What Are Opioids?Opioids are among the world’s oldest known class of drugs. They are used for analgesia, or pain relief. Opioids are derivatives of morphine, a narcotic pain reliever. The term opioid generally refers to morphine and other opium poppy-based medications. Opioids work by decreasing pain signals being transmitted through the nervous system, which suppresses our perception of pain.
Examples of opioids are hydrocodone, oxycodone (OxyContin), morphine, fentanyl (Duragesic), and hydromorphone (Dilaudid). Hydrocodone and oxycodone can be prescribed in combination with acetaminophen (Tylenol), which are marketed under the brand names Vicodin and Percocet. Opioids are available in many different forms such as pills, liquids, or suckers. Other methods of administering opioids include shot, skin patch, and suppository.
Conditions Associated With Long-Term Opioid UseIt is estimated that one-third of U. S. adults suffer from chronic pain. Chronic pain is the most common reason for long-term opioid use. There are many causes of chronic pain. The following chronic pain conditions may require treatment with long-term opioid use.
1. Low back pain, from many different causes that include:
- Degenerative disc disease (DDD)
- Bulging/protruding disc
- Ruptured/herniated disc
- Vertebral compression fractures
- Spinal stenosis
- Ankylosing spondylitis
2. Hip pain, from many different causes that include:
3. Daily headache. Categories include:
6. Multiple sclerosis (MS)
7. Inflammatory bowel disease:
- Crohn’s disease
- Ulcerative colitis
Adverse Effects And Risks Of Long-Term Opioid UseMost medications have adverse effects and opioids are no different. Adverse effects of opioids may include fatigue, constipation, sedation, nausea, vomiting, confusion, dry mouth, constricted pupils (miosis), and itching (pruritis). More serious adverse effects may include urinary retention, respiratory depression, hallucination, hypothermia, delirium, hyperalgesia (increased sensitivity to pain), and abnormal heartbeats (arrhythmias). Large doses of opioids can lead to serious respiratory depression, oxygen deprivation, unconsciousness, and death.
Other less known adverse effects of long term opioid use include:
- Immunosuppression. Opioids can lead to a diminished immune response.
- Amenorrhea. Opioids can cause hormonal disturbances that culminate in the absence of the female menstrual cycle.
- Galactorrhea. Opioids can cause inappropriate secretion of milk from the breasts.
- Decreased libido. Libido can also be referred to as sex drive.
- Androgen deficiency. Long-term opioid use, especially long-acting opioids, is a key risk factor in the development of hypogonadism, which is characterized by lower than normal levels of the male sex hormone testosterone.
- Osteoporosis. It is characterized by thinning and weakening of bone making it more susceptible to fracture.
Long-term opioid use can also lead to tolerance, dependence, and addiction. Tolerance is an adaptation characterized by the need for increasing or more frequent dosing of an opioid. Dependence can be physical or psychological.
Physical dependence is a scenario in which the abrupt cessation of an opioid results in a withdrawal syndrome. Psychological dependence is an emotional need for a substance that has no underlying physical need. Although a concern, research has shown that a small percentage of patients with long-term opioid use suffer from addiction. Addiction is characterized by a persistent pattern of dysfunctional opioid use that may include any or all of the following:
- Loss of control over the use of opioids
- Preoccupation with getting opioids, even when adequate pain relief has been achieved
- Continued use despite adverse physical, psychological, or social consequences
Other consequences of long-term opioid use are abuse, misuse, and diversion. Patients may exhibit aberrant drug-related behaviors such as tampering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids, and refilling prescriptions early. Diversion of opioids is a growing concern, but research has shown only a small percentage of those requiring long-term opioid use actually divert their opioids to others. The motivation for diversion is typically money, as mass quantities of opioids can fetch high prices on the black market. As a result, we have seen increasing trends in deaths attributed to opioid abuse.
ConclusionOpioids are a very old class of medications used to treat pain. Long-term opioid use is usually associated with a chronic pain condition. In the U. S., one-third of all adults suffer from chronic pain. Most opioids do a nice job of relieving pain, especially the strong opioids who outperformed non-steroidal anti-inflammatory drugs (NSAIDs) and tricyclic antidepressants (TCAs). Adverse effects are commonplace with long-term opioid use and can range from annoying to life-threatening. They are best dealt with in an urgent manner.
Long-term opioid use can suppress the immune system making one more susceptible to infection. Many hormonal imbalances can be triggered by long-term opioid use. Ominous signs in the long-term use of opioids include tolerance, dependence, and addiction. Today, many more deaths are a direct result of the abuse, misuse, and diversion of opioid medications. As a result, interest in abuse-deterrant and tamper-resistant opioid formulations is on the rise and may be a tool against opioid medication abuse.
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