Health Risks Associated With Long-Term Opioid Use

Although most people are aware of the risks for opioid addiction, few patients and even fewer health care providers are aware of the broader array of health risks associated with long-term opioid use for chronic pain. These risks include:

• hormone disruption
• sleep disturbance and sleep apnoea
• depression (new-onset depression or recurrence of depression)
• anxiety
• greater pain sensitivity
• addiction
• tolerance and dependence
• slowed cognitive functioning
• narcotic bowel syndrome and severe constipation
• unintentional overdose and overdose death

 Opioids have direct and indirect psychological effects. For instance, opioids cause hormonal dysregulation and sleep disturbance, and indirectly these can affect mood, anxiety, and behaviour.

OPIOID RESTRICTIONS

Opioids are scheduled drugs that require Drug Enforcement Agency (DEA) and Food and Drug Administration oversight, and require physicians to have special prescribing licenses. These rules were established because prescription opioids are abused by those seeking to achieve a ‘high.’ As such, prescription opioids have great street value when sold illegally.

State and federal guidelines exist regarding dose limits for opioid prescriptions for chronic pain. In recent years, opioid over-prescribing (too many prescriptions and at risky doses) have contributed to a fraction of patients becoming addicted and to unintentional overdose deaths, often from patients unwittingly combining prescribed medications (even taken exactly as prescribed, opioids combined with other drugs can be a deadly combination; Sun et al.,