Opioids Long-term effects of medical opioids? (pain mgmt)

[SydneyGal]

I've searched the archives, but couldn't find anything that answered my question:

What are the long-term effects of taking medical opioids, i.e. for years or more?

I'm asking mostly the people who are on opioids for pain management, i.e. have only ever taken medical-grade opioids, mostly pills rather than IV, and generally sticking to prescribed doses.

I've seen lots of web sites that say long-term opioids cause liver failure, veins collapsing, life of crime etc., though I'm pretty sure the first is due to contaminants in street drugs, the second injecting, and the third is moral panic BS, since neither of the heroin addicts in my extended family became criminals, despite raging addictions. So I'm interested in the effects of the meds themselves -- not contaminants, injecting, or the messed-up approach to drug abuse and addiction in our society. (Unless you're addicted to caffeine, then you're all good.)

I'm probably the big square around here: I'm a long-term pain patient on a bupe patch (20mcg) plus bupe sublingual (200mcg) for breakthrough pain. I rarely exceed prescribed doses, and only when I have bad pain flare-ups -- i.e. I don't ever take it recreationally. I've only ever had IV anything in hospital when the nurses did it; never injected myself.

I've been on bupe since 2007; oxycodone before that. In that time, a doc made me get off opioids once and switched me to tramadol, cymbalta and neurontin, which made me bed-ridden again.

I'm now under pressure from new doc to get off opioids again. I'm fine with trying all the other stuff they've proposed (Lyrica, pacing, more physio, counselling, etc.) but I'm not convinced opioids are that terrible to be on long-term. They keep citing one particular recent paper, which found people on opioids for over a decade had a range of altered inflammatory immune and endocrine markers, although the paper authors seemed to think the former was due to the patients' assorted underlying illnesses; not opioids. Other than that, everything I've read says there aren't enough studies of long-term use to really know how bad it is.

So people on medical opioids long-term, what are the actual side-effects you've experienced?

 

[SydneyGal]

Forgot to mention: I'm female and getting to the age where if I'm gonna have kids, I'd better start trying soon. The docs say it'll be near impossible to conceive while I'm on opioids (esp. considering my other medical issues make it 50-50 whether I'll ever be able to have kids).

Anyone on long-term medical opiates here, who's tried to get preggers? Or had it happen by accident?

 

[Psychedelic Jay]

Opiates are particularly safe...

The only major effects opiates have are acute toxicity in overdose, and kidney damage from ever escalating doses.

In your situation, women have testosterone too, since the opiates lower that, also increasing estrogen and progesterone, it messes with menstrual cycles....

What is birth control? Synthetic estrogens...

 

[SydneyGal]

Thanks Jay, that's good to hear. (Well, apart from maybe acting like birth control...)

I've heard of the testosterone thing messing with exercise, and I am a lot less fit now than when I started using opiates... but honestly, I think that's probably as much due to my lovely diseased innards than the bupe, if not more so. I do notice that going hiking, I get mild withdrawal after the first half-hour or so, which I've always assumed was due to my body metabolising the bupe faster, or something? (Now I just take an extra tablet before a long hike.)

I'd also heard that long-term opioids mess up your energy levels, and I do have chronic fatigue issues... but again, it's hard to tell whether that's due to pain meds, or my body attacking itself constantly. And frankly, I get out of bed and do stuff a lot more on my meds, than I used to before I had adequate pain mgmt and just had to grit my teeth and bear it.

It would actually be really helpful to hear from someone who uses medical opioids regularly without some underlying disease complicating things... anyone??

Honestly, it's so hard to get accurate info about opioids; so much of what I've been told (even by medical professionals) is tainted with "OMG JUNKIES!!!" hysteria, and turns out to not be accurate.

 

[belfort]

well i self administered opiods for many years and a few effect i noticed were a major decrease in sex drive..i actually felt more sensitive to pain too towards the end of my addiction...


yes, opiods really hurt my overall energy levels..at the end i was lethargic..

 

[Psychedelic Jay]

It would actually be really helpful to hear from someone who uses medical opioids regularly without some underlying disease complicating things... anyone??

You are talking to one.

I use bupe and oxycodone when not using heroin.

Half the time I don't feel like doing anything. I use strong stimulants to push through the sedation a lot...

I have made a Bupe/cocaine nasal spray...

