long term opiates use and heart health

[theseeker]

Recently, a study was done on elderly patients taking pain medications for arthritis. It was thought that opiates were much safer for treating pain than drugs like Vioxx or NSAID's like Advil because the latter two drugs are associated with increased heart attack risk and stomach bleeding respectively. What they found was that in the group that took opiates- both the internal bleeding and heart attack risks were greatly increased. The study is here:

http://archinte.ama-assn.org/cgi/content/short/170/22/1968

This study was done in the elderly. However, what about those of us who are younger but abuse opiates long-term? I wonder if we'll have a greater incidence of heart attacks, strokes, etc? I think alot of people-including me- assume opiates are pretty harmless to your physical health over the long term (assuming you don't take enough to OD of course).

Any opinions?

 

[theseeker]

I wrote this a few months ago but bumped it because I think it warrants some thinking about. Anyone have any ideas?

 

[Voxide]

This study was done in the elderly. However, what about those of us who are younger but abuse opiates long-term? I wonder if we'll have a greater incidence of heart attacks, strokes, etc? I think alot of people-including me- assume opiates are pretty harmless to your physical health over the long term (assuming you don't take enough to OD of course).

Any opinions?

That assumption is fucking retarded and the use of any drug over a prolonged period will always have negative repercussions. If you think opiates aren't physically harmful, you're kidding yourself.

 

[theseeker]

Indeed- NO drug- used over a "long period of time"- is harmless. What is a long period of time? The results were a surprise to the investigators. Very few people who dabble in doing opioid pills- even low doses- think twice about the long term cardiac health problems associated with them. I'm not talking about shooting heroin here and dying because of respiratory failure. I'm talking about doses of opioids well below the fatal threshold.

 

[Voxide]

Indeed- NO drug- used over a "long period of time"- is harmless. What is a long period of time? The results were a surprise to the investigators. Very few people who dabble in doing opioid pills- even low doses- think twice about the long term cardiac health problems associated with them. I'm not talking about shooting heroin here and dying because of respiratory failure. I'm talking about doses of opioids well below the fatal threshold.

That's because for the most part, the type to use opiates recreationally is interested in short-term satisfaction. This is not meant to be an offensive generalization. It's indeed much more true than your average opiate user will admit. Opiates in general are a lot more physically forgiving. More so than other drugs. With meth, you can literally feel the brain damage being done. Oxycodone and others are more silent in the way they eventually effect your pain receptors. In a perfect world, there would be no cuts in people's bags, no such thing as hep C, veins would be indestructible, and clean pins would be available at all times. We don't live in a perfect world. Obviously the risks are much greater when you're talking about H, but recreational use of even mild opiates like codeine will be rewarded in time.

Even when looking at it from a natural standpoint, any human being with common sense should know that anything that makes you feel THAT good isn't good for your body. I definitely would not be comfortable taking a drug for an extended period of time, even if everyone says it's ok. What that period of time is, I don't know. Use your imagination. You don't need statistics or scientific research for that. In conclusion, all I have to say is: Everything you do in your younger days, you will pay for later in life. The bill is steep for some. Easily payable for others. Even something as benign as pot isn't an exception. Anybody reading this can head on over to CD and get some first hand opinions of veteran smokers who can no longer partake due to intense panic attacks and anxiety.

Opiates have the potential to do serious damage and should be approached with extreme caution at all times.

 

[theseeker]

I wonder what the mechanism of cadiotoxicity, if it exists, would be. It's well known that Methedone causes arrhthmia because of prolonged Q-T. This is believed to arise from blockade of hERG related potassium channels. However, some of the more popular opioids like oxycodone have a low affinity for these channels at relatively low doses.

 

[DooMMooD]

I wouldn't be surprised as to this.

It is fairly known that opiates, long term, do some liver damage in some forms (I am not 100% sure as to the specifics, I just remember this off the top of my head). Not to mention the things these drugs do to your brain, as well as any other area that has a high concentration of opiate receptors (GI tract).

This would not surprise me. Long term use of opiates tends to mess with your biochemistry on levels that people cannot imagine, because its like a stack of dominoes. Opiate use suppresses your testosterone production, your immune system, it messes with many aspects of your biochemistry and biological functioning; it would not be that far fetched that some aspects of opiate abuse would affect your heart as well (either directly, or indirectly by influencing another system or aspect of your body).

Does anyone have anymore information regarding this? I always thought my heart was one of the organs to be spared the opiate stick, but as i said, I would not be surprised if I were mistaken.

 

[Hammilton]

Rather the heart is one of the few that it does harm in the long term.

Opiates as a class are not hepatotoxic. However, Vicodin, containing APAP, is well known for damaging the liver. It may be there some selected opioids might cause damage to the liver themselves, but I can't think of any obvious ones on the top of my head.

