Opioids Opiates, Opioids and The Cardiovascular system

[bpayne]

Please Forgive me if this is not sufficient to meet ADD standards, I thought it might due to there possibly being compelx explanations in the answers to this question if not please feel free to move moderators

Does opioids and Opiates do damage or incur stress on the heart and cardiovascular system? I ask because for 1. I remember getting IV hydromorphone in the hospital.. they told me they had to Monitor my Blood pressure as they Administered it before they would let me leave, I also remember my BP skyrocketing on the machine after administration but it went back down quickly.. (I left with a script for 25 2 mg dilaudid for a simple abscess lol)
Also I have a Family Member with Late stage Liver and Lung cancer.. he has started going Downhill rather Fast.. He has always been allergic to Morphine and the doctor actually told him he couldn't prescribe him anything stronger than Ibuprofen for this Reason,, once I found this out I had quite a Talk with him and told him to Demand some Oxycodone as it would be Quite safe.. after our Talk he received Oxycodone sure enough... anyway to the point.
He has gone downhill Really fast become very weak and Incoherent and had to be Rushed to the Hospital today with Failing Kidneys.. pneumonia, and A racing heart.. they are still stabilizing him as I type.. but he is conscious during all this and in a Lot of pain.. I was surprised to hear that They still have not given him any pain medicine even though he's been in the ER for at least 5 hours.. They said that they haven't given him anything due to watching out for his heart ..
So that is Two situations I've encountered where doctors have been very careful about administering opioids based upon watching for Cardiac problems.. I have always assumed that Opiates would be good for the heart lowering the Heart rate and relieving Stress Is the Opposite True? I had also thought that Opiates did no damage to the body except for the notorious addiction of course.. but otherwise thought they were relatively benign.. Have I been completely wrong in these assumptions.. and are All of us who take opiods on a daily basis possibly doing damage to our cardiovascular system as well?
I'd really like to know the answers to these questions as this could Change everything about my decisions to use these medicines..
Again if My question is out of place I apologize.. I just thought that the explanations could possibly get a little complicated therefore veering this closer to Add material rather than Bdd.
Thanks again!
Bpayne

 

[Epsilon Alpha]

To the best of my knowledge opioids have a fairly benign effect on heart function, however delta and kappa opioid receptors are generally known to depress cardiac output and blood pressure. In the case of severe compromising of the heart/lungs it might be a notable concern as the effects often seen in overdose may occur at lower doses. You might want to talk with your doctor about your atypical reaction to opioids, but I really can't say much other than that. PM me and I'll try and clarify any other concerns you have.

I think Other Drugs might be an appropriate place to put this, but feel free to post related questions in the "Big and Banging" sticky over in ADD.

 

[Swimmingdancer]

Other Drugs (which is where this got moved to) is good for intermediate level questions about opioids. ADD is more for discussion of scientific articles and such.

Opioids can affect the cardiovascular system, and the ways depend on the specific opioid, and the individual person of course. In general they can lower the blood pressure and slow the heart, but some people do get rises in blood pressure and/or heart rate. Some opioids can prolong the QT interval and cause irregular heartbeats (this includes oxycodone).

Even though opioids may often lower blood pressure or slow heart rate, that does not mean they would be a good idea to give to someone in your friend's condition. It is a more complicated than assuming that it is because he has a fast heartbeat and they must just be worried opioids would raise his heart rate further, if that's what you are thinking. The doctors are likely watching out for more than just his heart too, since he has pneumonia and kidney failure. If someone is in a critical state, they may feel it's best not to introduce any drugs that have the potential to make things worse, or to mask his health problems, and someone who is in that state would be more likely to have fatal complications from opioids or have them worsen his condition. It may sound not compassionate to not give him any pain meds yet, but his pain is not going to kill him and they need to focus on whatever is best as far as saving his life is concerned.

A lot of people are always saying opioids are harmless except for addiction and possibility of overdose, and I strongly disagree with that, particularly when it comes to long-term use. There are many adverse health effects associated with long-term use, please let me know if you would like me to list some.

