What the Doctors Don't Tell You About Painkillers

Long term opioid use is a tricky subject. While many people with chronic pain have benefited from taking opioids over a long period of time and stopped taking them without problem, it can be far more difficult for people who have had substance abuse problems.

For people with addictive tendencies, the risk of taking prescription opioids is that they will not be able to cease use when it is time to stop.

There is also the additional risk of prescription opioids serving as a catalyst for a relapse to their original drug of choice. These dangers are often not understood by doctors who prescribe these medications, so it is crucial to educate yourself on what can go wrong.

What are opioids?

Opioids are a type of medication that act on the central nervous system to relieve pain. They work by binding to opioid receptors in the brain and spinal cord, reducing the brain’s perception of pain.

Prescription opioids can be natural or synthetic (man-made). Natural opioids include morphine, codeine, and opium. Synthetic opioids include Fentanyl, Methadone, and Tramadol.

Each opioid medication works slightly differently in the length of its duration of action and in its strength. Fundamentally, they are all prescribed for the management of moderate to severe pain, and pain that does not respond to other non-opioid analgesics.

All opioids are addictive and can cause drug dependence with as little as 5 to 10 days of continuous use.

Dangers of taking prescription opioids in addiction recovery

For most people, prescription opioid use is not a big deal. If someone injures themselves, has a bad tooth ache or severe period pain, taking opioids is likely an option that will help to reduce pain and allow them to function.

These people may even have no difficulties with long term opioid use either. A patient recovering from an operation might take a prescribed opioid for a few months, then follow a brief tapering off programme and experience no cravings.

If someone has substance abuse problems, though, the story can be very different. A person who has had problems with drugs or alcohol in the past may be prescribed opioids and start taking them at the recommended dosage. They realise they like the effect and begin to increase the dosage. Before they know it, their prescription has run out and they are in pain again.

Often, people with addiction will then try to acquire more prescription medication, or relapse onto street drugs or alcohol so that they do not have to go through withdrawal or even just to go back to baseline.

Why do some people get addicted to prescription opioids and some people not?

It may not be obvious why some people get addicted to prescription opioids and others do not. Studies in addiction have found that there is likely to be two factors involved.

The first is genetics. If you have someone in your family who has substance abuse problems, then you are far more likely to have issues yourself as you share the same genes

The second is environmental causes. If you grew up in a dysfunctional family, you have a greatly increased risk of having addiction problems due to the way you were brought up. The same goes for someone who had high numbers of Adverse Childhood Experiences (ACE).

It is also possible for people to become primed for addiction later in life. For example, if a soldier goes to war and sees horrific violence, they might develop Post Traumatic Stress Disorder (PTSD). This can cause the brain to become rewired in a way that may make them more susceptible to addiction and self-medication.

Can I take prescription opioids if I have had addiction problems in the past?

If you have had problems with addiction in the past, it is difficult to say whether you will be safe taking prescription opioids.

However, if you can relate to any of the following statements below, you should not take opioids unless absolutely necessary:

• You were addicted to opioids. While people who were addicted to drugs and alcohol may risk addiction if they take prescription opioids, there is far more risk if you were addicted to opioids in the past. The chances of becoming hooked again are very high if you take them.
• You have not been clean/sober for long. If you do not have at least a couple of years of sobriety, extreme caution is advised. People new to recovery typically have not developed as much self awareness as those in longer-term recovery and may not have as much knowledge around falling back into addiction.
• You frequently relapse. If you often relapse, taking prescription opioids is likely to cause you to relapse again.
• You are under a lot of stress. Having a lot of pressure in your life increases the likelihood that you will become hooked on prescription opioids if you take them. Stress produces excessive amounts of activity in the brain, which opioids in turn will calm. This effect can prove very addictive.

If you are in extreme pain and are not sure whether to take prescription opioids, speak with the people around you. Talk with friends who have been sober for a long time, with your sponsor, or with an addiction professional. They may be able to help you clarify whether you should take prescription opioids or not.

The physical effects of long term opioid use

Long term opioid use can lead to a number of physical health problems. Your doctor is unlikely to advise you of the long term implications involved.

The physical effects of long term opioid use include:

• Chronic constipation: Over time opioids can make you extremely constipated. This can cause problems with your bowel and its ability to function naturally.
• Sexual dysfunction: If you are a man and you take opioids, you may struggle to maintain an erection. Both men and women may lose interest in sex, which may cause a rift between you and your partner.
• Hormonal problems: Men who take opioids on a long term basis are likely to have reduced levels of testosterone. Besides regulating sex drive, testosterone also optimises bone mass, fat distribution, muscle mass and strength. It also helps with the production of red blood cells and sperm. This means that all these can be affected by long term opioid use.
• In women, opioids effect luteinising hormones, estradiol and progesterone: Luteinising hormones control a woman’s menstrual cycle. Estradiol is essential for the functioning of the reproductive system. Progesterone is important for getting pregnant and maintaining pregnancy. Taking opioids can therefore stop women from getting a period and becoming pregnant.
• Sleep problems: Taking opioids may cause you to sleep more of the time, or they might stop you from sleeping. The longer you take them for the more difficult you will find it to regulate your sleep into healthy patterns
• Liver issues: Opioids may also contain other painkillers such as paracetamol. Taking medication with paracetamol in it for long periods of time can damage the liver. Be aware that you may not feel liver pain from liver damage until you cease use of painkillers.
• Decreased immunity: Opioids can cause immune system functioning to reduce. This means that you may get sick easier.