Most of what you talk about is relatively meaningless. Suppressing the immune system is mildly worrisome, but I don't think there's any proven increased risk of colds or the flu in patients using opioids long term for pain, and suppressing testosterone production doesn't seem to cause any negative effects.

 

[TheLostBoys]

Elderly patients in these studies are just that, elderly with possibly other complications not known at the time of these studies & could be the reasons the elders suffer increased risk of heart attacks & stomach bleeding, etc.....

 

[DooMMooD]

Firstly, from what a friend who is going into pain management as a speciality, he has told me that even without acetaminophen, opiates eventually do, long term, do damage to your liver. We didnt have time to discuss the details, next time I will ask him, but I have been informed of this by a person who is actively studying this as his field, and I trust his views on a lot of this stuff.

I admit, I was unaware of it myself, and in fact thought he was referring to acetaminophen, but he told me that even without it, opiates long term will do damage to your liver, plain and simple.

I just wanna say too that I definitely get sick MUCH MORE FREQUENTLY when I am doing opiates, muchhhhh much more frequently. Also the lessened testosterone inhibits my ability to build muscles, be active, etc.

You claim that these things are small issues, but, long term how do you think suppressed testosterone is going to interfere with your bodys hormone production and other issues? Lack of testosterone causes other problems. Lack of immune system leads to other problems: being sickly all the time and weak is a combination that can prove well, very very bad long term.

These two things alone affect your body in many more ways than it would first appear at the surface. As i said, its almost a cascading effect, these things effect other aspects of your body and biochemistry. Opiates dont directly cause the effects that these things cause, but indirectly they do by interfering with these systems.

 

[theseeker]

Elderly patients in these studies are just that, elderly with possibly other complications not known at the time of these studies & could be the reasons the elders suffer increased risk of heart attacks & stomach bleeding, etc.....

This statement is incorrect.It would be good if someone at least glanced at the study.

This was a CONTROLLED study- that is- they took into account the health risks of the population under study. More specifically- the old people who took opiates had more heart attacks than the old people who didn't. The study was done in a very good journal, these aren't a bunch of hacks.

 

[theseeker]

Firstly, from what a friend who is going into pain management as a speciality, he has told me that even without acetaminophen, opiates eventually do, long term, do damage to your liver. We didnt have time to discuss the details, next time I will ask him, but I have been informed of this by a person who is actively studying this as his field, and I trust his views on a lot of this stuff.

I admit, I was unaware of it myself, and in fact thought he was referring to acetaminophen, but he told me that even without it, opiates long term will do damage to your liver, plain and simple.

I just wanna say too that I definitely get sick MUCH MORE FREQUENTLY when I am doing opiates, muchhhhh much more frequently. Also the lessened testosterone inhibits my ability to build muscles, be active, etc.

You claim that these things are small issues, but, long term how do you think suppressed testosterone is going to interfere with your bodys hormone production and other issues? Lack of testosterone causes other problems. Lack of immune system leads to other problems: being sickly all the time and weak is a combination that can prove well, very very bad long term.

These two things alone affect your body in many more ways than it would first appear at the surface. As i said, its almost a cascading effect, these things effect other aspects of your body and biochemistry. Opiates dont directly cause the effects that these things cause, but indirectly they do by interfering with these systems.

I have no idea where you're getting this information from. The reason why many opiate addicts get more bronchial infections is believed to be from the inhibition of cilia activity in the lungs brought on by opiate activity. It has absolutely nothing to do with the immune system. Nothing whatsoever.

Where are you getting the hormonal/opiate connection? I have never heard of this.

 

[DooMMooD]

Its a known fact that opiates inhibit the production of testosterone. Testosterone is a hormone, lack of testosterone causes problems due to hormonal imbalance. (ever notice how opiate addicts tend to have a lotta acne? as well as lacking in muscle mass? )

it is also a known fact that opiates inhibit the immune system. Im not the only one to think this in this thread alone either if you read you'll see that hammilton agrees. What seem like small issues are in fact just pieces to a larger puzzle: these things being altered in and of themselves further affect other ares of your body and biochemistry.

Look into this stuff if you dont believe me.

Here, if you dont feel like looking yourself (regarding immune system suppression):

http://www.ncbi.nlm.nih.gov/pubmed/1301643

The consequence is that opiates at pharmacological concentrations suppress cell-mediated immunity, as reflected by depressed T-dependent antibody production by B lymphocytes, altered T lymphocyte functions such as proliferation, delayed-type hypersensitivity, graft-versus-host responses and decreased cytotoxic NK cell activity.

I'm making myself lunch in between classes so I dont have time to fish out more or testosterone related studies, but I think thats a good startin point and you are more than welcome to research the rest on your own if you dont want to believe it.