A simple coffee or caffeine supplement every now and then won't hurt.

 

[Timber]

They can cause restless legs, periodic limb movement disorder (another form of the same thing), in men atrophy of sex hormone glands, and in case of morphine have some consequences for the immune system while taking them. They can also cause hypersensitivity to pain, and that effect is not exaggerated.

I do think that there is a slight loss in pleasure in life from taking them for a decade plus.

 

[f33lg00d]

Most of the long term side effects are mental stuff as a result of euphoria in a bottle; lazyness, introversion to a fault, irritability, depression. Low doses or bupe, that don't really have any euphoric effect on people - i find them not mentally taxing, actually help my depression a lot, but it depends on the person. I agree with all the earlier posts also.

 

[RTrain]

You are talking to one.

I use bupe and oxycodone when not using heroin.

Half the time I don't feel like doing anything. I use strong stimulants to push through the sedation a lot...

I have made a Bupe/cocaine nasal spray...

A simple coffee or caffeine supplement every now and then won't hurt.

Oh yeah coffee and Bupe is a great combo. Well coffee and any opioid, but with Bupe I think the coffee is absolutely necessary. Drink the coffee about 75-90 minutes after the bupe SL and when it all comes together its not too bad. I can't speak for cocaine, never with bupe but have with other opioids, its a good time but I am too naturally wired for coke unless something strong is there to counter the edginess.

As for the OP I'd say there is some risk involved in the frequent constipation, but that can limited and isn't so bad for some people. Kidney damage is a possibility, most notably the metabolites of morphine can stress the kidneys a bit. I would guess the damage is nowhere near as great as frequent alcohol binges put on the kidneys, or a frequent high sodium diet for that matter. Vast majority of the danger is poor IV practices causing viruses, abcesses, and such. Of course chemical alterations in the brain, which will resolve if the necessary amount of abstinent time is taken.

 

[onetwonine]

I take synthetic testosterone and am pretty constipation free on methadone. Feel safe.

 

[SydneyGal]

Thank you everyone, for the great responses!

well i self administered opiods for many years and a few effect i noticed were a major decrease in sex drive..

I've heard of that one, but thankfully seem to have escaped it. (Well that, or my poor bf would be a lot sorer than he already is if I wasn't on bupe... hehe.)

i actually felt more sensitive to pain too towards the end of my addiction...

Yeah, I've been having some allodynia (i.e. stuff that shouldn't be painful registering as pain) and they suspect I might have hyperalgesia (i.e. pain feeling more intense than it ought to be) lately. Not the funnest thing around.

yes, opiods really hurt my overall energy levels..at the end i was lethargic..

So there's a good possibility my low energy levels are due to the bupe, not just the disease... hmmm...

You are talking to one.

I use bupe and oxycodone when not using heroin.

Half the time I don't feel like doing anything. I use strong stimulants to push through the sedation a lot...

I have made a Bupe/cocaine nasal spray...

A simple coffee or caffeine supplement every now and then won't hurt.

Caffeine doesn't really agree with me, unfortunately. At best, I blabber non-stop for a few hours, then my gut turns itself in knots... and that's from a strong cup of tea, not coffee even! For whatever reason, my body just doesn't seem to like stimulants (I tried speed once and it was not a good idea, either.) My stimulant of choice is a nice strong cup of peppermint tea... and yes, I'm a total wuss. But maybe I should try to build up some caffeine tolerance, since I do get a lot more done in the 3-4 blabbering hours, before my gut knots itself up and I have to go lie down for a bit.

As for bupe/cocaine nasal sprays... that's one I'm probably not gonna try, even if I could afford it. (I'm on disability payments half the time when I'm too sick to work, so the only coke I can afford is the bottled black sugar sludge, haha.) I tried cocaine once a long time ago, and that's one where if I got started I would keep coming back for more... and more... and more... Not a good idea for me.

They can cause restless legs, periodic limb movement disorder (another form of the same thing), in men atrophy of sex hormone glands, and in case of morphine have some consequences for the immune system while taking them. They can also cause hypersensitivity to pain, and that effect is not exaggerated.