 

[wrongdose]

As SD said, there are lots of long term effects if taken regularly. I won't mention them as I think you are just asking about immediate side effects. Long term heart disease/risk of heart attack is established however, higher in women than men....i can't quite remember why though.

I'm sorry about your family member, late stage liver disease is pretty horrid.

 

[bpayne]

it's odd you stated that because not longer after they started a Morphine drip he passed away

 

[Kayla Crystal <3]

Wow, hunn, I'm sorry to hear that..

The three others who posted here had some great information to give you.. Opiods are generally known to slow the heart rate down & reduce blood pressure but there are always those rare occasions in which it could do just the opposite. For your family member, I feel they were only being cautious because they were probably unsure of what exactly was going on & what had been causing every effect that was happening to him.. So cautious that they were not comfortable introducing a drug into his body that coul have a deadly effect.

Now, you had mentioned that he was allergic to morphine yet they put him on a morphine drip?

why?!?!​

There are many other pain medications not containing morphine properties that they could have have him to help with the pain. I guess I'm just very confused on why they would give him something they known would harm him. Did they already know he only had a short time left and just wanted to give him the best pain treatment possible on his way out..?

Once again, I'm am very sorry for your loss and will keep you & your family in my prayers..
Good luck, sorry I couldn't give you any direct answers to your question..

Xoxo,
Kayla. 8)

 

[wrongdose]

I'm so sorry. I checked back hoping to hear some good news. Liver disease is a massive stress on the body, the other organs have to work so much harder. I didn't realise he was allergic to morphine though. I hope you are ok.

 

[Swimmingdancer]

So sorry to hear about your loss Hope you are ok. And Bluelight is a good place to talk about things if you feel like talking. But it's ok if you don't too.

I wouldn't assume the morphine worsened his condition, it might have been that his condition was already terminal and they wanted to give him some pain relief.

 

[SaosinEngaged]

I'd actually like to hear some of the long term effects of opiate abuse, aside from decreasing testosterone levels. I too, perhaps naively, was under the assumption that most opiates (aside from the synthetics) are generally non-toxic to your organs and do not specifically harm any individual one. I always believed the danger to be addiction and possible overdose.

I don't recall ever finding any scholarly research paper indicating (apparently severe) long term health issues from chronic opiate use.

 

[Swimmingdancer]

I'd actually like to hear some of the long term effects of opiate abuse, aside from decreasing testosterone levels. I too, perhaps naively, was under the assumption that most opiates (aside from the synthetics) are generally non-toxic to your organs and do not specifically harm any individual one. I always believed the danger to be addiction and possible overdose.

I don't recall ever finding any scholarly research paper indicating (apparently severe) long term health issues from chronic opiate use.

Yeah, it's hard to find them unless you seek them out, and it's also au under-studied topic because pharmaceutical companies that make these drugs don't want to pay for that kind of research; opioids are HUGE business. It's also difficult to study effects of long-term use of drugs, as opposed to acute toxicity. And then it is even harder to study people who used opioids long-term and actually stopped using them (which can present it's own problems), and to also not get the conclusions dismissed with excuses like "that might not be directly caused by the drug".

One of the effects on the heart I mentioned above has been studied quite a bit, the lengthening of the QT interval (this is not known to happen with all opioids however). The QT interval is a measure of the time between the start of the Q wave and the end of the T wave in the heart's electrical cycle. In general, the QT interval represents electrical depolarization and repolarization of the left and right ventricles. A lengthened QT interval is a biomarker for ventricular tachyarrhythmias like torsades de pointes and a risk factor for sudden death. Most opioids are known to limit/block hERG channels. When this channel's ability to conduct electrical current across the cell membrane is inhibited, it can result in a potentially fatal disorder called long QT syndrome and create a risk of sudden death. hERG has also been associated with modulating the functions of some cells of the nervous system and with establishing and maintaining cancer-like features in leukemic cells.

The levomethadyl and methadone groups were significantly more likely to manifest a QTc greater than 470 or 490 milliseconds (28% for the levomethadyl group and 23% for the methadone group) or an increase from baseline in QTc greater than 60 milliseconds (21% of the levomethadyl group and 12% of the methadone group). In subjects whose dosage of levomethadyl or methadone remained fixed over at least 8 weeks, the QTc continued to increase progressively over time.[source]

There are plenty more studies like this.

