Motivational interviewing is a type of counseling, and it’s been found to slow the abuse.
With this form of counseling, therapists work with patients to ignite a desire to change through empathizing with their experiences. The therapists work in a very non-confrontational way while helping patients identify discrepancies between how they wish to act and what they’re actually doing.
The therapy had other benefits besides reducing opioid abuse rates. It lifted participants’ self-confidence and reduced their feelings of depression and anxiety. It also reduced the amount of pain they felt. This work is important, researchers say, because older adults face a higher risk of health complications related to abuse.
Opioid addiction resources
If you need help for overcoming addiction or support for someone you know, try one of the resources below.
This website offers a database of treatment programs and other resources to connect you or your loved one to needed help.
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a toll-free hotline available 24/7, 365 days a year. It’s 1-800-662-HELP (4357). The organization’s website also has a database allowing you to type in your address and find nearby treatment facilities.
Getting help
If you use opioids and are worried about opioid side effects or further risks for abuse or dependence, there is help. An interventional pain management doctor can help you find complementary treatments that help you reduce pain and decrease the amount of opioids you take.
They’ll do this with complementary, non-invasive treatments like physical therapy or chiropractic. For more serious cases of chronic pain, they can rely on interventional techniques, like steroid injections or radiofrequency ablation. They can also help you manage opioid side effects.
To learn more about these treatment approaches, click here to find a pain specialist in your area.