I've read about the immune system stuff a couple of times, but they're never specific about what opioids actually do to it. And in 'Opium for the Masses', he says that opium addicts never got sick, although even if it's true it's possibly due to one of the many other chemicals found in opium, which are removed from medical opiates. Plus it could maybe be that the immune system just didn't put up a normal response to infections, since it's not the pathogen which causes the fever, aches and pains etc., but mostly your body's immune response to it.

Does anyone know more about what opioids actually do to your immune system??

I do think that there is a slight loss in pleasure in life from taking them for a decade plus.

Yeah, I'm definitely feeling that. It's a lot like the thing you get with clinical depression, where good things seem kinda dull and it takes something huge and amazing to actually make you feel 'up'. I've just finished a huge round-the-world trip which I saved up for years to do; I have the most wonderful boyfriend who I'm more sexually compatible with than anyone I've ever been with; I just moved into a cute little cottage right in the forest, which we pay almost no rent for because bf is working on the property... and still, it often feels a bit 'yeah, whatever'. I should be super-happy and I'm not.

I do have other life stressors like being poor and sick, having PTSD that's been flaring up recently and stuff... but I can usually focus on the positives and be happy anyway, but it's been getting harder lately. Interesting that it might be due to the bupe.

 

[Psychedelic Jay]

opiates reduce you immune response...

 

[SydneyGal]

Most of the long term side effects are mental stuff as a result of euphoria in a bottle; lazyness, introversion to a fault, irritability, depression. Low doses or bupe, that don't really have any euphoric effect on people - i find them not mentally taxing, actually help my depression a lot, but it depends on the person. I agree with all the earlier posts also.

I'm not getting nearly as much done atm as I'd like, so I can probably tick #1 on that list (lazyness)... and definitely irritability and depression.

Wouldn't say I'm introverted, but I've gotten less and less social while I'm on bupe. Although it's hard to tell if that's due to bupe, or other meds I'm on, or just being sick (which messed up my social life because I often plan to do something, then have a flare-up and can't do it after all -- including going out to see friends, going to concerts, etc.)

And the irritability was definitely at least partly due to other meds I was on, which cause awful crazy-psycho-bitch mood swings in me, but sometimes I have to take them anyway 'cos they're the only thing that suppresses the underlying illness well. (Everything else I'm on is symptomatic relief only, e.g. bupe, amitriptyline for nerve pain, Lyrica etc.)

It is really hard to tell what's causing anything, when there's the illness, a bunch of different meds, PTSD and occasional depression all in the mix...

Oh yeah coffee and Bupe is a great combo. Well coffee and any opioid, but with Bupe I think the coffee is absolutely necessary. Drink the coffee about 75-90 minutes after the bupe SL and when it all comes together its not too bad. I can't speak for cocaine, never with bupe but have with other opioids, its a good time but I am too naturally wired for coke unless something strong is there to counter the edginess.

OK, going to have to try building up some caffeine tolerance; would be good to be getting a lot more done, I'm a bit of a blob atm.

Sounds like you're kinda the same with coke as I am with most stimulants, I get pretty jangly on all of them.

As for the OP I'd say there is some risk involved in the frequent constipation, but that can limited and isn't so bad for some people.

Yeah, I have the usual constipation issues, which I have to keep on top of so they don't get too bad. Oranges are the best for me to keep things moving; I guess it's all the fiber in them. Though if it gets bad, I just eat a heap of lactose; I'm badly lactose intolerant, so it's not pleasant, but it does clear everything out. But then, I'm a nutter who refuses to take the fiber supplement stuff my doc recommends because taking my daily stuff to 'keep me regular' makes me feel like an old lady. Not the cleverest thing to do, I know.

Kidney damage is a possibility, most notably the metabolites of morphine can stress the kidneys a bit. I would guess the damage is nowhere near as great as frequent alcohol binges put on the kidneys, or a frequent high sodium diet for that matter. Vast majority of the danger is poor IV practices causing viruses, abcesses, and such. Of course chemical alterations in the brain, which will resolve if the necessary amount of abstinent time is taken.

OK, that kidney stuff freaks me out a bit; I've been in hospital twice in the last couple of months with kidney issues that my docs still haven't figured out. They're not sure whether it's an infection, or the disease I have spreading to my kidneys again... should I ask them to check whether the bupe's messing with my kidneys??

But good to know that if the fatigue and stuff I've been having is due to meds, it'll correct itself if I'm off them for a while. I still don't know if I'll be able to handle the pain of my illness without opioids, but it's sounding like I should at least try to get off them, if I can...