During recent years some opioids have been associated with prolonged QT and torsade de pointes (TdP). In vitro testing has shown that most opioids can block the cardiac potassium channels. This indicates that QT prolongation and TdP could be a more general problem associated with the use of these drugs.

In vitro patch clamp testing has shown that most opioids can block human ether-a-go-go related gene (hERG) channels that are known to underlie cardiac repolarizing I(Kr) current. This indicates that QT prolongation and TdP could be a more general problem associated with the use of these drugs. The aims of this study were to evaluate the association between different opioids and the QTc among patients and measure hERG activity under influence by opioids in vitro.

One hundred chronic nonmalignant pain patients treated with methadone, oxycodone, morphine or tramadol were recruited in a cross-sectional study.

The known association between methadone dose and QTc was confirmed. Higher oxycodone dose was also associated with longer QTc. A 100 mg higher oxycodone dose was associated with a 10 ms longer QTc. Neither morphine nor tramadol dose was associated with the QTc. Electrophysiological testing revealed low-affinity inhibition of the potassium current through hERG channels expressed in HEK293 cells.

Oxycodone is capable of inhibiting hERG channels in vitro.[source]

I could write a lot, and that's just basically one specific adverse effect of opioids, and I have to go to bed, but if you'd like me to post studies/papers/etc on more adverse effects of opioids I certainly can. I like dispelling the myth that opioids are harmless aside from possibility of addiction/overdose. I have quite a few health problems from being on opioids for so long that are seriously impacting my life.

 

[SaosinEngaged]

Wow, that's actually terrifying. I'm familiar with the QT interval.

Now I have to ask, is it established anywhere to be a significant risk? Do addicts/chronic patients actually drop dead like someone born with genetically Long QT syndrome or Wolf-Parkinson-White?

I think you've just given me a new reason to get the fuck off, and stay off. Does this prolongation subside when opiate use is discontinued?

Again, I have to ask, how significant of a risk do you believe this to be? Especially because I take relatively large amounts of Oxy (300mg range daily). Would any activity that raises heartrate increase the risk, just as any physical activity increases the risk of sudden death in individuals with Long QT syndrome?

Wow. I repeat, Wow. I want off.

 

[mareseatoats]

Bp, so sorry that your family member is not doing so well. For those who aren't allergic to opiates, if of course the opiate isn't laced with anything from the streets, it is usually not too tough on the cardiovascular system. The only time I have felt more uncomfortable stress on my heart-has been after a long run on opiates, or even a short run; and withdrawal begins to set in. If you already aren't working with a heart that is in tip top shape, cold-turkey opiate detox can actually be dangerous for some. So hopefully, you'll just never be in a spot where you'll be detoxing, or if you do, get some help weening off-just to save your ticker some extra stress.

 

[Swimmingdancer]

Wow, that's actually terrifying. I'm familiar with the QT interval.

Now I have to ask, is it established anywhere to be a significant risk?

Do you mean significant risk of QT prolongation or significant risk of death via QT prolongation? I'm really not sure how likely the risk of sudden death is, that hasn't been established. I have had one friend suddenly drop dead, but the autopsy was inconclusive (not surprisingly, but it's of note that this person was slim and young and seemed otherwise healthy). There was one study in 2002 of 17 people with methadone-associated TdP, none of those patients died, but 14 needed a pacemaker or implantable defibrillator. Risk level is really not known yet, and oxycodone has been even less studied than methadone. As I said, pharmaceutical companies don't want to pay for this kind of research. Drug-induced prolongation of QT interval is very real, though I don't think it happens to everyone and it's going to happen in different degrees.

Do addicts/chronic patients actually drop dead like someone born with genetically Long QT syndrome or Wolf-Parkinson-White?

