46 people die every day from overdoses involving prescription opioids, states a report by the CDC. Many people are prescribed opioid medications for a variety of reasons, including surgery, injury, and pain management for cancer or chronic pain. While they do work as a temporary measure for managing pain, there are many health risks associated with using opioids and they are highly addictive. Long term use of prescription opioids for chronic pain also carries the risk of death by overdose (1), because you need increasing amounts to feel the same level of pain relief. Luckily, regenerative medicine offers therapies that can heal the cause of your pain, rather than merely trying to manage it.
What are opioid medications and how do they work?
Opioids are a class of medications prescribed to treat pain, which includes Morphine, Codeine, Oxycodone, Hydrocodone, and Fentanyl. Some are naturally occurring, and others are synthetic, but they all work by interacting with opioid receptors in the nerve cells in your body.
You have these receptors because your body produces compounds such as endorphins, which work to reduce pain, anxiety, and the negative effects of stress. When opioid medications bind to the receptors, they mimic the pain-relieving action of your natural endorphins by blocking the pain signal traveling from your body to your brain. This softens your perception of pain and may also help you feel calm and relaxed.
Opioids are prescribed for pain from surgery and dental procedures, usually only for 3 to 7 days after the surgery. They are also prescribed for severe pain from cancer. Many doctors will prescribe opioid medications for managing chronic pain as well, but this is concerning because of the risks involved with long term use. Furthermore, research does not support the idea that opioids are the most effective tool for long-term pain management.
Erin Krebs, et al. conducted a year-long study in 2016, comparing opioid pain relievers with non-opioid pain relievers to discover their effects on pain-related function, pain intensity, and any adverse effects. They studied 240 patients with chronic back pain or hip or knee osteoarthritis pain and found that pain-related function was nearly the same for both groups, but pain intensity was actually lower for those taking non-opioid pain relievers. Additionally, side effects from the medication were almost double in the group taking opioid pain relievers. Krebs concluded that “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain” (2).
Side effects of long-term opioid therapy.
Constipation, sleepiness, confusion, nausea, and vomiting are common side effects of opioids. Life-threatening side effects include shallow breathing, slowed heart rate, and loss of consciousness. Addiction and overdose are a major concern with continued use.
Opioids also modify the way your brain processes pain. With long-term use, your body becomes dependent on the medication and loses some of its natural ability to fight pain. When you do quit taking the opioids, it is common to have increased feelings of pain until your body recovers from its dependence.
In 2012, a group of doctors reviewed studies on potential adverse effects of long-term opioid therapy. This review found that long-term use negatively impacts many of the body’s systems and has led to an increasing number of deaths due to opioid overdose. They concluded that “chronic opioid treatment for noncancer pain is associated with diverse adverse effects across many organ systems.” Opioid therapy for chronic pain was discovered to harm the body in the following ways (1).
The Gastrointestinal (GI) System
25% of patients experienced nausea and 40 to 45% experienced constipation which then requires anti-nausea medications and stool softeners or laxatives. Opioid therapy can also cause vomiting, abdominal cramps, bloating, bowel obstruction, and even GI bleeding. Constipation reduces a person’s quality of life and one-third of patients with chronic constipation reported depression and psychological distress.
The Respiratory System
As many as 75% of patients using opioids around the clock for over 6 months experienced sleep disordered breathing which includes central sleep apnea, ataxic breathing, hypoxemia, and carbon-dioxide retention. Those with severe sleep apnea usually endure a far lower quality of life. Respiratory depression, bradycardia, and hypotension are life-threatening side effects which may occur with overdose. Since people need ever increasing doses to feel the same amount of pain relief, an overdose can happen without realizing you are at risk.
The Cardiovascular System
When opioid therapy was compared to NSAIDs and COX-2 inhibitors, “opioid therapy was associated with a 77% increased risk of cardiovascular events (eg, myocardial infarction, heart failure)” (1). Risk of myocardial infarction and cardiovascular revascularization were also higher than that of the general population.
The Central Nervous System
Comorbid clinical depression was 38% higher in patients on chronic opioid therapy. Dizziness and sedation are common effects, which lead to increased risk of falls and fractures. Interestingly, heightened sensitivity to pain was also common.
The Musculoskeletal System
An increased risk of fractures is a significant adverse effect, with higher doses leading to higher risk, especially among the elderly. This is concerning because “overall mortality has remained at a notably high level of 21.9% after 1 year [of a hip fracture]. Furthermore, those who do survive such an event often do not regain their health-related quality of life” (1).
The Endocrine System
Both male and female endocrine systems are strongly impacted by chronic opioid therapy. Males may experience fatigue, sexual dysfunction, infertility, hypogonadism, and decreased testosterone levels. Decreased testosterone may increase the risk of insulin resistance and metabolic syndrome. Testosterone rebuilds healthy tissue, so decreasing testosterone levels also inhibits your body’s ability to repair itself, feeding the cycle of damage that causes