I do really like that this forum gives actual accurate info about opioids; not the ridiculous moral panic BS I keep hearing, but also not glossing over the fact that they do have side effects, like any drug.

 

[SydneyGal]

opiates reduce you immune response...

Thanks Jay.

So the legend that opium addicts never got sick (other than w/d, of course) was likely just that their bodies didn't mount much of a response to pathogens, so no dramatic fevers, aches and all that. Interesting.

My health issues mean I'm mildly immuno-compromised to begin with, so it's interesting that my docs are happy to prescribe stuff that might suppress my immune system more. I guess my immune system isn't too terrible, medically speaking, and having proper pain meds did help me get a lot more done when I started them. I'm honestly not sure how much they're helping and how much they're hindering things now, though.

The new pain clinic I've been sent to is very gung ho about getting patients off opioids, to the point of being really off-putting. (I don't like getting lectures about being an addict because I take pain meds exactly as prescribed and strictly for physical pain; I studied psychology so I know that physical dependency is not the same as addiction, and I don't have the psychological or behavioral markers of addiction.) But seeing a long list of possible long-term side-effects of opioids and ticking off about half of them provides a lot of additional motivation to try all their other stuff, to see if it works.

Thank you everyone for the really helpful responses; it's a tough decision, whether I ought to try to get off opioids, and having some more info is really good.

 

[RTrain]

^Yeah I use to not even be able to drink a cup of coffee without jitters and palpatations. It wasn't until I started using opiates regularly did I start using coffee regularly. I am very sensitive to stimulants, too. One thing that helped is I take a beta blocker, pretty small dose of a very cardiac specific beta blocker.

If I was having kidney issues and on Bupe maintanence I would bring it up to a doctor. I assume the doctors who have treated you know you are on the bupe, but might not know much about the medication. It has metabolites similar to morphine, gluconarides. The morphine gluconarides if they accumulate in the body can cause adverse effects, like myoclonus, hyperalgesia, and nausea. I am not sure about the build up of metabolites of bupe, info is tough to find on the issue but I do remember reading about at least one person using bupe with similar issues to the build up of morphine metabolites..

 

[BIGsherm7272]

I actually heard from a doctor at the last rehab I was at that a study found that in some chronic-pain pain and long-term abusers of opiates that they found an enlarged heart, and they believe it to be directly due to opiate use. I don't remember exactly everything he told me, but that is the gist of it. Don't take my word on it, just heard it from a doctor.

But yea for the most part most opiates that don't contain tylenol are pretty harmless to your body, with the exception of methadone.

 

[Dr Pepper]

Look up studies with wound healing and opiates.. it pretty much doubles the time (this is with moderate dose oxy)..
Also decimates testosterone levels and estrogen levels.. anything controlled by LH. I'm sure it has other negative effects as well.. such as addiciton/dependence..

 

[Lady Codone]

If you can manage to elude the "big two" (overdose and addiction), opiates are generally benign. Many of the negative effects arise from injecting, using adulterated street dope or simply using them irresponsibly. Then there are the prescription combo drugs that contain acetaminophen, ibuprofen or others that can cause organ damage over time.

I've read medical journal articles stating that some opiates (methadone and oxycodone, for instance) can have negative effects on heart function in some people. This is the reason propoxyphene was discontinued. I'll have to find some sources for this. In the meantime, use opiates as little as you can, take care of your health and you should be fine.

 

[RTrain]

I actually heard from a doctor at the last rehab I was at that a study found that in some chronic-pain pain and long-term abusers of opiates that they found an enlarged heart, and they believe it to be directly due to opiate use. I don't remember exactly everything he told me, but that is the gist of it. Don't take my word on it, just heard it from a doctor.

But yea for the most part most opiates that don't contain tylenol are pretty harmless to your body, with the exception of methadone.

My guess is this is a result of the strain the body takes from severe physical dependence and the resulting withdrawal from abstinence. Think about how many days some long time addicts have been sick and how it causes tachycardia and hypertension, leading to the enlarged heart. I don't think its a result of the drugs effects itself, but still a direct result of using the drug so it is a long term health concern.

 

[Lady Codone]

Ahh, yes. Here's an article that discusses methadone and heart problems caused by QT prolongation. Doesn't sound fun.