I assume it depends on the severity and other contributing factors. QT interval prolongation and TdP associated with the use of certain opioids are potentially fatal. The risk is going to vary from person to person and be affected by such factors as taking high doses, taking other drugs that prolong the QT interval or increase blood levels of the drug, low potassium or magnesium levels, anxiety, and predispositions like being female (women appear to have a much greater risk of developing drug-induced TdP), underlying cardiac conditions, having congenital long QT interval syndrome (even that you weren't aware of), genetic mutations in hERG channels, etc. A growing number of researchers are actually recommending that people should undergo ECG testing and give a complete medical history etc before being prescribed opioids that can prolong the QT interval.

Does this prolongation subside when opiate use is discontinued?

That's a good question. I don't really know. I discontinued methadone almost 2 months ago and my heartbeat is currently still abnormal - I was on methadone for a very long time though. I'm going to wait a while and get more tests done. I'm also taking potassium and magnesium now.

Would any activity that raises heartrate increase the risk, just as any physical activity increases the risk of sudden death in individuals with Long QT syndrome?

I can only assume so.

 

[SaosinEngaged]

^ I was referring to significant risk of developing TdP.

Thanks very much for the elaboration. I can't believe I've never heard of this; I've read so many articles about opiates in my three years using them. I suppose you're absolutely right; Big Pharma (tm) doesn't want this information getting out.

For clarification, my layman interpretation of that research suggests Methodone causes a quite a bit more pronounced QT prolongation than Oxy, right? IIRC, it was many times more.

And I have to emphasize, this is really quite frightening. Abnormalities in your hearts conduction are nothing to ignore, and cardiac arrythmias are life threatening. Truly crazy.

I think I read Magnesium supplementation can help as well?


Ironically, cardiac risks are the primary reason I've NEVER messed with any stimulants. From amphetamine salts to cocaine.

Edit: Found this, interesting - http://www.dhp.virginia.gov/dhp_programs/pmp/docs/May2010/HaigneyCardiotoxicMethadone5-1-10.pdf

 

[SaosinEngaged]

EDIT: No idea why I accidentally double posted the same thing. My apologies, go ahead and delete

 

[Swimmingdancer]

^You can delete your own posts, when you click "Edit" there is an option to delete, (then you have to select delete again - let me know if you need further explanation ).

I was referring to significant risk of developing TdP.

I think the risk level is unknown at this point, there are probably plenty of people who don't realize they have it unless/until they are hospitalized, and even then it may not be reported as being associated with the drug. There are case reports of drug-induced TdP from opioids but there is no studies/articles about its likelihood.

For clarification, my layman interpretation of that research suggests Methodone causes a quite a bit more pronounced QT prolongation than Oxy, right? IIRC, it was many times more.

There is not as much research on oxycodone as methadone, and the oxycodone users in studies were generally taking lower doses, so I'm not sure if it can be fully ascertained yet whether or not equivalent doses have equivalent effects on QT interval prolongation, my best guess at this point would be that methadone is likely worse than oxy, but I will try to find some more info for you.

I think I read Magnesium supplementation can help as well?

Yes, I added that to my post, I'm taking magnesium as well.

Edit: Found this, interesting - http://www.dhp.virginia.gov/dhp_programs/pmp/docs/May2010/HaigneyCardiotoxicMethadone5-1-10.pdf

Yes it is, thanks for sharing

Also to add to my last post, I have seen a few case reports where they found withdrawing the person from the drug or reducing the dose did rapidly shorten the QT interval, but I have no idea if effects on the heart could be longer-lasting or permanent in people who have taken the drug for an extended period of time, there is really no info on that. (I guess I will let you know what happens to me, I have to get more tests done and methadone does take a very long time to fully clear from the body, plus I am currently still sporadically taking some drugs that may also prolong the QT interval as I have had a really rough time quitting methadone).

I feel bad for sort of derailing bpayne's thread, although it is on-topic with what he/she originally asked about, so hopefully it's ok . I just feel bad since their family member passed away.

I would like to do a thread about all the adverse effects of opioids at some point, I am tired of so many people telling others there are none aside from addiction/dependence and overdose. For one example, opioids can mess with your insulin levels (yep, another effect I have) and cause hypoglycemia, hyperglycemia, a pre-diabetic state etc. As far as this topic, I'll try to find a list of which opioids are and aren't known to affect QT interval, and maybe list some other common drugs that do in case people want to avoid them.