To quote something else I found online right quick in 1 second of searching (not a study but from a seemingly reliable source with vast knowledge regarding the topic) which sums a lot of it up but by no means covers every single minute aspect:

For example, chronic opiate abuse a can lead to lymphadenopathy, lymphocytosis, hyperimmunoglobulinemia and altered T-cell function. That these disorders occur means that opiates directly impair the immune response through opiate receptors located on immune cells. Short acting opiates such as heroin can alter the immune system by affecting the hypothalmic-pituitary-adrenal axis through changes in serum cortisol, the stress hormone These also cause a suppression of the immune system.These effects are not limited to heroin but also other opiates including methadone...

Opiates also affect muscles. Opiate addicts are also frequently victims of a disease called rhabdomylosis (breakdown of muscle tissie). It does appear that this is due to the drug and not associated conditions. .


Source(s):
[They are] a forensic psychopharmacologist, author of several books, taught neurophysiology and neuropharmacology for many years.

For a recent review, you might consult the Handbook of the Medical Consequences of Alcohol and Drug Abuse (2008).

I in turn, will now ask you where you got your information from stating that opiate activity has "absolutely nothing to do with the immune system. Nothing whatsoever" ? Clearly this is not the case by any means and that is quite a bit of misinformation to be propagating.

Youre saying its "believed" to be from impaired cilia activity, yet it is a known fact that opiates suppress immune system and immunological responses.

Edit: sorry btw if i came off sounding like a dick, this is just the first time ive ever heard of someone arguing against the fact that opiates interfere with one's immune system, and im just curious as to whether theres more to the story than I have learned.

Theres really more to these pills than everyone assumes guys (just like every drug) even the most educated on opiates (pain management docs) still learn new stuff. These things do more to our body than most people will ever learn about; not as "safe" as all us opiate addicts/users proclaim(ed) them to be.

 

[theseeker]

hmmmm- I now see your point. I'm incorrect. I know that cilia movement is reduced and that is most likely the reason for bronchial infections. I would certainly like to see a dose response curve of opiate load vs some measure of immune function.

I don't know about hard-core IV use. Like where people slam bags and bags of dope and wake up at 5 in th AM puking. I mean- I just can't imagine what the fuck that does. The health risks under those conditions are numerous (obviously).

I should be more specific- my bad. I'm talking about using 20-60mg oxycodone/hydrocodone daily. Within prescription limits like indicated in the study.

 

[DooMMooD]

I dont shoot up. Never have. As of late i either use like 30ish mg oxymorphone or like 60-90mg oxycodone to get "high" (aka a little better lol, i dont get super high anymore regardless unless i do tonsss of OC. I guess the opana gets me decently high i scratch a lot ), but I mostly binge and am a weekend warrior (lack of funds as most people).

So I'm not exactly within the prescription range but im not at the other end of slamming bags of skag and waking up at 5am.

Though I have fucked with heroin and quite a few opiates under the sun, and have gotten "bad" in the past (snorting lots of H daily last summer, doing like 300mg morphine a day via mixed ROAs, hydromorphone), ive never gotten to that point either.

But my point i was trying to come to here (lol) is that: even with my use lightened now, I'll def say i still get sicker than the average person. I'm not saying for crazy dope slammers either, I'm discussing basically what you are, moderate opiate use.

Although another point: these issues apply (for the most part) whether the use is light, medium, severe, or deadly. As long as its somewhat on a long term/consistent basis; i mean not just dosing 1 time or once every 5 weeks, i'm talking on a you know, somewhat regular basis, weekends like me, daily, 4 days on 3 days off, etc, not really as related to dosage, although the higher dosage may make the problems more apparently or worse.

 

[theseeker]

I hear ya, man. I'm on the light end of the opiate use spectrum. I never take more than 30-40mg of oxy per day or 250mg tramadol. However, I do this pretty much every day with a few weeks break between oxy use.

Also- it's not been established that opiate use affects young hearts. That article only noticed a difference in the elderly who had painful conditions like rheumatoid arthritis, etc. So no hard conclusions are warranted.

I think so far our discussion has brought out that even light opiate use has several kind of negative systemic affects.

I'd really like to know what a possible mechanism for cardiotoxicity under light use would be. I implicate potassium channels above. Can anyone add something on this?

 

[Wizzle]

Isn't it safe to say that a lot of the problems are caused by a reduced ability to feel needs of your own body, like thirst and hunger, because you are high? To me it seems logical that you get more sick when you are out of it a few times during the week even if it is not a direct drug effect.

 

[Hammilton]

I may agree that it makes changes in your body, but I wouldn't take a doc's word about the liver damage. Read studies for your knowledge, not someone's say-so.

The rest of the stuff, testosterone and the immune system, are minor. If they weren't minor you'd be seeing AIDS like syndromes.