Opioids can actually increase your pain

While opioids work to reduce pain, they can sometimes make people more sensitive to pain. This is seen more often when people take large amounts of opioids for a long period of time.

Long term opioid use can cause:

• A broader area of pain than was originally felt
• New pain may develop without a specific diagnosis
• Stimulation that was not previously painful becoming painful

The mental effects of long term opioid use

Taking opioids for prolonged periods of time can also lead to a number of mental health problems.

Mental health issues related to long term opioid use include:

• Depression: Taking opioids for a long period can cause depression. Depression can also been seen when opioid use is ceased, and this can continue for up to a year afterward.
• Irritability: While people often seem a little more mellow when they first start taking opioids, long-term opioid use can have the opposite effect. Long-term use can cause users to be frequently irritable.
• Impaired cognition: Brain functioning is significantly impacted by long-term opioid use. Often, after usage is ceased, brain functioning becomes even more impaired, as the brain recalibrates. Following this, people often recover most or all of their original cognitive ability. However, if someone uses opioids for multiple years and in large amounts, they may never regain the function they once had.
• Memory problems: Long term users of opioids may start frequently forgetting things. While someone’s memory is likely to improve after they stop, they may still experience issues with their memory for a long time afterward.

Alternatives to long term opioid use

There are a number of alternatives to long term opioid use, including:

• Non-opioid painkillers: For people with addiction problems, taking painkillers that are not opioid-based are preferable, as they are unlikely to be addictive. These medications are not without risk, though. Medications like paracetamol can damage the liver when used over a long period of time, and anti-inflammatories like ibuprofen or naproxen can cause bleeding of the stomach.
• Acupuncture: This healing method began in China around 3000 years ago. It works by placing needles along meridian points in the body. This is said to stimulate healing and reduce pain.
• Massage therapy: A well-trained masseuse can work wonders for reducing muscle pain in the body. Massage can also help people who receive it to sleep better.
• Meditation: Sitting in meditation can help you to change the way that your mind interprets pain. If you practice consistently, you may find that pain begins to lose some of the negativity that you normally associate with it.
• Yoga: Yoga can relieve tension, boost blood flow around the body, stretch muscles to reduce pain and promote healing, and according to yogis, you can even purify the body.
• Cognitive Behavioural Therapy: Having a course of CBT with a professional can help you change your relationship with pain.

The importance of transparency with doctors regarding opioid use

If you have had problems with addiction in the past and are seeing your doctor about alleviating pain, it is important that you are completely open with them. Without informing them of your problems with substance abuse, you may be at risk of being prescribed medication that you will become addicted to.

If you feel like you may have difficulty saying no if you are offered prescription opioids by a doctor, you should consider taking someone with you who can support you.

The Oxycontin Saga - a warning about long term opioid use

The dangers of long term opioid use are well exemplified in the story of Oxycontin. Oxycontin is a drug that was initially introduced by the pharmaceutical company Purdue Pharma in 1995.

The drug was marketed as having low abuse liability due to it being slowly released into the body. The original packaging stated that "delayed absorption as provided by OxyContin tablets, is believed to reduce the abuse liability of this drug".

Partly due to these untrue claims and partly as a result of aggressive Purdue Pharma marketing to physicians, Oxycontin became an incredibly popular method of treating pain in the United States. Sales grew from $48 million in 1996 to $1.1 billion in 2000.

It was not until March 2016 that the CDC issued guidelines which advised doctors to prescribe Oxycontin and other opioids as a last resort for pain, and only at the lowest effective dose. By then, though, it was too late. Millions of people had become addicted to the drug.

When restrictions were placed on doctors prescribing Oxycontin, users who were addicted to the drug were left high and dry. Many of them turned to street opioids such as heroin or fentanyl.

This story shows the dangers of doctors prescribing painkillers without knowing the risks. While many doctors may now know about the issues involves with using painkillers for people with substance abuse disorder, you should not take this for granted.

In 2021, the Sacklers were fined $4.3 billion of the $10 billion they made from selling Oxycontin.

Protect your recovery, avoid long-term opioid use

If you are in pain and have had substance abuse problems, you should be very careful about any opioid use. Even if opioids were not your drug of choice, cross-addiction can and does happen.

In instances where opioids are necessary for the management of severe or acute pain, ensure that your doctor is well informed. Also, be transparent with those that support your recovery. Ask for help straight away, if you feel yourself slipping.

If you choose to use opioids, use them as briefly and sparingly as possible.

If you have a problem with prescription opioids and want help, please speak to your doctor honestly. Also, you can access online meetings and a recovery community right here at Recoverlution.

Read more:

Preventing prescription drug addiction: The dangers of prescription medications

References:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590093/
• https://www.nature.com/articles/d41586-019-02686-2
• https://www.healthline.com/health-news/oxycontin-and-the-opioid-epidemic-heres-the-truth-behind-the-hulu-series-dopesick#A-slap-on-the-wrist
• https://www.ft.com/content/1db7800f-78d5-474e-9b1e-744b1c1a837c
• https://www.studyfinds.org/pain-relievers-weaken-immune-system/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590093/