 

[pbuilder]

^statistically how likely is that whole qt thing. I feel like everything in life has its risk , from the food you eat to the way you commute to work.

 

[Swimmingdancer]

^statistically how likely is that whole qt thing. I feel like everything in life has its risk , from the food you eat to the way you commute to work.

No one knows at this point. One study of 47 methadone pain patients found that they all had prolonged QT interval. But the risks of that causing TdP and life-threatening or fatal situations are unknown. Of course it's true that everything in life has risks, but I think people should be as informed as possible about the risks they are taking and the ways to minimize them, isn't that the purpose of this forum after all?

In general "normal" QTc should be under 400ms. For risk of sudden cardiac death, "borderline QTc" is 431-450 ms, and an "abnormal" QTc above 450ms. Another study on methadone maintenance patients taking various doses found that 27 out of 167 had a QT interval of 500ms or longer (compared with no patients in the control group), and that the lowest methadone dose found in this study to increase the QT interval above 500ms was 30mg/day. Researchers have also found a progressive prolongation in the QT interval of methadone patients even when their dose remained stable, so basically the longer you're on it the worse it gets. One study on oxycodone found that for every 100mg of oxycodone used the QTc was on average 10ms longer, so most people taking under 100mg/day had close to normal QTc, whereas most people taking 500mg or more had Qtcs of over 450ms.

One prospective study on sudden cardiac deaths in methadone users with normal therapeutic doses, excluding cases in which higher methadone levels were present and were therefore presumed to be overdoses, and excluding recreational drug users, only 23% were found to have structural abnormalities of the heart. The implication is that the remainder could potentially have been caused by prolonged QT interval/TdP.

There really haven't been enough studies done on this topic yet, and there are so many contributing factors (as I listed in another post above) that it's impossible to calculate one's individual risk level. If I had additional risks factors I would be extra careful, and I would try to reduce the ones that I could control (dose, use of other drugs, take supplements, get my heart checked, try not to stay on the drug for long periods of time, etc).

Source for much of the above with lots more info: Methadone-Associated Q-T Interval Prolongation and Torsades de Pointes

. . . . . . . . . . .

List of Opioids and whether or not they are known to prolong the QT interval:

Methadone - definitely, with risk of TdP even with normal therapeutic doses
LAAM - same as above
Oxycodone - yes, but research is still limited at this point
Dextropropoxyphene - definitely; it's being withdrawn from the market in many places for this reason
Buprenorphine - yes, but research is inconclusive (some studies sources say yes, some say no) *believed to be lower risk than methadone
Heroin - unlikely/not known to, but some common cuts can
Most other common opioids - not known/likely to, in normal therapeutic doses at least

 

[bpayne]

It's fine ya'll, anything that can help others be more safe or aware of any lesser known complications is all good with me.. As to it being a Morphine drip.. this is what his wife Barbara said.. but I think it may have actually been something else because they were aware of his allergy.. He was a good friend to me.. A military police officer in his younger years and in later years a correctional officer... people thought that me and him wouldn't get along to begin with because I have quite a lengthy criminal history and considering his career and all.. but it turned out that We became the best of friends.. he is the dude I would speak to and hang around with at family gatherings more than just about anyone else. He had gotten diagnosed with Lung cancer about a year or so ago.. and the treatment was Really hard on his body he couldn't take it.. but he would plug along as well as he could.. they said the cancer was gone at one point.. then at another check it had spread to his Liver. Eventually the chemo stopped working.. and the side effects were too great. . he stopped the chemo.. it only took about a month for him to pass.. much sooner than any of us expected.. I had spoke to him about a week ago and he sounded fine.. but apparantly the last few days he became very forgetful and incoherent and wouldn't eat much .. he was rushed to the hospital with multiple organ Failure on Sunday .. they had gotten him somewhat stabalized and my girl could even hear him in the background fussing at the doctors.. so I assumed he would pull right on through.. apparantly I was wrong.. he was gone by around 10 pm that night

Oh and I have a question which lends itself to the discussion at hand.. do u think that Kratom could possible do the qt interval thing as well? being that it is a minor stimulant?